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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants.
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Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants.

机译：关于早产儿红细胞输注的自由与限制性指南的随机试验。

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OBJECTIVE: Although many centers have introduced more restrictive transfusion policies for preterm infants in recent years, the benefits and adverse consequences of allowing lower hematocrit levels have not been systematically evaluated. The objective of this study was to determine if restrictive guidelines for red blood cell (RBC) transfusions for preterm infants can reduce the number of transfusions without adverse consequences. DESIGN, SETTING, AND PATIENTS: We enrolled 100 hospitalized preterm infants with birth weights of 500 to 1300 g into a randomized clinical trial comparing 2 levels of hematocrit threshold for RBC transfusion. INTERVENTION: The infants were assigned randomly to either the liberal- or the restrictive-transfusion group. For each group, transfusions were given only when the hematocrit level fell below the assigned value. In each group, the transfusion threshold levels decreased with improving clinical status. MAIN OUTCOME MEASURES: We recorded the number of transfusions, the number of donor exposures, and various clinical and physiologic outcomes. RESULTS: Infants in the liberal-transfusion group received more RBC transfusions (5.2 +/- 4.5 [mean +/- SD] vs 3.3 +/- 2.9 in the restrictive-transfusion group). However, the number of donors to whom the infants were exposed was not significantly different (2.8 +/- 2.5 vs 2.2 +/- 2.0). There was no difference between the groups in the percentage of infants who avoided transfusions altogether (12% in the liberal-transfusion group versus 10% in the restrictive-transfusion group). Infants in the restrictive-transfusion group were more likely to have intraparenchymal brain hemorrhage or periventricular leukomalacia, and they had more frequent episodes of apnea, including both mild and severe episodes. CONCLUSIONS: Although both transfusion programs were well tolerated, our finding of more frequent major adverse neurologic events in the restrictive RBC-transfusion group suggests that the practice of restrictive transfusions may be harmful topreterm infants.
机译：目的：尽管近年来许多中心对早产儿采取了更多限制性输血政策，但尚未系统地评估允许降低血细胞比容水平的益处和不利后果。这项研究的目的是确定早产儿红细胞（RBC）输注的限制性指南是否可以减少输血次数而无不良后果。设计，地点和患者：我们将出生体重为500至1300 g的100例住院早产婴儿纳入一项随机临床试验，比较了2种红细胞压积阈值。干预：将婴儿随机分为自由输血组或限制性输血组。对于每组，仅当血细胞比容水平降至指定值以下时才进行输血。在每组中，输血阈值水平随着临床状况的改善而降低。主要观察指标：我们记录了输血次数，供体暴露次数以及各种临床和生理结果。结果：自由输血组的婴儿接受了更多的红细胞输血（5.2 +/- 4.5 [平均值+/- SD]相比，限制性输血组为3.3 +/- 2.9）。但是，婴儿所接触的供体数量没有显着差异（2.8 +/- 2.5对2.2 +/- 2.0）。完全避免输血的婴儿比例在两组之间没有差异（自由输血组为12％，限制性输血组为10％）。限制性输血组的婴儿更容易发生实质性脑出血或脑室白细胞软化，并且他们的呼吸暂停发作频率更高，包括轻度和严重发作。结论：尽管两种输血方案均耐受良好，但我们发现限制性红细胞输注组中更频繁发生的主要不良神经事件表明，限制性输血的做法可能对早产婴儿有害。

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