中国新生儿重症监护病房极早及超早产儿非红细胞血制品使用现况

目的分析2019年中国新生儿协作网(CHNN)新生儿重症监护病房住院的极早及超早产儿非红细胞血制品的使用现状及单位间差异,为探讨输注合理性与规范性提供证据。方法基于CHNN大规模极早产儿队列数据库进行横断面研究,纳入2019年生后24 h内收入CHNN 57家NICU治疗、出生胎龄<32周且接受完整治疗的6598例早产儿。收集患儿一般情况,描述不同出生胎龄、不同病情危重程度早产儿非红细胞血制品(血小板、血浆、人免疫球蛋白、白蛋白、冷沉淀和凝血酶原复合物)的使用率及次数。输注过至少1种非红细胞血制品即为输注组。采用两独立样本t检验、秩和检验或χ²检验进行输注组和非输注组组间比较。使用线性回归模型对单位间输注率和单位特征进行相关性分析。结果6598例早产儿出生胎龄为30.0(28.7,31.0)周,出生体重为(1353±312)g,女2877例(43.6%)。2816例(42.7%)早产儿为输注组,输注次数为3(1,6)次。与未输注组相比,输注组患儿出生胎龄更小(Z=17.62,P<0.01),出生体重更低(t=18.64,P<0.01),小于胎龄、多胎以及产房高级复苏比例均更高(χ²=31.06、12.82、287.52,均P<0.01),女婴比例以及本院出生比例则均更低(χ²=10.68、78.23,均P<0.01)。总研究人群中,使用率高的非红细胞血制品依次为白蛋白25.4%(1674例)、人免疫球蛋白21.5%(1417例)、血浆18.9%(1245例)。901例超早产儿中,60.4%(544例)输注过非红细胞血制品,使用次数4(2,8)次;5697例极早产儿中,39.9%(2272例)输注过非红细胞血制品,使用次数3(1,6)次。病情危重和非危重组中非红细胞血制品输注率分别达62.2%(1693/2723)和29.0%(1123/3875),输注次数分别为4(2,7)次和2(1,4)次。57家NICU中,调整与非红细胞血制品输注相关的因素后,各单位间极早及超早产儿非红细胞血制品输注率差异有统计学意义(校正χ²=153.48,P<0.01)。结论2019年中国NICU救治的极早及超早产儿中,接近半数曾接受非红细胞血制品输注,各单位非红细胞血制品使用率存在巨大差异。

Non-erythrocyte blood products transfusion in very preterm and extremely preterm infants in Chinese neonatal intensive care units

Objective To describe the use of non-erythrocyte blood products transfusion in very preterm and extremely preterm infants in the neonatal intensive care units(NICU)of the Chinese Neonatal Network(CHNN)in 2019,to explore the disparity between different centers,and to further investigate the rationality and standardability of non-erythrocyte blood products transfusion.Methods This was a cross-sectional study based on the CHNN cohort of very preterm and extremely preterm infants.All 6598 infants with gestational age(GA)<32 weeks and admitted to the 57 NICU of CHNN within 24 h of life in 2019 were enrolled.Non-erythrocyte blood products included platelet,plasma,albumin,immunoglobulin,cryoprecipitate and prothrombin complex.Infants who received at least one type of non-erythrocyte blood products were defined in transfusion group.The comparison between infants with and without transfusion was done by t-test,rank-sum test orχ2 test as appropriate.Linear regression model was used to generate adjusted transfusion rate of each center,and to investigate the correlation between adjusted rate and center-level characteristics.Results A total of 6598 infants were enrolled in the study,with gestational age of 30.0(28.7,31.0)weeks and birth weight of(1353±312)g,and 43.6%(2877)of them were female.Among them,42.7%(2816)infants were enrolled in transfusion group,with the times of transfusion as 3(1,6)times.Compared to the infants without any transfusion of non-erythrocyte blood products,those infants received transfusion had lower gestational age(Z=17.62,P<0.01),lower birth weight(t=18.64,P<0.01),higher proportion of small-for-gestation age(χ2=31.06,P<0.01),multiple birth(χ(2)=12.82,P<0.01)and intensive resuscitation in delivery room(χ(2)=287.52,P<0.01),as well as lower proportion of females(χ(2)=10.68,P<0.01)and even lower proportion of infants born in this hospital(χ(2)=78.23,P<0.01).Among the entire study population,albumin(25.4%,1674 cases),immunoglobulin(21.5%,1417 cases)and plasma(18.9%,1245 cases)were the most commonly used non-erythrocyte blood products.Overall,60.4%(544/901)infants with gestational age<28 weeks received transfusion 4(2,8)times.A total of 39.9%(2272/5697)infants between 28-31weeks received non-erythrocyte blood products 3(1,6)times.The non-erythrocyte blood products transfusion rates of critically-ill and non-critically-ill infants were 62.2%(1693/2723)and 29.0%(1123/3875)respectively,and the transfusion times were 4(2,7)and 2(1,4)times.The transfusion rates varied significantly among different NICU,and the disparities remained obvious after adjustment(adjustedχ(2)=153.48,P<0.01).Conclusion Near half of very preterm and extremely preterm infants admitted to Chinese NICU in 2019 receive non-erythrocyte blood products during hospitalization with significant disparities among different hospitals.