■红细胞(RBC)输血是治疗早产新生儿贫血的常见医学干预措施;然而,最佳输血实践,如门槛,仍然不确定。
■为临床医生在极早产新生儿中使用红细胞输血提供建议。
■一个国际指导委员会审查了对6项随机临床试验(RCT)进行系统评价的证据,这些试验比较了基于高血红蛋白和低血红蛋白或基于血细胞比容的输血阈值。指导委员会就证据确定性评级达成共识,并与利益攸关方组织的一个小组合作审查证据。根据家长代表和利益相关者小组的意见,指导委员会使用了建议分级,评估,发展,和评估(等级)方法来制定建议。
■对6项随机对照试验的系统评价,包括3483名参与者(1759名女性[51.3%];平均[SD]年龄范围,25.9-29.8[1.5-3.0]周)用作建议的基础。在试验中,较高血红蛋白浓度(自由)与较低血红蛋白浓度(限制性)阈值研究组的范围相似。然而,具体阈值根据疾病的严重程度而有所不同,这是在试验中使用可变标准定义的。有证据表明,低输血阈值在重要的短期和长期结局中几乎没有差异。推荐的血红蛋白阈值根据出生后一周和呼吸支持需求而变化。在出生后第1、2和3周或更长时间,对于呼吸支持的新生儿,推荐阈值为11、10和9g/dL,分别;对于没有或最少呼吸支持的新生儿,推荐阈值为10、8.5和7g/dL,分别(将血红蛋白转化为每升克数,乘以10.0)。
■这份共识声明建议采用限制性红细胞输注策略,有适度的证据确定性,妊娠少于30周的早产新生儿。
UNASSIGNED: Red blood cell (RBC) transfusion is a common medical intervention to treat anemia in very preterm neonates; however, best transfusion practices, such as thresholds, remain uncertain.
UNASSIGNED: To develop recommendations for clinicians on the use of RBC transfusions in very preterm neonates.
UNASSIGNED: An international steering committee reviewed evidence from a systematic review of 6 randomized clinical trials (RCTs) that compared high vs low hemoglobin-based or hematocrit-based transfusion thresholds. The steering committee reached consensus on certainty-of-evidence ratings and worked with a panel from stakeholder organizations on reviewing the evidence. With input from parent representatives and the stakeholder panel, the steering committee used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to develop recommendations.
UNASSIGNED: A systematic review of 6 RCTs encompassing 3483 participants (1759 females [51.3%]; mean [SD] age range, 25.9-29.8 [1.5-3.0] weeks) was used as the basis of the recommendations. The ranges for higher hemoglobin concentration (liberal) vs lower hemoglobin concentration (restrictive) threshold study arms were similar across the trials. However, specific thresholds differed based on the severity of illness, which was defined using variable criteria in the trials. There was moderate certainty of evidence that low transfusion thresholds likely had little to no difference in important short-term and long-term outcomes. The recommended hemoglobin thresholds varied on the basis of postnatal week and respiratory support needs. At postnatal weeks 1, 2, and 3 or more, for neonates on respiratory support, the recommended thresholds were 11, 10, and 9 g/dL, respectively; for neonates on no or minimal respiratory support, the recommended thresholds were 10, 8.5, and 7 g/dL, respectively (to convert hemoglobin to grams per liter, multiply by 10.0).
UNASSIGNED: This consensus statement recommends a restrictive RBC transfusion strategy, with moderate certainty of evidence, for preterm neonates with less than 30 weeks\' gestation.