Farag Marwa Mohamed, Thabet Mohamed Alaa Eldin Hassan, El Beheiry Ahmed Adel Hassan, Hammad Bahaa Salah-El Din, Khalifa Mohammed Attia, Elsebaee Amany Abdel Hamed
Assistant Professor of Pediatrics and Neonatology, Pediatric Department, Alexandria University Hospital, Alexandria, Egypt.
Pediatric Department, Professor of Pediatrics and Neonatology, Alexandria University Hospital, Alexandria, Egypt.
Ital J Pediatr. 2025 May 16;51(1):140. doi: 10.1186/s13052-025-01978-w.
To transfuse or not to transfuse premature infants" is still one of debatable issues in neonatal care that has not been completely solved. Recognizing hemodynamically significant (HS) anemia might be part of the solution. Our purposes were to investigate the hemodynamic effects of late onset anemia and red blood cells (RBCs) transfusion on premature neonates with gestational age 28-32 weeks and to tailor transfusion needs based on hemodynamic variables and Hb/HCT level.
In the current study, 36 anemic preterm infants with a gestational age of 28-32 weeks and a postnatal age of 3-9 weeks, all having a hematocrit (HCT) level below 30% and being candidates for red blood cell (RBC) transfusions, were compared to 36 non-anemic infants with HCT levels of 30% or higher in terms of hemodynamic parameters during their initial scans. Each anemic infant underwent a second scan 24 h after receiving RBC transfusions. The hemodynamic parameters assessed included left ventricular cardiac output (LVO) and the flow velocities in the renal (RA), anterior cerebral (ACA), and celiac (CA) arteries, measured using functional echocardiography and Doppler imaging. The hemodynamic changes were related to the presence of clinical signs in the anemic infants.
LVO, stroke volume (SV), heart rate (HR), and ACA-peak systolic velocity (PSV) were significantly increased in anemia of prematurity and significantly decreased after RBCs transfusions. With an area under the ROC curve of 0.862, LVO displayed the highest diagnostic performance for HS-anemia of prematurity.
LVO, SV, HR, ACA-PSV, hemodynamic parameters can be used for diagnosing HS-anemia and can provide objective criteria for identifying patients in need of RBCs-transfusions. They also help in monitoring response of RBCs-transfusion in anemic preterm infants. Those cut off measures require validation by future studies.
“是否对早产儿进行输血”仍是新生儿护理中一个尚未完全解决的有争议的问题。识别具有血流动力学意义（HS）的贫血可能是解决问题的一部分。我们的目的是研究迟发性贫血和红细胞（RBC）输血对胎龄28 - 32周的早产儿的血流动力学影响，并根据血流动力学变量和血红蛋白/血细胞比容水平调整输血需求。
在本研究中，将36例胎龄28 - 32周、出生后3 - 9周的贫血早产儿（所有婴儿血细胞比容（HCT）水平低于30%且为红细胞（RBC）输血候选者）与36例HCT水平为30%或更高的非贫血婴儿在初次扫描时的血流动力学参数进行比较。每个贫血婴儿在接受RBC输血后24小时进行第二次扫描。评估的血流动力学参数包括左心室心输出量（LVO）以及肾动脉（RA）、大脑前动脉（ACA）和腹腔动脉（CA）的血流速度，使用功能超声心动图和多普勒成像进行测量。血流动力学变化与贫血婴儿的临床体征相关。
在早产儿贫血中，LVO、每搏输出量（SV）、心率（HR）和ACA峰值收缩速度（PSV）显著增加，RBC输血后显著降低。LVO的ROC曲线下面积为0.862，对早产儿HS贫血显示出最高的诊断性能。
LVO、SV、HR、ACA - PSV等血流动力学参数可用于诊断HS贫血，并可为识别需要RBC输血的患者提供客观标准。它们还有助于监测贫血早产儿RBC输血的反应。这些截断措施需要未来的研究进行验证。
