Evaluation of Risk Factors Associated with Red Blood Cell Transfusion in Preterm Infants

Abstract

Red blood cell(RBC) transfusions(TF), are frequently administered in preterms during their stay in neonatal intensive care unit(NICU).Up to 90% of very low birth weight preterms receive one or more transfusions in first weeks of life.In our study,we aimed to evaluate the risks associated with ES transfusion in preterms born <34GW. Materials and Methods: 68 infants born under 34 GW were included.The medical records of infants were retrospectively reviewed.Demographic information and clinical findings of the babies were evaluated in the first week,7-14. days and 14-21. days.The number of blood samples were recorded.The infants were divided into two groups as transfused and non-transfused.Clinical outcomes were compared. Results: Of the 68 cases included, 35(51.4%) were female and 33(48.5%)were male.Mean birth weight of TF and non-TF group were 1301±402.8 g and 1425±462.3 (p>0.05) and mean gestational age was 30.0±2.64 and 30.8±2.04 weeks (p>0.05) respectively.Twenty-five (36.7%) patients had multiple TF.The mean weight and gestational week of the group with multiple TF was 1041±205 g and 28.7±1.2 weeks, respectively.In the TF group, the first, second and third TF days were postnatal 21.4±10.9, 29.6±11.6 and 32.83±8.9 days, respectively.There was a significant difference in terms of duration of ventilator stay, hospitalization time, sepsis and inotropic requirement(p <0.05). Cumulative blood loss between 7-14 days were significantly higher in TF group(p <0.05).There was no difference regarding cumulative blood loss between 14th and 28th days(p=0.009).The duration of ventilator stay of the babies in the multiple TF group was also statistically higher (p <0.05). At postnatal 7 th,14 th,28th day, it was seen that the transfused group gained less weight.Bronchopulmonary dysplasia was found to be increased in TF group than non-TF group.When the groups were compared in terms of ROP, the rate was found similar in both groups (p>0.05). Conclusion: In our study, we found that babies receiving TF had longer duration of ventilator stay,hospitalization,sepsis and inotropic requirement.The number of blood samples taken in first two weeks increased the need for TF.In order to reduce the need for TF in preterms, it is necessary to reduce the number of blood samples taken by using micro methods and non-invasive monitoring.

Keywords

• preterm,red blood cell suspension,transfusion

Pretermlerde Eritrosit Transfüzyonu ile İlişkili Risk Faktörlerinin Değerlendirilmesi

Öz

Giriş-Amaç: Preterm bebeklere yenidoğan ünitesinde (YYBÜ) yatışları esnasında çoğu kez eritrosit süspansiyonu (ES) transfüzyonu (TF) yapılması gerekmektedir. Çok düşük doğum ağırlıklı (ÇDDA) bebeklerin %90 kadarına yaşamın ilk haftalarında bir veya daha fazla ES transfüzyonu yapılmaktadır.Çalışmamızda 34 gestasyonel haftanın (GH) altında doğan pretermlerde ES transfüzyonu ile ilişkili olabilecek risk faktörlerini değerlendirmeyi amaçladık. Materyal-Metod: Çalışmamıza YYBÜ’de takip edilen 34 GH altında doğan 68 bebeğin tıbbi kayıtları retrospektif olarak incelendi. Bebeklerin demografik verileri ve klinik verileri ile doğum sonrası alınan tüm kan örneklerinin sayısı kaydedildi.Bebekler TF yapılan ve yapılmayan grup olarak ikiye ayrılarak, istatistiksel olarak morbiditelerin oluşumu ve mortalite açısından kıyaslandı. Bulgular: Çalışmaya dahil edilen 68 olgunun 35‘ı kız (%51.4), 33’ü (%48.5) erkekti. Transfüzyon alan ve almayan olguların ortalama doğum tartıları ve gestasyon haftaları sırasıyla 1301 ± 402.8 g ile 1425 ± 462.3 g. (p>0.05) ve 30.0 ± 2.64 ile 30.8 ± 2.04 hafta idi (p>0.05). Olguların 25’ine (%36.7) çoklu TF tedavisi uygulanmıştı. TF olan grupta birinci, ikinci ve 3. TF günleri sırasıyla postnatal 21.4 ±10.9, 29.6±11.6 ve 32.83±8.9 gün idi. TF almayan ve alan grup kıyaslandığında doğum tartısı, gestasyon haftası, ventilatörde kalma süresi, hastanede yatış süresi, sepsis ve inotrop ihtiyacı açısından istatistiksel anlamlı fark bulundu (p<0.05). TF yapılan grupta kümülatif kan kaybı 7-14.gün arası anlamlı olarak yüksek saptandı (p<0.05). 14-28.gün arasında kümülatif kan kaybı açısından fark saptanmadı (p=0.009). Çoklu TF alan bebek grubunun ortalama tartı ve gestasyon haftasının sırasıyla 1041±205 gr ve 28.7±1.2 hafta olduğu görüldü. Çoklu TF alan gruptaki bebeklerin ventilatörde kalış süreleri de istatistiksel olarak yüksekti (p<0.05). PN 7.,14. ve 28. günlerde TF alan gruptaki bebeklerin tartı alımlarının daha az olduğu tespit edildi (p<0.05). TF alan grupta BPD görülme sıklığı anlamlı biçimde yüksekti. TF alan grupta ROP sıklığı daha yüksek saptansa da istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Sonuç: Çalışmamızda TF alan bebeklerin doğum tartısı ve gestasyon haftasının daha düşük, ventilatörde kalma süresi,hastanede yatış süresi, sepsis görülme ve inotrop ihtiyacı sıklığının daha yüksek olduğunu saptadık.Özellikle ilk iki haftada alınan kan örnek sayısının fazla olması TF ihtiyacını arttırmakta idi. Pretermlerde ES TF ihtiyacının azaltılması için kan örneği alım sayısının azaltılması, mümkünse mikro yöntemlerin kullanılması ve invaziv olmayan monitörizasyon yöntemlerinin kullanılması gerekmektedir.

Anahtar Kelimeler

• preterm,eritrosit suspansiyonu,transfüzyon

Kaynakça

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