超低出生体重儿 45例临床资料分析

近年超低出生体重儿(extremely low birth weight infant,ELBW)管理成为新生儿领域研究的热点和难点。超低出生体重儿各器官发育极不成熟,易发生各种合并症,严重者危及生命。我们通过对45例ELBW的临床资料进行回顾性分析,为进一步提高ELBW管理水平提供帮助。     

超低出生体重儿的生存现状及远期生活质量

超低出生体重儿(ELBW)是指出生体重＜1 000g的早产婴儿.近年来,随着围生医学的迅速发展,ELBW存活率在发达国家已达80％以上.但随着存活率的提高,ELBW的生存现状及远期生活质量开始受到新生儿医师的关注.ELBW不仅生长发育及营养状况不及同胎龄的足月成熟儿,其远期呼吸系统、神经系统、受教育及就业等方面均存在一定问题.     

极低出生体重儿输血治疗及危险因素分析

目的 分析本院极低出生体重儿的输血状况及危险因素.方法 回顾性分析本院2011-2013年收治的胎龄＜37周、出生体重＜1500 g、住院时间≥7天的早产儿资料,按是否输血分为输血组及未输血组,记录并比较两组早产儿的一般情况、合并症、输血组早产儿输血前临床症状、输血前血红蛋白值(Hb)和红细胞压积(Hct)以及输血时间等,Logistic回归分析极低出生体重儿输血的相关因素.结果 研究纳入的142例极低出生体重儿中需输悬浮红细胞51例,占35.9％,68例次;贫血症状主要有需氧疗、经皮氧饱和度不稳定、心率快、需机械通气、体重不增等.输血组出生体重、胎龄低于未输血组,出生窒息、出生需气管插管、CPAP支持、呼吸窘迫综合征(RDS)、肺炎、支气管肺发育不良发生率高于未输血组,住院天数长于未输血组,差异有统计学意义(P＜0.05);两组败血症和坏死性小肠结肠炎发生率差异无统计学意义(P＞0.05).Logistic回归分析显示,胎龄(OR =0.400)和体重(OR=0.994)是极低出生体重儿输血的保护性因素,肺炎(OR=3.620)和RDS(OR =3.863)是极低出生体重儿输血的独立危险因素(P均＜0.05).结论 极低出生体重儿出生胎龄小、体重低、患RDS或肺炎时输血风险明显增加,对于贫血伴有临床缺氧症状的极低出生体重儿应输血治疗.     

超低体重新生儿输红细胞方式的变化

超低出生体重（ＥＬＢＷ）新生儿由于身体极度虚弱，需要经常输血．在过去的１０年内，输血标准修改了三次，限制越来越严格．该研究假设这些变化降低了ＥＬＢＷ新生儿的输血次数及供血者的暴露次数。 方法１９８９～１９９７年出生的体重在５００ｇ至９９９ｇ的２５６名新生儿作为研究对象。以每次输血标准修改的时间为起点分为三个阶段：１９８９－０４～１９９０-０９～１９９２－１２，１９９５-０１～１２）。前瞻性记录临床数据，并对输血机关的各种资料进行回顾性图表分析。 结果　每个新生儿的平均输血次数从第一阶段的７次降到第三…     

重组人类促红细胞素和铁剂在极低出生体重儿中的应用研究

目的评价重组人类促红细胞素(rhFPO)和铁剂对极低出生体重儿(VL-BW)输血的影响及预防早产儿贫血的效果.方法对59例出生体重≤1500 g,胎龄≤34周的早产儿进行研究,其中治疗组31例于生后第5～7天开始予以rhEPO治疗(250 U/kg·次,皮下注射,每周2次),共6周,同时补充铁剂和多种维生素;对照组28例未给予rhEPO和铁剂治疗.比较两组的血液学指标、输血的量和次数.结果组间胎龄、出生体重、生后第1周的血红蛋白(Hb)、抽血的量和次数、并发症、机械通气的天数无差别.每个病人的输血次数和量,rhEFO治疗组为(0.7±1.0)次/人、(8.4±13.4)ml/kg,对照组为1.6±1.2)次/人、(20.8±15.9)ml/kg;两组对比,差异有非常显著性(P＜0.001).治疗组74.19%不需输血,而对照组32.14%不需输血(P＜0.001).两组生后Hb均逐渐下降,但对照组下降较治疗组明显(P＜0.005);最低的Hb均值,治疗组为(98.5±16.1)g/L,对照组为(84.9±19.3)g/L.治疗组网织红细胞于rhEPO治疗1周后即较对照组明显升高(P＜0.001),治疗组第2周达高峰.两组血清铁(SI)生后均呈下降趋势,但治疗组下降较对照组明显(P＜0.001).结论rhEPO预防性治疗早产儿贫血效果显著,可减少VLBW的输血量和次数.     

重组人类促红细胞生成素防治早产儿贫血的临床研究

目的探讨重组人类促红细胞生成素(rHu-Epo)防治早产儿贫血的疗效.方法将33例早产儿按入院次序分成治疗组17例,对照组16例.治疗组出生第1周即予rHu-Epo500IU*kg-1*w-1,隔日1次,每周3次皮下注射,共5周;对照组未予rHu-Epo治疗.两组早产儿生后第3周开始口服铁剂[元素铁5mg*kg-1*d-1],必要时输血,共观察7周.结果治疗组第2周开始网织红细胞较对照组明显升高(P＜0.01),第3周后渐下降但与对照组比较仍有显著差异(P＜0.05);两组患儿出生后Hb均渐下降,但治疗组程度较轻,最低Hb值较对照组高(P＜0.01),达最低Hb值的时间较对照组早(P＜0.01).治疗组血清铁蛋白第2周开始较对照组低(P＜0.01).治疗组输血率与对照组比较明显减少(P＜0.05).观察期末治疗组早产儿体重增长的速率较对照组高(P＜0.05).结论早期大剂量rHu-Epo能减轻早产儿贫血的程度,减少或避免输血;体内充足的铁储备是确保rHu-Epo疗效的重要因素.     

促红细胞生成素加大剂量铁剂防治极低出生体重儿贫血临床观察

目的　观察重组人类促红细胞生成素(rH -EPO)加大剂量铁剂防治极低出生体重儿贫血的疗效。方法　将3 4例极低出生体重儿随机分为治疗组1 6例和对照组1 8例;两组观察对象均于出生第四天起开始口服葡萄糖酸亚铁糖浆(按元素铁9mg/kg·d计算)、VitC 0. 2g/d、VitE 1.5mg/d ,治疗组在上述常规治疗的基础上加rH -EPO每周60.0IU/kg ,分三次皮下注射,疗程满6周结束。结果　治疗组治疗后网织红细胞计数(Ret)较同日龄对照组明显升高(P <0.0 1 ) ;两组血红蛋白(Hb)及红细胞压积(Hct)均于出生后逐渐下降,但治疗组下降缓慢,两组在治疗后第1、3、5、7周相比均有极显著性差异(P <0.0 1 ) ;治疗组疗程结束后存在贫血者4例( 2 5 .0 0 % ) ,对照组1 3例( 72. 2 2 % ) ,两组相比x2 =7.5 6,P <0.0 1 ,有极显著性差异;治疗组输血2例,而对照组输血1 1例。结论　rH -EPO加大剂量铁剂能有效防治极低出生体重儿贫血,能最大限度地减少输血治疗,可作为极低出生体重儿的一项常规治疗     

早产儿贫血病因与防治研究进展

<正>近年来,随着围产医学及新生儿急救医学的发展、产前糖皮质激素和外源性肺表面活性物质的广泛应用、高配置暖箱及多种呼吸机模式的支持,早产儿,包括极低出生体重儿(very low birth weight,VLBW)和超低出生体重儿(extremely low birth weight,ELBW)的存活率已有显著提高~([1])。新生儿贫血症是早产儿,尤其是VLBW和ELBW常见且严重的并发症之一,如不及时纠正,可导致患儿进一步     

超低出生体重儿生后两年内护理经费的研究

目的　研究超低出生体重儿生后 2年护理费用与出生体重、预后的关系 ,并与正常出生体重儿的消费进行比较。设计　费用数据来自经治医院和对父母的问卷调查。有关超低出生体重儿和正常体重儿的围产期、新生儿期和生后 2年的数据由国立超低出生体重儿注册机构前瞻性收集。对象　 1996～ 1997年赫尔辛基大学医院出生的 71名超低出生体重儿和 6 0名正常出生体重儿。方法　收集超低出生体重儿和正常出生体重儿的医疗护理费用 ,包括住院、门诊医疗护理费用、药费、康复及辅助工具费用、旅费、日常护理费用、住院期间父母的住宿费和生后 2年内的误工费。结果　存活的超低出生体重儿生后 2年的平均健康护理费用为 10 4 6 35美元 ,而正常出生体重儿为 3135美元。仅生后住院费用一项即占总支出的 6 4 % ,出院后第 1年和第 2年费用分别占 2 0 %和 13%。未存活的超低出生体重儿的平均住院费用为 1995 0美元。与正常出生体重儿比较 ,发育正常的极低出生体重儿的费用为其 2 5倍 ,轻度病残者为 33倍 ,重度病残者达 6 8倍。出生体重与重症监护支出呈负相关 ,但与出院后花费无关。结论　极低出生体重儿的花费在生后2年内逐渐下降 ,即使发育正常的超低出生体重儿支出也高于正常出生体重儿。低出生体重儿的花费似与生后住院     

早产儿管理指南

早产儿是指出生时胎龄〈37周的新生儿,其中出生体重〈1500g者为极低出生体重儿（VLBW）,〈1000g为超低出生体重儿（ELBW）。在早产儿中,胎龄〈32周或出生体重〈1500g者临床问题较多、病死率较高,是早产儿管理的重点。由于早产儿已逐渐成为新生儿领域的重要问题,新生儿学组经过讨论,制定《早产儿管理指南》,供各单位参考。     

Changing practices of red blood cell transfusions in infants with birth weights less than 1000 g

OBJECTIVE: Extremely low birth weight (ELBW) infants frequently undergo transfusion because they are critically ill, often need artificial ventilation, and have the highest blood sampling loss in relation to their weight. During the last decade our transfusion guidelines were changed 3 times to become more restrictive. We hypothesized that these modifications substantially decreased the number of transfusions in our ELBW infants. METHODS: We performed a single-center analysis of 256 infants with birth weights from 500 to 999 g who were admitted from 1989 to 1997 and included 3 study periods, each starting with newly modified transfusion guidelines in April 1989, September 1991, and January 1995. We evaluated prospectively recorded clinical data and retrospective chart analysis for transfusion-related information. RESULTS: The median number of transfusions per infant decreased from 7 in the first period to 2 in the third period, whereas donor exposure decreased from 5 to 1 and blood volume transfused decreased from 131 to 37 mL/kg birth weight (P <.01). The median venous hematocrit measured before transfusion decreased from 43% to 35% in infants who underwent ventilation and from 41% to 31% in spontaneously breathing infants. The median birth weight decreased from 870 to 740 g and the median gestational age from 27 to 25 completed weeks (P <.01). The overall survival rate was 75% and did not change. The incidences of retinopathy, intraventricular hemorrhage, and patent ductus arteriosus remained unchanged. CONCLUSION: Over this 9-year period with increasingly restrictive transfusion guidelines, the transfusion number decreased by 71% and the donor exposure by 80% in ELBW infants without adverse clinical effects.     

Cost effective use of satellite packs in neonates: importance of birth weight

BACKGROUND: Blood banks split an adult packed red cell bag (usually 250 ml) into 30 ml bags, making a total of eight neonatal "satellite" packs per donor. These packs are then "allocated"/"committed" to be used to serially transfuse a newborn. Aim: To study transfusion requirements of premature infants in relation to their birth weight and thereby attempt to rationalise the method of dispensing satellite blood packs. METHOD: Data on the distribution of neonatal transfusions with respect to weight were obtained retrospectively from unit A (51 infants, 168 transfusions) and unit B (46 infants, 151 transfusions). These data were used to model the effect of different policies on donor exposure and number of unused packs. RESULTS: Infants weighing less than 1000 g at birth have significantly higher transfusion requirements than those weighing 1000 g or more (p = 0.001 (unit A), p = 0.004 (unit B)). Our model predicted a significant reduction in donor exposure if eight packs/infant were allocated to those weighing < 1000 g, and a significant cut in the number of unused packs if four satellite packs/infant were allocated to those weighing > or = 1000 g. CONCLUSIONS: It would be safer and cost effective to allocate eight packs/infant to those with birth weights < 1000 g and four packs/infant to those with birth weights > or = 1000 g.     

Red blood cell transfusions in newborn infants: Revised guidelines

In general, health care professionals taking care of high risk infants in neonatal intensive care units have become more restrictive in their use of red blood cell transfusion over the past 10 years. The present statement is intended for those caring for high risk newborn infants (preterm to one month of age). The objectives of this statement are to provide guidelines to reduce the incidence of anemia in preterm and term infants, to identify strategies to decrease the need for red blood cell transfusions and to limit donor exposure in this population. Recommendations for red blood cell transfusions are included.     

Recombinant human erythropoietin in premature infants. Evaluation of a one year experience]

Recently, recombinant human erythropoietin (rhEPO) has been claimed to diminish red blood cell transfusions in premature infants. After a year of experience, we investigated whether early rhEPO treatment would reduce the need for transfusion. PATIENTS AND METHODS: Fifty premature infants of gestational age < or = 32 weeks admitted to our NICU in 1997, received rhEPO 750 UI/kg/week from day 3 to 5 for six weeks. They were compared with 50 untreated controls admitted in 1996. RESULTS: The treatment and control groups did not differ for gestational age, weight at birth, CRIB score, and blood losses. We were not able to detect any difference in the number of transfused infants, and in the number of transfusions per infant until discharge. However, treated infants received significantly fewer transfusions per infant between day 16 and day 45 (0.42 +/- 0.67 vs. 0.8 +/- 0.99). Infants with a birth weight between 1,000-1,250 g received fewer transfusions in the EPO group. CONCLUSION: rhEPO treatment can be useful, but in association with other procedures: conservative transfusion criteria, minimization of phlebotomy losses and early iron supplementation.     

Lead exposure from blood transfusion to premature infants

OBJECTIVE: The objective of this study was to determine the exposure of premature infants to lead from blood transfusions. STUDY DESIGN: Blood lead concentrations were determined for 19 very premature infants at the time of admission, at 4 weeks of life, and before and after transfusions and in the donor packed red blood cells of 79 transfusions. RESULTS: The number of transfusions per patient was 4. 2 +/- 2.8 (mean +/- SD) with 15.7 +/- 1.9 mL/kg packed red blood cells for a lead dose of 1.56 +/- 1.77 microg/dL. The total dose of lead from these transfusions over the 4-week period was 4.0 +/- 2.8 microg/kg (range, 0.9-10.6 microg/kg). Increases in post-transfusion blood lead concentration were linear with doses higher than 1.5 microg/dL. Packed red blood cells with a blood lead concentration of > or = 5 microg/dL resulted in an elevated post-transfusion blood lead concentration in some infants. CONCLUSIONS: The lead exposure to these infants through blood transfusion exceeds the acceptable daily intake values for lead and may result in unacceptably high post-transfusion blood lead concentrations. Use of packed red blood cells with lead concentrations <3.3 microg/dL is one cost-effective means to reduce exposure.     

Glucose tolerance and insulin secretion in very small babies.

Nineteen exchange transfusions were performed via the umbilical artery using blood preserved with acid-citrate and dextrose in 8 infants of 34-40 weeks gestation (larger infants) and 9 very small infants of 26-33 weeks gestational age. The plasma glucose rise which was similar in both groups stimulated insulin secretion from the larger infants but not the very small infants. No significant differences occurred between the groups in the fall in mean free fatty acid levels or increase in growth hormone secretion. Following transfusion there was a sharp rise in mean plasma insulin concentration in the larger infants and a smaller rise in the very small infants. A highly significant positive correlation was found between the maximum posttransfusion plasma insulin and the birth weight of the infants. Plasma glucose levels of less than 30 mg/100 ml occurred in 2 larger and 5 very small infants during the first 3 hours after transfusion. One infant of birth weight 0.98 kg received four transfusions; in 2 where he received ACD blood via the umbilical artery or vein, insulin secretion was not stimulated but in the other 2 in which glucagon or arginine was added to the ACD donor blood, insulin secretion was stimulated. Feeding practice should take account of the fact that although very small infants secret less insulin than larger infants during exchange transfusion they are more likely to become hypoglycaemic in the immediate posttransfusion period.     

Low incidence of acquired cytomegalovirus infection in neonates transfused with washed red blood cells

To define the incidence of cytomegalovirus (CMV) infection in infants given transfusions of washed blood cells from random donors, 100 infants who were identified as being CMV seronegative at birth were resampled at hospital discharge and again six weeks after hospitalization. All infants received washed red blood cell products; 37 infants received nonleukodepleted platelets and/or plasma. There were 7.4 donor exposures per infant. Donor units were assayed for anti-CMV IgG and IgM at the time of donation. Seventy-six infants received at least one transfusion from a seropositive donor (mean transfusion volume, 89 mL; mean, 3.7 seropositive donor exposures). Infection was defined by seroconversion to anti-CMV. None of the recipients of exclusively seronegative blood seroconverted. A single infant who received 34 mL of washed cells from a seropositive donor (IgG+, IgM-) and 31 mL of washed cells from a seronegative donor showed IgM anti-CMV 15 days after transfusion and IgG anti-CMV at a six-week follow-up visit. No recipients of IgM+ blood were infected. Our data demonstrate a 1.3% incidence of anti-CMV seroconversion following receipt of washed red cells from seropositive donors. This rate is within background levels for hospitalized neonates and is significantly lower than results of similar studies using unwashed blood.     

Cytomegalovirus infection in a neonatal intensive care unit. Blood transfusion practices and incidence of infection

We studied blood transfusion variables and cytomegalovirus (CMV) infection in 385 infants admitted to the Duke University Medical Center, Durham, NC, neonatal intensive care unit over 14 months. Cytomegalovirus antibody titers were measured at birth and monthly thereafter. Urine cultures for CMV were performed regularly. Infants admitted in the first six months (n = 197) received conventionally prepared blood. Infants admitted in the remaining eight months (n = 188) were given frozen, deglycerolized blood. Of the 105 infants weighing 1250 g or less (low birth weight [LBW]), 90 (86%) received transfusions. Two hundred eighty infants weighed more than 1250 g (non-LBW), and 111 (40%) of these were given blood. In the first six months of the study, three infants had CMV viruria. One case was congenital; two were acquired. Both infants who acquired infection were antibody-positive at birth and received multiple transfusions. In the remaining eight months, five infants had CMV viruria. Two cases were congenital; three were acquired. The three infants who acquired infection were antibody-positive at birth and received multiple transfusions. Our study demonstrates that infants with an LBW are more likely to receive blood transfusion and to be given significantly more blood than non-LBW infants. There was no difference in the number of infants acquiring CMV in the two periods despite the use of different preparations of blood.     

Red blood cell transfusions in very and extremely low birthweight infants under restrictive transfusion guidelines: is exogenous erythropoietin necessary?

OBJECTIVE: To examine the number and volume of red blood cell transfusions (RBCTs) in very and extremely low birthweight infants under restrictive red blood cell transfusion guidelines without erythropoietin administration, and to compare the results with those reported in similar infants receiving erythropoietin. METHODS: From April 1996 to June 1999, all RBCTs given to infants with a birth weight of less than 1500 g were prospectively recorded. Data on RBCT combined with erythropoietin treatment and RBCT guidelines were extracted from four prospective randomised trials of erythropoietin for anaemia of prematurity. RESULTS: When the restrictive RBCT guidelines were followed, the number of RBCTs and volume transfused were similar to those reported during erythropoietin administration. CONCLUSIONS: RBCT guidelines may have a similar impact on RBCT in very low birthweight infants to the administration of erythropoietin. The effect of RBCT guidelines on RBCT frequency should be considered when evaluating the efficacy of erythropoietin administration to preterm infants.     

Strict guideline reduces the need for RBC transfusions in premature infants

The aim of this study was to verify if the adoption of a strict guideline would reduce the need for red blood cell transfusions in the first 28 days of life in very low birth weight preterm infants. Retrospective study of two cohorts of very low birth weight infants transfused according to neonatologist decision (Period 1) or according to a strict guideline for erythrocytes transfusion (Period 2). Clinical and hematological data of 80 premature infants transfused in both periods of the study were obtained by chart review. During the first 28 days of life, 45 (62.5%) of 72 premature infants born in the Period 1, and 44 (55.7%) of 79 newborns born in Period 2 received at least one erythrocyte transfusion; p = 0.40. Among patients transfused, the median number of transfusions was four per infant transfused (range: 1-13; mean: 4.6 +/- 3.2) in Period 1 and 3 (range: 1-18; mean: 4.0 +/- 3.5) in Period 2; p = 0.26. The median volume of erythrocytes administered per infant transfused in Period 1 was 40 ml kg(-1) (range: 10-170; mean: 48.8 +/- 38.3) and in Period 2 was 30 ml kg(-1) (range: 10-225; mean: 43.4 +/- 40.4), p = 0.41. Multiple linear regression analysis, after adjusting for birth weight, clinical risk index for babies, blood loss and days of ventilation, showed that the adoption of the strict guideline reduced the volume of erythrocytes transfused in 15.91 ml kg(-1) per infant transfused (95% CI: -24.69-7.14) p < 0.001. The adoption of a strict guideline reduced the need for red blood cells transfusions in very low birth weight infants.