Changing patterns of red blood cell transfusion in very low birth weight infants

被引:135
作者
Widness, JA
Seward, VJ
Kromer, IJ
Burmeister, LF
Bell, EF
Strauss, RG
机构
[1] UNIV IOWA, DEPT PREVENT MED, IOWA CITY, IA 52242 USA
[2] UNIV IOWA, DEPT PATHOL, IOWA CITY, IA 52242 USA
关键词
D O I
10.1016/S0022-3476(96)70150-6
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective: Anemia develops in increasing numbers of critically ill very low birth weight (VLBW) infants who survive the neonatal period, and they receive multiple red brood cell (RBC) transfusions. Despite their need for prolonged medical treatment, we hypothesized that VLBW infants presently receive fewer RBC transfusions as a result of the growing awareness of transfusion risks and improvement of neonatal care. Methods: RBC transfusion practices and clinical outcomes in infants with birth weights of 1.5 kg or less were analyzed retrospectively in three selected years: 1982, before awareness of the human immunodeficiency virus; 1989, before surfactant availability; and 1993, before erythropoietin approval. Results: Progressive declines in RBC transfusions, donor exposures, and transfusion volumes occurred concurrently with decreases in morbidity and mortality rates. Transfusions per infant (mean +/- SD) declined from 7.0 +/- 7.4 in 1982 to 5.0 +/- 5.8 in 1989 to 2.3 +/- 2.7 in 1993 (p <0.001). This decline was associated with a decrease in pretransfusion hematocrit (33.6% +/- 2.8% in 1982, 34.2% +/- 3.7% in 1989, and 29.8% +/- 5.1% in 1993; p <0.001). The distribution of RBC transfusions given by week of life among study years did not change; 70% of RBC transfusions were given within the first 4 weeks, when infants are sickest. Although the percentage of VLBW infants weighing more than I kg at birth and never receiving any RBC transfusions increased with time (17% in 1982, 33% in 1989, and 64% in 1993), more than 95% of infants weighing 1 kg or less in all years received transfusions. Conclusions: Overall administration of neonatal transfusions has decreased markedly, most likely because of multiple factors. Because most RBC transfusions are given to infants weighing I kg or less in the first weeks of life, therapeutic strategies should focus on this group of VLBW infants during this critical period. The temporal changes observed in transfusion patterns emphasize the importance of including concurrent controls in future studies evaluating transfusion interventions.
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页码:680 / 687
页数:8
相关论文
共 34 条
[1]  
ALVERSON DC, 1995, CLIN PERINATOL, V22, P609
[2]  
[Anonymous], STAT PRINCIPLES EXPT
[3]  
BIFANO EM, 1995, CLIN PERINATOL, V22, P657
[4]   ASSESSMENT OF ANEMIA IN NEWBORN-INFANTS [J].
BLANCHETTE, VS ;
ZIPURSKY, A .
CLINICS IN PERINATOLOGY, 1984, 11 (02) :489-510
[5]   THE ROLE OF RBC TRANSFUSION IN THE PREMATURE-INFANT [J].
BLANK, JP ;
SHEAGREN, TG ;
VAJARIA, J ;
MANGURTEN, HH ;
BENAWRA, RS ;
PUPPALA, BL .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1984, 138 (09) :831-833
[6]   PREDICTION OF THE NEED FOR TRANSFUSION DURING ANEMIA OF PREMATURITY [J].
BROWN, MS ;
BERMAN, ER ;
LUCKEY, D .
JOURNAL OF PEDIATRICS, 1990, 116 (05) :773-778
[7]   EFFECT OF HIGH-DOSES OF HUMAN RECOMBINANT ERYTHROPOIETIN ON THE NEED FOR BLOOD-TRANSFUSIONS IN PRETERM INFANTS [J].
CARNIELLI, V ;
MONTINI, G ;
DARIOL, R ;
DALLAMICO, R ;
CANTARUTTI, F .
JOURNAL OF PEDIATRICS, 1992, 121 (01) :98-102
[8]   HIGH-FREQUENCY VENTILATION [J].
CLARK, RH .
JOURNAL OF PEDIATRICS, 1994, 124 (05) :661-670
[9]   THE EFFECTS OF CORTICOSTEROID ADMINISTRATION BEFORE PRETERM DELIVERY - AN OVERVIEW OF THE EVIDENCE FROM CONTROLLED TRIALS [J].
CROWLEY, P ;
CHALMERS, I ;
KEIRSE, MJNC .
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 1990, 97 (01) :11-25
[10]   BLOOD-TRANSFUSION IN THE PRETERM INFANT [J].
DEAR, P .
ARCHIVES OF DISEASE IN CHILDHOOD, 1984, 59 (04) :296-298