新生儿贫血和输血的评估与管理

Evaluation and management of neonatal anemia and blood transfusion

贫血和输血是新生儿尤其是早产儿常见的临床问题。新生儿贫血的定义及影响因素有哪些?早产儿贫血与足月儿有何不同?贫血时机体病理生理学的变化、对组织和细胞有何影响?贫血的预防策略和治疗方法有哪些?输注红细胞有无统一的血红蛋白阈值?输血有哪些风险?本文针对上述问题,提出贫血的定义应考虑胎龄、日龄、宫内或生后发育状态(如生长发育迟滞)、营养等影响。不能认为"早产儿贫血"是生理性和良性事件,其发生与内源性促红细胞生成素水平低下和医源性失血有关。新生儿(尤其早产儿)贫血是能够预防的,预防重于治疗。新生儿输注红细胞缺乏统一的血红蛋白阈值并面临输血风险。

Anemia and blood transfusion are common clinical problems in newborns,especially premature infants.What are the definition and influencing factors of neonatal anemia?What is the difference between anemia in preterm infants and full-term infants?What are the changes of pathophysiology and their effects on tissues and cells during neonatal anemia?What are the prevention strategies and treatment methods of neonatal anemia?Is there a uniform hemoglobin threshold for neonatal transfusion of red blood cells?What are the risks of blood transfusion?In view of the above problems,this review proposed that the definition of anemia should consider the effects of gestational age,day age,intrauterine or postnatal development status(such as growth retardation),nutrition and so on."Physiological anemia of infancy"can occur in healthy term infants;"anemia of prematurity"can not be considered as a physiologic and benign event,which is related to the low level of endogenous erythropoietin and iatrogenic blood loss.It is emphasized that neonatal anemia(especially premature infants)is preventable and can be prevented,and prevention is more important than treatment.Neonates lack a uniform hemoglobin threshold and are at risk of blood transfusion during red blood cell transfusion.