极/超低出生体质量儿输血频次对不良结局的预警价值：一项回顾性队列研究
Predictive Value of Red Blood Cell Transfusion Frequency for Adverse Outcomes in Very and Extremely Low Birth Weight Infants: a Retrospective Cohort Study
方小红 1许淳 1黄达丽 1许丽萍1
作者信息
- 1. 363000 福建省漳州市，福建医科大学附属漳州市医院新生儿科
- 折叠
摘要
背景 极/超低出生体质量儿（VLBWI/ELBWI）生后28 d内红细胞输注（RBCT）需求普遍，当前争议集中于输血阈值策略的选择，缺乏对输注频次及疾病严重度校正的深入探讨。目的 本研究旨在探讨VLBWI/ELBWI生后28 d内输血频次与不良结局（严重并发症及院内死亡）之间的关系。方法 回顾性分析2018—2020年福建医科大学附属漳州市医院新生儿重症监护室收治的408例VLBWI/ELBWI的数据。根据RBCT情况将408例患儿分为输血组（303 例）与无输血组（105 例）。比较两组患儿的临床特征和不良结局［至少出现其中1种并发症，包括早产儿视网膜病变（ROP）>2期、中重度支气管肺发育不良（BPD）、院内死亡］。使用Spearman秩相关分析探讨出生胎龄（GA）、出生体质量（BW）及合并症（分娩室插管、机械通气>5d、已证实的败血症、脑室周围-脑室内出血3~4级）与输血次数之间的关系。使用多因素Logistic回归模型评估GA、BW、合并症及输血次数与VLBWI/ELBWI发生不良结局之间的关联。结果 408例患儿中男256例（62.7%）、女152例（59.3%），平均GA（29.8±2.1）周，平均BW（1 205±248）g。其中303例（74.3%）患儿生后28 d内接受了RBCT。输血组与无输血组患儿GA、BW、5 min Apgar、小于胎龄儿（SGA）、分娩室插管、机械通气>5d、已证实的败血症、脑室周围-脑室内出血3~4级、ROP>2期、中重度BPD、院内死亡比较，差异有统计学意义（P<0.05）。相关性分析结果显示，GA、BW与输血次数呈负相关（rs=-0.544，P<0.001；rs=-0.541，P<0.001），合并症与输血次数呈正相关（rs=0.385，P<0.001）。多因素Logistic回归分析结果显示，GA≥30周（OR=0.482，95%CI=0.281~0.827，P=0.008）、BW≥1 250g（OR=0.447，95%CI=0.261~0.765，P=0.003）是VLBWI/ELBWI发生不良结局的保护因素，有合并症（OR=1.868，95%CI=1.138~3.066，P=0.013）、输血次数≥3次（OR=3.275，95%CI=1.707~6.275，P<0.001）是VLBWI/ELBWI发生不良结局的危险因素。结论 生后28 d内接受RBCT在VLBWI/ELBWI中较为普遍（74.3%），且GA<30周、BW<1 250g、有合并症、输血次数≥3次可能是严重并发症及院内死亡的独立危险因素。建议将“28 d内输血次数≥3次”作为VLBWI/ELBWI高危预警标志，≥3次输血患儿强化并发症监测以改善预后。
Abstract
Background Very/extremely low birth weight infants (VLBWI/ELBWI) have a common need for red blood cell transfusion (RBCT) within 28 days after birth. The current controversy centers on the selection of the transfusion threshold strategy, with a lack of in-depth discussion on the frequency of red blood cell transfusion and the correction for disease severity. Objective This study aimed to explore the relationship between the frequency of blood transfusion within 28 days after birth for very low birth weight infants (VLBWI) and adverse outcomes (severe complications and in-hospital death). Methods A retrospective analysis was conducted on the data of 408 very low birth weight infants and extremely low birth weight infants admitted to the Neonatal Intensive Care Unit of Zhangzhou Hospital Affiliated to Fujian Medical University from 2018 to 2020. Based on the results of RBCT, 408 infants were divided into the blood transfusion group (303 cases) and the no-blood-transfusion group (105 cases). Compare the clinical characteristics and adverse outcomes of the two groups of children [at least one of the following complications must occur, including retinopathy of prematurity (ROP)>stage 2, moderate to severe bronchopulmonary dysplasia (BPD), and in-hospital death]. Spearman rank correlation analysis was used to explore the relationships between gestational age at birth (GA), birth weight (BW), and complications (delivery room intubation, mechanical ventilation for more than 5 days, confirmed sepsis, grade 3-4 periventricular-intraventricular hemorrhage) and the number of blood transfusions. A multivariate Logistic regression model was used to assess the associations between GA, BW, comorbidities and the number of blood transfusions and the occurrence of adverse outcomes in VLBWI and extremely low birth weight infants (ELBWI). Results Among the 408 infants, 256 were male (62.7%) and 152 were female (59.3%). The average gestational age was (29.82.1) weeks and the average birth weight was (1 205248) grams. Among them, 303 cases (74.3%) of the infants underwent RBCT within 28 days after birth. There were statistically significant differences (P5 days, confirmed sepsis, grade 3-4 periventricular-intraventricular hemorrhage, ROP>stage 2, moderate to severe BPD, and in hospital death. The results of the correlation analysis showed that GA and BW were negatively correlated with the number of blood transfusions (rs=-0.544, P<0.001; rs=-0.541, P<0.001), while complications were positively correlated with the number of blood transfusions (rs=0.385, P<0.001). The results of the multivariate Logistic regression analysis showed that GA30 weeks (OR=0.482,95%CI=0.281-0.827, P=0.008) and BW 1 250 g (OR=0.447, 95%CI=0.261-0.765, P=0.003) were protective factors for adverse outcomes in VLBWI/ELBWI, while having complications (OR=1.868, 95%CI=1.138-3.066, P=0.013) and the number of blood transfusions 3 times (OR=3.275, 95%CI=1.707-6.275, P<0.001) were risk factors for adverse outcomes in VLBWI/ELBWI. Conclusion Receiving RBCT within 28 days after birth is relatively common in VLBWI/ELBWI cases (74.3%), and factors such as GA<30 weeks, BW<1 250 g, presence of complications, and 3 blood transfusions may be independent risk factors for severe complications and in-hospital mortality. It is suggested that " 3 blood transfusions within 28 days" be used as a high-risk warning sign for VLBWI/ELBWI, and for infants with 3 blood transfusions, intensified monitoring of complications should be carried out to improve prognosis.关键词
极低出生体质量儿/超低出生体质量儿/红细胞输注/输血次数/不良结局引用本文复制引用
方小红,许淳,黄达丽,许丽萍.极/超低出生体质量儿输血频次对不良结局的预警价值：一项回顾性队列研究[EB/OL].(2026-03-12)[2026-03-15].https://chinaxiv.org/abs/202603.00068.学科分类
临床医学/儿科学/基础医学
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