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Can Early Haemoglobin Level and Number of Blood Transfusions Predict Bronchopulmonary Dysplasia ?

Yıl 2023, , 87 - 95, 06.09.2023
https://doi.org/10.18614/deutip.1213488

Öz

Background: Currently, no practical biomarker has been discovered for early recognition of the development of bronchopulmonary dysplasia(BPD). This study aimed to evaluate the predictive value of early complete blood count (CBC) indices along with red blood cell transfusion(RBCT) frequency for the development of moderate/severe BPD, and to identify a promising predictive risk model for BPD.
Methods: In this cross-sectional study, one-hundred-sixty-two neonates born before the 32nd weeks of gestation were retrospectively. Predictive role of CBC parameters in the first three postnatal days(PD) and the number of RBCTs on weekly basis were evaluated by univariate/multivariate analysis as well as multivariate data mining processing.
Results: Despite several factors affected BPD development in univariate analysis, gestational age, PD3 haemoglobin level and frequency of RBCT were found to be the independent predictors of BPD in multivariate analysis. The haemoglobin<155 g/L in the PD3 predicted moderate/severe BPD with 60% sensitivity and 88% specificity(AUC 0.80). Having received at least one RBCT during the first three postnatal weeks had AUC 0.81(sensitivity 0.91,and specificity 0.81). During hospitalisation, more than four RBCT predicted moderate/severe BPD with 0.83 sensitivity and 0.93 specificity(AUC0.96). A model including gestational age, PD3 haemoglobin value, and number of RBCT predicted BPD risk with 87% sensitivity and 86% precision using data mining methods.
Conclusion: Results emphasise that even just one blood transfusion in the first weeks is an independent risk factor for BPD. Even though BPD is multifactorial, initial haemoglobin value and RBCT frequency may serve as non-invasive and practical parameters to estimate BPD development risk.

Kaynakça

  • 1. Thébaud, B. et al. Bronchopulmonary dysplasia. Nature Reviews Disease Primers vol. 5 Preprint at https://doi.org/10.1038/s41572-019-0127-7 (2019).
  • 2. Laughon, M. M. et al. Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants. Am J Respir Crit Care Med 183, 1715–1722 (2011).
  • 3. Bolouki Moghaddam, K. et al. The Association of Mean Platelet Volume with Intra Ventricular Hemorrhage and Broncho Pulmonary Dysplasia in Preterm Infants. Iran J Ped Hematol Oncol 5, 227–32 (2015).
  • 4. Hussein, N. F., el Helaly, N. S., Abdel Ghany, E. A. & Anis, S. K. Relationship between Mean Platelet Volume and Bronchopulmonary Dysplasia and Intraventricular Hemorrhage in Very Low Birth Weight Neonates. Journal of American Science vol.8http://www.americanscience.orghttp//www.americanscience.orgeditor@americanscience.org554http://www.americanscience.org.58 (2012).
  • 5. Cekmez, F. et al. Mean platelet volume in very preterm infants: A predictor of morbidities? Eur Rev Med Pharmacol Sci 17, 134–137 (2013).
  • 6. Dani, C., Poggi, C. & Fontanelli, G. Relationship between platelet count and volume and spontaneous and pharmacological closure of ductus arteriosus in preterm infants. Am J Perinatol 30, 359–364 (2013).
  • 7. Collard, K. J. Transfusion related morbidity in premature babies: Possible mechanisms and implications for practice. World J Clin Pediatr 3, 19 (2014).
  • 8. Arsan, S., Korkmaz, A. & Oğuz, S. Turkish neonatal society guideline on prevention and management of bronchopulmonary dysplasia. Turk Pediatri Ars 53, S138–S150 (2018).
  • 9. Jobe, A. H. & Bancalari, E. NICHD / NHLBI / ORD Workshop Summary. Am J Respir Crit Care Med 163, 1723–1729 (2001).
  • 10. Villar, J. et al. INTERGROWTH-21st very preterm size at birth reference charts. The Lancet 387, 844–845 (2016).
  • 11. Griffin, I. J., Tancredi, D. J., Bertino, E., Lee, H. C. & Profit, J. Postnatal growth failure in very low birthweight infants born between 2005 and 2012. Arch Dis Child Fetal Neonatal Ed 101, F50-5 (2016).
  • 12. Hellström, W., Martinsson, T., Hellstrom, A., Morsing, E. & Ley, D. Fetal haemoglobin and bronchopulmonary dysplasia in neonates: An observational study. Arch Dis Child Fetal Neonatal Ed 106, F88–F92 (2021).
  • 13. Raffaeli, G. et al. Iron homeostasis disruption and oxidative stress in preterm newborns. Nutrients 12, 1–21 (2020).
  • 14. Duan, J. et al. Association between Hemoglobin Levels in the First 3 Days of Life and Bronchopulmonary Dysplasia in Preterm Infants. Am J Perinatol 33, 998–1002 (2016).
  • 15. Fogarty, M. et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol 218, 1–18 (2018).
  • 16. Devon Chabot, R., Qian-Yun, Z. & Tracy I, G. Automated Hematology. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics https://www.clinicalkey.com/service/content/pdf/watermarked/3-s2.0-B9780323359214000739.pdf?locale=en_US (2018).
  • 17. Alyamac Dizdar, E. et al. Low platelet count is associated with ductus arteriosus patency in preterm newborns. Early Hum Dev 88, 813–816 (2012).
  • 18. Demir, N. et al. Is platelet mass a more significant indicator than platelet count of closure of patent ductus arteriosus? Journal of Maternal-Fetal and Neonatal Medicine 29, 1915–1918 (2016).

Erken Hemoglobin Değeri ve Kan Transfüzyon Sayısı Bronkopulmoner Displaziyi Öngörebilir Mi?

Yıl 2023, , 87 - 95, 06.09.2023
https://doi.org/10.18614/deutip.1213488

Öz

Giriş: Bronkopulmoner displazi (BPD) gelişiminin erken tanınması için pratik bir biyobelirteç henüz keşfedilmemiştir. Bu çalışma, orta/şiddetli BPD gelişimi için erken tam kan sayımı (CBC) indekslerinin yanı sıra kırmızı kan hücresi transfüzyonu (RBCT) sıklığının hastalığı öngörmedeki değerini ve BPD için umut verici bir öngürücü risk modeli belirlemeyi amaçlamıştır.
Gereç ve Yöntem: Bu kesitsel çalışmada, 32. gebelik haftasından önce doğan 162 yenidoğan retrospektif olarak incelendi. Doğum sonrası ilk üç gündeki (PD) tam kan sayımı parametrelerinin öngörücü rolü ve haftalık bazda RBCT sayısı, tek değişkenli/çok değişkenli analizin yanı sıra çok değişkenli veri madenciliği işleme ile değerlendirildi.
Bulgular: Tek değişkenli analizde BPD gelişimini etkileyen birkaç faktöre rağmen, çok değişkenli analizde gebelik yaşı, PD3 hemoglobin düzeyi ve RBCT sıklığının BPD'nin bağımsız belirleyicileri olduğu bulundu. PD3'teki hemoglobin <155 g/L, %60 duyarlılık ve %88 özgüllükle (EAA 0.80) orta/şiddetli BPD'yi öngördü. Doğum sonrası ilk üç hafta boyunca en az bir RBCT almış olmak, EAA 0.81'e sahipti (duyarlılık 0.91 ve özgüllük 0.81). Hastanede yatış sırasında, dörtten fazla RBCT, 0,83 duyarlılık ve 0,93 özgüllük (AUC0,96) ile orta/şiddetli BPD'yi tahmin etti. Gebelik yaşı, PD3 hemoglobin değeri ve RBCT sayısını içeren bir model, veri madenciliği yöntemlerini kullanarak %87 hassasiyet ve %86 kesinlik ile BPD riskini tahmin etti.
Sonuç: Sonuçlar, ilk haftalarda sadece bir kan transfüzyonunun bile BPD için bağımsız bir risk faktörü olduğunu vurgulamaktadır. BPD çok faktörlü olsa da, başlangıç ​​hemoglobin değeri ve RBCT frekansı, BPD gelişme riskini tahmin etmek için invazif olmayan ve pratik parametreler olarak hizmet edebilir.

Kaynakça

  • 1. Thébaud, B. et al. Bronchopulmonary dysplasia. Nature Reviews Disease Primers vol. 5 Preprint at https://doi.org/10.1038/s41572-019-0127-7 (2019).
  • 2. Laughon, M. M. et al. Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants. Am J Respir Crit Care Med 183, 1715–1722 (2011).
  • 3. Bolouki Moghaddam, K. et al. The Association of Mean Platelet Volume with Intra Ventricular Hemorrhage and Broncho Pulmonary Dysplasia in Preterm Infants. Iran J Ped Hematol Oncol 5, 227–32 (2015).
  • 4. Hussein, N. F., el Helaly, N. S., Abdel Ghany, E. A. & Anis, S. K. Relationship between Mean Platelet Volume and Bronchopulmonary Dysplasia and Intraventricular Hemorrhage in Very Low Birth Weight Neonates. Journal of American Science vol.8http://www.americanscience.orghttp//www.americanscience.orgeditor@americanscience.org554http://www.americanscience.org.58 (2012).
  • 5. Cekmez, F. et al. Mean platelet volume in very preterm infants: A predictor of morbidities? Eur Rev Med Pharmacol Sci 17, 134–137 (2013).
  • 6. Dani, C., Poggi, C. & Fontanelli, G. Relationship between platelet count and volume and spontaneous and pharmacological closure of ductus arteriosus in preterm infants. Am J Perinatol 30, 359–364 (2013).
  • 7. Collard, K. J. Transfusion related morbidity in premature babies: Possible mechanisms and implications for practice. World J Clin Pediatr 3, 19 (2014).
  • 8. Arsan, S., Korkmaz, A. & Oğuz, S. Turkish neonatal society guideline on prevention and management of bronchopulmonary dysplasia. Turk Pediatri Ars 53, S138–S150 (2018).
  • 9. Jobe, A. H. & Bancalari, E. NICHD / NHLBI / ORD Workshop Summary. Am J Respir Crit Care Med 163, 1723–1729 (2001).
  • 10. Villar, J. et al. INTERGROWTH-21st very preterm size at birth reference charts. The Lancet 387, 844–845 (2016).
  • 11. Griffin, I. J., Tancredi, D. J., Bertino, E., Lee, H. C. & Profit, J. Postnatal growth failure in very low birthweight infants born between 2005 and 2012. Arch Dis Child Fetal Neonatal Ed 101, F50-5 (2016).
  • 12. Hellström, W., Martinsson, T., Hellstrom, A., Morsing, E. & Ley, D. Fetal haemoglobin and bronchopulmonary dysplasia in neonates: An observational study. Arch Dis Child Fetal Neonatal Ed 106, F88–F92 (2021).
  • 13. Raffaeli, G. et al. Iron homeostasis disruption and oxidative stress in preterm newborns. Nutrients 12, 1–21 (2020).
  • 14. Duan, J. et al. Association between Hemoglobin Levels in the First 3 Days of Life and Bronchopulmonary Dysplasia in Preterm Infants. Am J Perinatol 33, 998–1002 (2016).
  • 15. Fogarty, M. et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol 218, 1–18 (2018).
  • 16. Devon Chabot, R., Qian-Yun, Z. & Tracy I, G. Automated Hematology. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics https://www.clinicalkey.com/service/content/pdf/watermarked/3-s2.0-B9780323359214000739.pdf?locale=en_US (2018).
  • 17. Alyamac Dizdar, E. et al. Low platelet count is associated with ductus arteriosus patency in preterm newborns. Early Hum Dev 88, 813–816 (2012).
  • 18. Demir, N. et al. Is platelet mass a more significant indicator than platelet count of closure of patent ductus arteriosus? Journal of Maternal-Fetal and Neonatal Medicine 29, 1915–1918 (2016).
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Çocuk Sağlığı ve Hastalıkları, Klinik Tıp Bilimleri (Diğer)
Bölüm Araştırma Makaleleri
Yazarlar

Can Akyıldız 0000-0002-7087-7006

Funda Tüzün 0000-0001-5348-1168

Yağmur Damla Akçura 0000-0001-8330-3311

Nuray Duman 0000-0003-0545-2914

Pembe Keskinoğlu 0000-0002-3459-1828

Hasan Özkan 0000-0003-1622-4087

Yayımlanma Tarihi 6 Eylül 2023
Gönderilme Tarihi 2 Aralık 2022
Yayımlandığı Sayı Yıl 2023

Kaynak Göster

Vancouver Akyıldız C, Tüzün F, Akçura YD, Duman N, Keskinoğlu P, Özkan H. Can Early Haemoglobin Level and Number of Blood Transfusions Predict Bronchopulmonary Dysplasia ?. DEU Tıp Derg. 2023;37(2):87-95.