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

Yıl 2020, Cilt: 51 Sayı: 1, 9 - 13, 15.01.2020

Didem Arman Nursu Kara

https://doi.org/10.16948/zktipb.672462

Cited By: 1

Öz

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.

Anahtar Kelimeler

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

Destekleyen Kurum

yok

Teşekkür

Doç. Dr. Serdar Cömert 'e büyük katkılarından dolayı teşekkür ederiz.

Kaynakça

• 1. Aladangady N, Asamoah F, Banerjee J. Blood transfusion and short term outcomes in premature infants. E-PAS 2014, p 4113252.
• 2. Keir AK, Yang J, Harrison A, Pelausa E, Shah PS. Temporal changes in blood product usage in preterm neonates born at less than 30 weeks’ gestation in Canada. Transfusion 2015;55:1340–1346.
• 3. Maier RF, Sonntag J, Walka MM, Liu G, Metze BC, et al. Changing practices of red blood cell transfusions in infants with birth weights less than 1,000 g. J Pediatr 2000;136: 220–224.
• 4. Türk Neonatoloji Derneği Kan Ürünleri Transfüzyon Rehberi [Internet]. Türk Neonatoloji Derneği. 2016. Available from http://www.neonatology.org.tr
• 5. Rosebraugh MR, Widness JA, Nalbant D, Peter Veng-Pedersen. A mathematical modeling approach to quantify the role of phlebotomy losses and need for transfusions in neonatal anemia. Transfusion 2013;53:1353–1360.
• 6. Christensen RD, Carroll PD, Josephson CD. Evidence based advances in transfusion practice in neonatal intensive care units. Neonatology. 2014;106: 245–253. 7. Widness JA, Madan A, Grindeanu LA, Zimmerman MB, Wong DK, et al. Reduction in red blood cell transfusions among preterm infants: results of a randomized trial with an in-line blood gas and chemistry monitor. Pediatrics 2005;115: 1299–1306.
• 8. Carroll PD, Widness JA. Nonpharmacological, blood conservation techniques for preventing neonatal anemia – effective and promising strategies for reducing transfusion. Semin Perinatol 2012;36(4):232–243.
• 9. Howarth C, Banerjee J, Aladangady N. Red blood cell transfusion in preterm infants: current evidence and controversies. Neonatology 2018;114(1):7–16.
• 10. Mohamed A, Shah PS. Transfusion associated necrotizing enterocolitis: a meta-analysis of observational data. Pediatrics 2012;129: 529–540.
• 11. Baer VL, Lambert DK, Henry E, Snow GL, Christensen RD. Red blood cell transfusion of preterm neonates with a Grade 1 intraventricular hemorrhage is associated with extension to a grade 3 or 4 hemorrhage. Transfusion 2011;51: 1933–1939.
• 12. Zhang Z, Huang X, Lu H. Association between red blood cell transfusion and bronchopulmonary dysplasia in preterm infants. Sci Rep 2014;4:4340.
• 13. Brooks SE, Marcus DM, Gillis D, Pirie E, Johnson MH, Bhatia J. The effect of blood transfusion protocol on retinopathy of prematurity: a prospective, randomized study. Pediatrics 1999;104:514–518.
• 14. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163(7):1723-9.
• 15. International committee for the classification of retinopathy of prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123: 991-999.
• 16. Papile LA, Burstein J, Burstein R. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 g. J Pediatr 1978; 92: 529-534.
• 17. Walsh MC, Kliegman RM. Neonatal necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986: 33; 179.
• 18. Haiden N, Schwindt J, Cardona F, Berger A, Klebermass K, Wald M, et al. Effects of a combined therapy of erythropoietin, iron, folate, and vitamin B12 on the transfusion requirements of extremely low birth weight infants. Pediatrics 2006 Nov;118(5):2004-13.
• 19. Counsilman CE, Heeger LE, Tan R, Bekker V, Zwaginga JJ, Te Pas BA. Iatrogenic blood loss in extreme preterm infants due to frequent laboratory tests and procedures. J Matern Fetal Neonatal Med 2019;1–6.
• 20. Collard KJ. Is there a causal relationship between the receipt of blood transfusions and the development of chronic lung disease of prematurity? Med Hypotheses 2006; 66: 355– 364.
• 21. Cooke RW, Drury JA, Yoxall CW, James C. Blood transfusion and chronic lung disease in preterm infants. Eur J Pediatr 1997; 156: 47– 50.
• 22. Hirano K, Morinobu T, Kim H, Hiroi M, Ban R, Ogawa S, et al. Blood transfusion increases radical promoting non-transferrin bound iron in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001; 84:188–193.
• 23. Wang YC, Chan OW, Chiang MC, Yang PH, Chu SM, Hsu JF, et al. Red blood cell transfusion and clinical outcomes in extremely low birth weight preterm infants. Pediatr Neonatol 2017; 58: 216–222.
• 24. Baer VL, Lambert DK, Henry E, Snow GL, Butler A, Christensen RD. Among very low birth weight neonates is red blood cell transfusion an independent risk factor for subequently developing a severe intraventricular hemorrhage? Transfusion 2011; 51: 1170– 1178.
• 25. Christensen RD, Baer VL, Lambert DK, Ilstrup SJ, Eggert LD, Henry E. Association among very low birthweight neonates between red blood cell transfusions in the week after birth and severe intraventricular hemorrhage. Transfusion 2014; 54: 104–108.
• 26. Hay S, Zupancic JA, Flannery DD, Kirpalani H, Dukhovny D. Should we believe in transfusion-associated enterocolitis? Applying a GRADE to the literature. Semin Perinatol 2017;41(1):80–91.
• 27. Dani C, Reali MF, Bertini G, E. M, Pezzati M, Rubaltelli FF. The role of blood transfusions and iron uptake on retinopathy of prematurity. Early Hum Dev 2001; 62: 57–63.
• 28. Kirpalani H, Whyte RK, Andersen C, Asztalos EV, Heddle N, Blajchman MA, et al. The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. J Pediatr 2006; 149: 301–307.
• 29. Nunes dos Santos AM, Guinsburg R, de Almeida MF, Procianoy RS, Marba ST, et al. Brazilian Network on Neonatal Research. Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units. BMC Pediatr 2015 Sep 4;15:113.
• 30. Jeon GW, Sin JB. Risk factors of transfusion in anemia of very low birth weight infants. Yonsei Med J 2013 Mar 1;54(2):366-73.