评估输血后新生儿改善情况的近红外光谱法：一项系统评价和荟萃分析。
The near-infrared spectroscopy to evaluate neonatal improvement after transfusion: a systematic review and meta-analysis.
作者信息
Zheng Shao Cong, He Shan
机构信息
College of Medicine, Kunming University of Science and Technology, Department of Pediatric, The First People's Hospital of Yunnan Province, Kunming, China.
Department of Pediatric, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China.
出版信息
BMC Pediatr. 2025 May 15;25(1):385. doi: 10.1186/s12887-025-05731-4.
BACKGROUND
Anemia of prematurity (AOP) is a common issue in neonatal intensive care units (NICUs) globally, associated with significant morbidity and mortality. Near-infrared spectroscopy (NIRS) has emerged as a noninvasive, real-time monitoring tool to assess tissue oxygenation and blood flow, potentially providing valuable insights into the impact of red blood cell transfusions in preterm infants with anemia. This study aimed to evaluate the effectiveness of NIRS in assessing improvements in preterm infants after red blood cell transfusions.
METHODS
This study followed a systematic review and meta-analysis design, adhering to the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. No geographic or temporal restrictions were imposed during the search. The final included studies spanned 2008-2017 and originated from four countries. A total of 214 articles were initially identified, and nine prospective observational studies were included in the final analysis. These studies focused on preterm infants diagnosed with anemia who required red blood cell transfusion therapy. The sample sizes in these studies ranged from 10 to 35 infants. The primary outcome was the changes in NIRS readings before and after transfusion. The secondary outcomes included changes in heart rate (HR), saturation of pulse oxygen (SPO), and hemoglobin (Hb) pre- and post-transfusion.
RESULTS
Meta-analysis demonstrated significant post-transfusion increases in CrSO (mean difference [MD] = -8.51, 95% CI: -12.34 to -4.68) and SrSO (MD = -15.68, 95% CI: -20.12 to -11.24). Subgroup analyses revealed greater improvements in CrSO for infants with higher baseline anemia severity (MD = -14.76, 95% CI: -18.19 to -11.33) and in SrSO (MD = -22.79, 95% CI: -26.96 to -18.62). Cerebral fractional tissue oxygen extraction (cFTOE) and splanchnic fractional tissue oxygen extraction (sFTOE) also showed significant changes. Hemoglobin levels increased post-transfusion (MD = -2.89, 95% CI: -3.21 to -2.57), while heart rate and peripheral oxygen saturation (SPO) remained unchanged.
CONCLUSIONS
The findings suggest that NIRS is a reliable tool for assessing the impact of red blood cell transfusions in preterm infants.
TRIAL REGISTRATION
PROSPERO (ID: CRD42024596069).
背景
早产贫血（AOP）是全球新生儿重症监护病房（NICU）中常见的问题，与显著的发病率和死亡率相关。近红外光谱（NIRS）已成为一种无创、实时监测工具，用于评估组织氧合和血流，有可能为贫血早产儿红细胞输血的影响提供有价值的见解。本研究旨在评估NIRS在评估红细胞输血后早产儿病情改善方面的有效性。
方法
本研究采用系统评价和荟萃分析设计，遵循《Cochrane干预措施系统评价手册》和PRISMA指南。检索过程中未施加地理或时间限制。最终纳入的研究涵盖2008 - 2017年，来自四个国家。最初共识别出214篇文章，最终分析纳入了9项前瞻性观察性研究。这些研究聚焦于诊断为贫血且需要红细胞输血治疗的早产儿。这些研究中的样本量从10至35名婴儿不等。主要结局是输血前后NIRS读数的变化。次要结局包括输血前后心率（HR）、脉搏血氧饱和度（SPO）和血红蛋白（Hb）的变化。
结果
荟萃分析表明，输血后CrSO（平均差[MD]= -8.51，95%可信区间：-12.34至-4.68）和SrSO（MD = -15.68，95%可信区间：-20.12至-11.24）显著增加。亚组分析显示，基线贫血严重程度较高的婴儿CrSO改善更大（MD = -14.76，95%可信区间：-18.19至-11.33），SrSO也是如此（MD = -22.79，95%可信区间：-26.96至-18.62）。脑部分组织氧摄取分数（cFTOE）和内脏部分组织氧摄取分数（sFTOE）也显示出显著变化。输血后血红蛋白水平升高（MD = -2.89，95%可信区间：-3.21至-2.57），而心率和外周血氧饱和度（SPO）保持不变。
结论
研究结果表明，NIRS是评估红细胞输血对早产儿影响的可靠工具。
试验注册
PROSPERO（编号：CRD42024596069）。
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