首次输血日龄与极低和超低出生体重儿近期主要并发症的相关性

Relationship between days of age at first blood transfusion and short-term main complications among very low and extremely low birth weight infants

目的分析首次输血日龄与极低和超低出生体重儿近期主要并发症的相关性。方法对2014年9月至2020年8月入住大连医科大学附属大连市妇幼保健院新生儿重症监护病房、胎龄小于32周、出生体重小于1500g且接受过输血治疗的486例早产儿资料进行回顾性研究,根据首次输血日龄分为第1周内首次输血组(127例)和第1周后首次输血组(359例),比较两组早产儿一般状况及近期主要并发症的情况。结果第1周内首次输血组与第1周后首次输血组相比,胎龄更小,出生体重更低,第1周使用有创机械通气的比例更高,差异均有统计学意义(t/χ^(2)值分别为-2.322、2.736、30.838,P<0.05)。第1周内首次输血组脑室内出血(IVH)的发病率高于第1周后首次输血组,差异有统计学意义(χ^(2)=11.236,P<0.05),而中重度支气管肺发育不良(BPD)、早产儿视网膜病(ROP)、Ⅱ期以上坏死性小肠结肠炎(NEC)和晚发败血症的发病率两组间差异均无统计学意义(P>0.05)。生后第1周内首次输血和第1周有创机械通气是IVH的独立危险因素,OR(95%CI)分别为2.125(1.132~3.990)、2.073(1.040~4.133),P<0.05。结论生后第1周内首次输血可能增加发生IVH的风险,应尽量推迟首次输血日龄,减少早期输血,有助于减少极低和超低出生体重儿IVH的发生。

Objective To analyze the relationship between days of age at first blood transfusion and short-term main complications among very low and extremely low birth weight infants.Methods Data of 486 premature infants,who were admitted into the Neonatal Intensive Care Unit,Dalian Maternal and Child Health Care Hospital Affiliated to Dalian Medical University from September 2014 to August 2020,with gestational age<32 weeks,birth weight<1500 g and underwent blood transfusion therapy,was retrospectively analyzed.According to the days of age at first blood transfusion,they were divided into the group with the first blood transfusion within the first week(127 cases)and the group with the first blood transfusion after the first week(359 cases).The general conditions and short-term main complications between the two groups were compared.Results Compared with the group with the first blood transfusion after the first week,the group with the first blood transfusion within the first week had younger gestational age,lower birth weight and higher proportion of using invasive mechanical ventilation at the first week,and the differences were statistically significant(t/χ^(2)=-2.322,2.736 and 30.838,respectively,P<0.05).The incidence of intraventricular hemorrhage(IVH)in the group with the first blood transfusion within the first week was higher than that in the group with the first blood transfusion after the first week,and the difference was statistically significant(χ^(2)=11.236,P<0.05).There were no differences in the incidences of moderate-severe bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),necrotizing enterocolitis(NEC)higher than stageⅡand late-onset sepsis between the two groups(P>0.05).First blood transfusion within the first week after birth and invasive mechanical ventilation within the first week were the independent risk factors of IVH,and the OR(95%CI)were 2.125(1.132-3.990)and 2.073(1.040-4.133),respectively,P<0.05.Conclusion First blood transfusion within the first week after birth increases the incidence of IVH.The days of age at first blood transfusion should be put off as late as possible,and reduce early blood transfusion,which help to minimize the occurrence of IVH among very low and extremely low birth weight infants.