Abstract:

Objective　To explore the red blood cell (RBC) transfusion situation and its risk factors in preterm infants with gestational age (GA) <32 weeks, and to provide clinical basis for reducing the blood transfusion rate of premature infants. Methods　The clinical data of 130 premature infants with GA <32 weeks admitted to Affiliated Hospital of Yangzhou University from January 2018 to December 2022 were retrospectively analyzed. They were divided into a blood transfusion group and a non-blood transfusion group based on whether they received blood transfusion or not. In the blood transfusion group, there were 30 males and 31 females, with  a gestational age of (29.79±1.66) weeks. In the non-blood transfusion group, there were 36 males and 33 females, with a gestational age of (31.13±1.02) weeks. By comparing the general data, maternal information, diagnosis and treatment status, etc., and the risk factors affecting blood transfusion in premature infants with GA <32 weeks were analyzed through univariate and multivariate logistic regression analysis. Independent sample t test was used for the measurement data with normal distribution, rank sum test was used for the measurement data with skew distribution, and χ² test was used for the count data. Results　Among the 130 preterm infants with GA <32 weeks, 61 cases were treated with blood transfusion, with an incidence of 46.92%. The results of univariate analysis showed that the gestational age, birth weight, hemoglobin (Hb) value at birth, hematocrit (HCT), and small-for date-infant ratio of the blood transfusion group were all lower than those of the non-blood transfusion group [(29.79±1.66) weeks vs. (31.13±1.02) weeks, (1 334.05±304.29) g vs. (1631.45±245.64) g, (166.00±24.77) g/L vs. (184.43±19.00) g/L, (51.04±7.95)% vs. (56.35±6.37)%, 9.84% (6/61) vs. 23.19% (16/69)], with statistically significant differences (t=-5.450, -6.160, -4.689, and -4.164, χ²=4.106; all P<0.05). The amount of blood collection within 2 weeks after birth and the proportions of Apgar score 1 min after birth ≤7 points, mechanical ventilation, tracheal intubation, apnea, neonatal respiratory distress syndrome (NRDS), bronchopulmonary dysplasia (BPD), and neonatal necrotizing enterocolitis (NEC) in the blood transfusion group were all higher than those in the non-blood transfusion group [(28.63±8.25) ml/kg vs. (20.84±5.27) ml/kg, 42.62% (26/61) vs. 13.04% (9/69), 95.08% (58/61) vs. 60.87% (42/69), 19.67% (12/61) vs. 1.45% (1/69), 68.85% (42/61) vs. 34.78% (24/69), 72.13% (44/61) vs. 52.17% (36/69), 21.31% (13/61) vs. 1.45% (1/69), 14.75% (9/61) vs. 2.90% (2/69)], with statistically significant differences (t=6.324, χ²=14.398, 21.349, 11.946, 15.036, 5.448, 11.305, and 4.444; all P<0.05). The time of parenteral nutrition, the time to reach adequate feeding, the time of oxygen inhalation, and the hospitalization time in the blood transfusion group were longer than those in the non-blood transfusion group [21.00 (15.00, 31.00) d vs. 11.00 (8.00, 17.00) d, 23.00 (17.00, 33.00) d vs. 12.00 (9.00, 17.50) d, 10.00 (4.00, 28.00) d vs. 3.00 (0, 6.00) d, (47.46±19.34) d vs. (27.62±8.78) d], with statistically significant differences (Z=-5.922, -6.075, and -5.687, t=7.368; all P<0.05). Multivariate logistic regression analysis showed that birth weight <1 500 g, amount of blood collection ≥25 ml within 2 weeks after birth, parenteral nutrition time ≥14 days, and use of mechanical ventilation were all independent risk factors for blood transfusion in preterm infants with GA <32 weeks (OR=4.243, 3.462, 7.425, and 7.218, all P<0.05), while Hb ≥160 g/L at birth was a protective factor (OR=0.072, P<0.05). Conclusion　Hb ≥160 g/L at birth is a protective factor for blood transfusion in premature infants with GA <32 weeks, while birth weight <1 500 g, blood collection volume ≥25 ml within 2 weeks after birth, parenteral nutrition time ≥14 days, and use of mechanical ventilation are independent risk factors for blood transfusion in premature infants with GA <32 weeks.

Key words:

Anemia, Blood transfusion, Premature infants, Gestational age <, 32 weeks, Mechanical ventilation, Risk factors

摘要：

目的　探讨胎龄<32周早产儿输血情况及危险因素，为临床降低早产儿输血率提供依据。方法　回顾性分析2018年1月至2022年12月扬州大学附属医院收治的130例胎龄<32周早产儿的临床资料，根据是否输血分为输血组（61例）和未输血组（69例）。输血组男30例、女31例，胎龄（29.79±1.66）周；未输血组男36例、女33例，胎龄（31.13±1.02）周。对比两组患儿一般资料、孕母资料、诊治情况等差异，并通过单因素和多因素logistic回归分析影响胎龄<32周早产儿输血的危险因素。符合正态分布的计量资料采用独立样本t检验，偏态分布的计量资料采用秩和检验，计数资料使用χ²检验。结果　在130例胎龄<32周早产儿中，输血治疗者61例，输血率为46.92%。单因素分析结果显示，输血组患儿胎龄、出生体质量、出生时血红蛋白（Hb）值、红细胞压积（HCT）、小于胎龄儿比例均低于未输血组［（29.79±1.66）周比（31.13±1.02）周、（1 334.05±304.29）g比（1 631.45±245.64）g、（166.00±24.77）g/L比（184.43±19.00）g/L、（51.04±7.95）%比（56.35±6.37）%、9.84%（6/61）比23.19%（16/69）］，差异均有统计学意义（t=-5.450、-6.160、-4.689、-4.164，χ²=4.106；均P<0.05）。输血组患儿生后2周内采血量及出生1 min Apgar评分≤7分、应用机械通气、需气管插管、呼吸暂停、新生儿呼吸窘迫综合征（NRDS）、支气管肺发育不良（BPD）、新生儿坏死性小肠结肠炎（NEC）比例均高于未输血组［（28.63±8.25）ml/kg比（20.84±5.27）ml/kg、42.62%（26/61）比13.04%（9/69）、95.08%（58/61）比60.87%（42/69）、19.67%（12/61）比1.45%（1/69）、68.85%（42/61）比34.78%（24/69）、72.13%（44/61）比52.17%（36/69）、21.31%（13/61）比1.45%（1/69）、14.75%（9/61）比2.90%（2/69）］，差异均有统计学意义（t=6.324，χ²=14.398、21.349、11.946、15.036、5.448、11.305、4.444；均P<0.05）。输血组患儿肠外营养时间、达足量喂养时间、吸氧时间、住院时间均长于未输血组［21.00（15.00，31.00）d比11.00（8.00，17.00）d、23.00（17.00，33.00）d比12.00（9.00，17.50）d、10.00（4.00，28.00）d比3.00（0，6.00）d、（47.46±19.34）d比（27.62±8.78）d］，差异均有统计学意义（Z=-5.922、-6.075、-5.687，t=7.368；均P<0.05）。多因素logistic回归分析显示，出生体质量<1 500 g、生后2周内采血量≥25 ml、肠外营养时间≥14 d、应用机械通气均为胎龄<32周早产儿需要输血的独立危险因素（OR=4.243、3.462、7.425、7.218，均P<0.05）；而出生时Hb≥160 g/L则是保护因素（OR=0.072，P<0.001）。结论　出生时Hb≥160 g/L是胎龄<32周早产儿输血的保护因素，出生体质量<1 500 g、生后2周内采血量≥25 ml、肠外营养时间≥14 d、应用机械通气是胎龄<32周早产儿输血的独立危险因素。

关键词:

贫血, 输血, 早产儿, 胎龄<, 32周, 机械通气, 危险因素