Brans Y W, Shannon D L, Ramamurthy R S
Pediatrics. 1981 Aug;68(2):175-82.
Volumes of plasma (PV), blood (BV), and red cells (RCV) were estimated within 32 hours of birth in 39 neonates with normal growth, 14 neonates with intrauterine growth retardation, and 20 neonates with macrosomia. Total PV, BV, and RCV increased linearly with birth weight and were unaffected by deviation in the quality of fetal growth. In proportion to body weight, PV/kg, BV/kg, and RCV/kg correlated neither with birth weight nor with the quality of intrauterine growth. Neonates with umbilical vein hematocrit (UV Hct) levels 51% to 60%, 61% to 65%, and 66% to 77% had progressively lower, but not statistically different, mean PV/kg (38.1 +/- 4.49, 37.6 +/- 5.41, and 34.8 +/- 5.16 ml/kg, respectively). On the other hand, they had progressively higher mean BV/kg (90 +/- 10.1 vs 101 +/- 13.7 ml/kg, P less than .002, and vs 110 +/- 19.0 ml/kg, P less than .001). They also had progressively higher mean RCV/kg (52 +/- 7.4, 64 +/- 8.7, and 75 +/- 16.4 ml/kg, P less than .001). Although PV/kg did not correlate with UV Hct, both BV/kg and RCV/kg increased linearly with increasing UV Hct (r = .58 and r = .79, respectively). Volume estimates were repeated after partial exchange transfusion in 29 neonates. Mean UV Hct decreased from 63 +/- 5.9% preexchange to 51 +/- 5.2% postexchange (P less than .001), mean PV increased from 37.7 +/- 5.56 to 47.6 +/- 7.99 ml/kg (P less than .001) and mean RCV decreased from 67 +/- 16.5 to 51 +/- 12.3 ml/kg (P less than .001). Despite precautions to keep the partial exchange isovolemic, mean BV decreased from 105 +/- 18.7 to 98 +/- 18.0 ml/kg (P = .001) and the mean PV increase (10 ml/kg) was less than the mean RCV decrease (16 ml/kg). These data suggest that neonates with polycythemic have normal PV but their RCV and BV are elevated in direct proportion to UV Hct. "Isovolemic" partial exchange transfusion decreases UV Hct, RCV, and BV and increases PV.
对39名生长正常的新生儿、14名宫内生长迟缓的新生儿和20名巨大儿在出生后32小时内估算了血浆量（PV）、血量（BV）和红细胞量（RCV）。总PV、BV和RCV随出生体重呈线性增加，且不受胎儿生长质量偏差的影响。按体重比例计算，PV/kg、BV/kg和RCV/kg与出生体重及宫内生长质量均无相关性。脐静脉血细胞比容（UV Hct）水平为51%至60%、61%至65%和66%至77%的新生儿，其平均PV/kg逐渐降低，但无统计学差异（分别为38.1±4.49、37.6±5.41和34.8±5.16 ml/kg）。另一方面，他们的平均BV/kg逐渐升高（90±10.1 vs 101±13.7 ml/kg，P＜0.002；vs 110±19.0 ml/kg，P＜0.001）。他们的平均RCV/kg也逐渐升高（52±7.4、64±8.7和75±16.4 ml/kg，P＜0.001）。尽管PV/kg与UV Hct无相关性，但BV/kg和RCV/kg均随UV Hct升高呈线性增加（r分别为0.58和0.79）。对29名新生儿进行部分换血输血后重复进行了容量估算。平均UV Hct从换血前的63±5.9%降至换血后的51±5.2%（P＜0.001），平均PV从37.7±5.56增至47.6±7.99 ml/kg（P＜0.001），平均RCV从67±16.5降至51±12.3 ml/kg（P＜0.001）。尽管采取了措施使部分换血保持等容，但平均BV从105±18.7降至98±18.0 ml/kg（P = 0.001），平均PV的增加量（10 ml/kg）小于平均RCV的减少量（16 ml/kg）。这些数据表明，红细胞增多症新生儿的PV正常，但其RCV和BV与UV Hct成正比升高。“等容”部分换血输血可降低UV Hct、RCV和BV，并增加PV。
