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极低出生体重儿贫血、输血治疗与坏死性小肠结肠炎的关联：一项临床观察研究
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Abstract:
目的：探讨极低出生体重儿(VLBW)贫血、红细胞输血与坏死性小肠结肠炎(NEC)发生的关联，评估贫血程度和输血治疗对NEC发生风险的影响。方法：回顾性分析2017年1月至2024年9月青岛大学附属医院新生儿重症监护病房收治的200例VLBW患儿临床资料。根据是否发生NEC分为NEC组(n = 68)和对照组(n = 132)。收集患儿一般资料、血红蛋白水平、贫血分级、红细胞输血相关情况等。采用单因素分析和多因素Logistic回归模型分析贫血与输血相关因素对NEC发生的影响。结果：两组在出生体重、胎龄、性别、Apgar评分等一般资料方面差异无统计学意义(P > 0.05)。NEC组红细胞输血率(73.5% vs 46.2%)、输血总次数(2.3 ± 1.1 vs 1.5 ± 0.9)、输血总量(35.1 ± 10.5？ml/kg vs 26.8 ± 8.7？ml/kg)及输血后48小时内NEC发生率(26.5% vs 3.8%)均显著高于对照组(均P < 0.05)。NEC组重度贫血发生率显著升高(25.0% vs 8.3%, P = 0.001)，血红蛋白正常者比例更低(P < 0.05)。多因素Logistic回归分析显示，红细胞输血(OR = 2.85)、重度贫血(OR = 1.42)、首次输血日龄提前(OR = 0.92)及出生体重较低(OR = 0.97)均为NEC发生的独立危险因素(P < 0.05)。结论：极低出生体重儿的重度贫血与红细胞输血均显著增加NEC的发生风险。应加强重度贫血早期识别与分级干预，合理把握输血时机，以降低NEC发生率并改善患儿预后。
Objective: To investigate the association between anemia, red blood cell (RBC) transfusion, and necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants, and to evaluate the impact of anemia severity and transfusion timing on NEC risk. Methods: A retrospective case-control study was conducted on 200 VLBW infants admitted to the NICU of the Affiliated Hospital of Qingdao University from January 2017 to September 2024. Patients were divided into the NEC group (n = 68) and the control group (n = 132) based on the occurrence of NEC. Clinical data including hemoglobin levels, anemia classification, and RBC transfusion history were collected. Univariate analysis and multivariate logistic regression were used to assess independent risk factors for NEC. Results: There were no significant differences in general characteristics such as gestational age, birth weight, sex, or Apgar scores between the two groups (P > 0.05). Compared with the control group, the NEC group had significantly higher RBC transfusion rates (73.5% vs 46.2%), transfusion frequency (2.3 ± 1.1 vs 1.5 ± 0.9), cumulative transfusion volume (35.1 ± 10.5？ml/kg vs 26.8 ± 8.7？ml/kg), and NEC onset within 48 hours post-transfusion (26.5% vs 3.8%) (all P < 0.05). The NEC group also had a higher incidence of severe anemia (25.0% vs 8.3%, P = 0.001) and a lower proportion of normal hemoglobin levels. Multivariate analysis identified RBC transfusion (OR = 2.85), severe anemia (OR = 1.42), earlier age at first transfusion (OR = 0.92), and lower birth weight (OR = 0.97) as independent risk factors for NEC (P < 0.05). Conclusion: Both anemia and RBC transfusion significantly increase the risk of NEC in VLBW infants. Early identification and appropriate
| [1] | Chen, Y.T., Lei, S., Tang, C., Lin, H., Weng, Y., Yeh, C., et al. (2025) Motor Skills as Early Indicators for Cognitive Development in Preterm Infants with Very Low Birth Weight. Pediatrics & Neonatology. https://doi.org/10.1016/j.pedneo.2025.01.010 |
| [2] | Belachew, A. and Tewabe, T. (2020) Neonatal Sepsis and Its Association with Birth Weight and Gestational Age among Admitted Neonates in Ethiopia: Systematic Review and Meta-Analysis. BMC Pediatrics, 20, Article No. 55. https://doi.org/10.1186/s12887-020-1949-x |
| [3] | Salas, A.A., Gunn, E., et al. (2024) Timing of Red Blood Cell Transfusions and Occurrence of Necrotizing Enterocolitis: A Secondary Analysis of a Randomized Clinical Trial. JAMA Network Open, 7, e249643. |
| [4] | Duchon, J., Barbian, M.E. and Denning, P.W. (2021) Necrotizing Enterocolitis. Clinics in Perinatology, 48, 229-250. https://doi.org/10.1016/j.clp.2021.03.002 |
| [5] | Li, T., Lin, S., Zhu, Y., Ye, D., Rong, X. and Wang, L. (2025) Basic Biology and Roles of CEBPD in Cardiovascular Disease. Cell Death Discovery, 11, Article No. 102. https://doi.org/10.1038/s41420-025-02357-4 |
| [6] | Kaufman, D.P., Khattar, J. and Lappin, S.L. (2025) Physiology, Fetal Hemoglobin. https://www.ncbi.nlm.nih.gov/books/NBK500011/ |
| [7] | Gavulic, A.E., Dougherty, D., Li, S., Carver, A.R., Bermick, J.R., Mychaliska, G.B., et al. (2021) Fetal Hemoglobin Levels in Premature Newborns. Should We Reconsider Transfusion of Adult Donor Blood? Journal of Pediatric Surgery, 56, 1944-1948. https://doi.org/10.1016/j.jpedsurg.2021.04.018 |
| [8] | Maheshwari, A., Patel, R.M. and Christensen, R.D. (2018) Anemia, Red Blood Cell Transfusions, and Necrotizing Enterocolitis. Seminars in Pediatric Surgery, 27, 47-51. https://doi.org/10.1053/j.sempedsurg.2017.11.009 |
| [9] | Zhao, S., Jiang, H., Miao, Y., Liu, W., Li, Y., Liu, H., et al. (2024) Factors Influencing Necrotizing Enterocolitis in Premature Infants in China: A Systematic Review and Meta-Analysis. BMC Pediatrics, 24, Article No. 148. https://doi.org/10.1186/s12887-024-04607-3 |
| [10] | Salem, A. and Patel, R.M. (2023) Red Blood Cell Transfusion, Anemia, Feeding, and the Risk of Necrotizing Enterocolitis. Clinics in Perinatology, 50, 669-681. https://doi.org/10.1016/j.clp.2023.04.014 |
| [11] | Song, J., Dong, H., Xu, F., Wang, Y., Li, W., Jue, Z., et al. (2021) The Association of Severe Anemia, Red Blood Cell Transfusion and Necrotizing Enterocolitis in Neonates. PLOS ONE, 16, e0254810. https://doi.org/10.1371/journal.pone.0254810 |
| [12] | Saroha, V., Josephson, C.D. and Patel, R.M. (2019) Epidemiology of Necrotizing Enterocolitis. Clinics in Perinatology, 46, 101-117. https://doi.org/10.1016/j.clp.2018.09.006 |
| [13] | Iskander, I.F., Salama, K.M., Gamaleldin, R.M. and Seghatchian, J. (2018) Neonatal RBC Transfusions: Do Benefits Outweigh Risks? Transfusion and Apheresis Science, 57, 431-436. https://doi.org/10.1016/j.transci.2018.05.007 |
| [14] | Rich, B.S. and Dolgin, S.E. (2017) Necrotizing Enterocolitis. Pediatrics in Review, 38, 552-559. https://doi.org/10.1542/pir.2017-0002 |
| [15] | 王卫平, 孙锟, 常立文. 儿科学[M]. 北京: 人民卫生出版社, 2018: 323-324. |
| [16] | 邵肖梅, 叶鸿瑁, 邱小汕. 实用新生儿学[M]. 第5版. 北京: 人民卫生出版社, 2018: 633-634. |
| [17] | Maheshwari, A. (2025) Severe Anemia Predisposes Very Premature Infants to Transfusion-Associated Necrotizing Enterocolitis. Seminars in Fetal and Neonatal Medicine, 30, Article ID: 101615. https://doi.org/10.1016/j.siny.2025.101615 |
| [18] | Kling, P.J. and Hutter, J.J. (2003) Hematologic Abnormalities in Severe Neonatal Necrotizing Enterocolitis: 25 Years Later. Journal of Perinatology, 23, 523-530. https://doi.org/10.1038/sj.jp.7210983 |
| [19] | Odom, T.L., Eubanks, J., Redpath, N., Davenport, E., Tumin, D. and Akpan, U.S. (2022) Development of Necrotizing Enterocolitis after Blood Transfusion in Very Premature Neonates. World Journal of Pediatrics, 19, 68-75. https://doi.org/10.1007/s12519-022-00627-0 |
| [20] | Kalteren, W.S., Bos, A.F., van Oeveren, W., Hulscher, J.B.F. and Kooi, E.M.W. (2021) Neonatal Anemia Relates to Intestinal Injury in Preterm Infants. Pediatric Research, 91, 1452-1458. https://doi.org/10.1038/s41390-021-01903-x |
| [21] | 刘欣, 刘利军, 蒋海燕, 等. 预测极早产儿坏死性小肠结肠炎发生风险列线图模型的建立[J]. 中国当代儿科杂志, 2022, 24(7): 778-785. |
| [22] | Singh, R., Visintainer, P.F., Frantz, I.D., Shah, B.L., Meyer, K.M., Favila, S.A., et al. (2011) Association of Necrotizing Enterocolitis with Anemia and Packed Red Blood Cell Transfusions in Preterm Infants. Journal of Perinatology, 31, 176-182. https://doi.org/10.1038/jp.2010.145 |
| [23] | Reber, K.M., Nankervis, C.A. and Nowicki, P.T. (2002) Newborn Intestinal Circulation: Physiology and Pathophysiology. Clinics in Perinatology, 29, 23-39. https://doi.org/10.1016/s0095-5108(03)00063-0 |
| [24] | Rose, A.T., Saroha, V. and Patel, R.M. (2020) Transfusion-Related Gut Injury and Necrotizing Enterocolitis. Clinics in Perinatology, 47, 399-412. https://doi.org/10.1016/j.clp.2020.02.002 |
| [25] | Patel, R.M., Knezevic, A., Shenvi, N., Hinkes, M., Keene, S., Roback, J.D., et al. (2016) Association of Red Blood Cell Transfusion, Anemia, and Necrotizing Enterocolitis in Very Low-Birth-Weight Infants. JAMA, 315, 889-897. https://doi.org/10.1001/jama.2016.1204 |
| [26] | Kirpalani, H. and Zupancic, J.A.F. (2012) Do Transfusions Cause Necrotizing Enterocolitis? The Complementary Role of Randomized Trials and Observational Studies. Seminars in Perinatology, 36, 269-276. https://doi.org/10.1053/j.semperi.2012.04.007 |
| [27] | 曾慧仪, 郭娟娟, 刘丹丹, 等. 新生儿输血相关性坏死性小肠结肠炎的影响因素分析[J]. 新医学, 2024, 55(7): 565-570. |
| [28] | Paul, D.A., Mackley, A., Novitsky, A., Zhao, Y., Brooks, A. and Locke, R.G. (2011) Increased Odds of Necrotizing Enterocolitis after Transfusion of Red Blood Cells in Premature Infants. Pediatrics, 127, 635-641. https://doi.org/10.1542/peds.2010-3178 |
| [29] | Christensen, R.D., Lambert, D.K., Henry, E., Wiedmeier, S.E., Snow, G.L., Baer, V.L., et al. (2010) Is “Transfusion‐associated Necrotizing Enterocolitis” an Authentic Pathogenic Entity? Transfusion, 50, 1106-1112. https://doi.org/10.1111/j.1537-2995.2009.02542.x |
| [30] | Mohamed, A. and Shah, P.S. (2012) Transfusion Associated Necrotizing Enterocolitis: A Meta-Analysis of Observational Data. Pediatrics, 129, 529-540. https://doi.org/10.1542/peds.2011-2872 |
| [31] | Parvizian, M.K., Barty, R., Heddle, N.M., Li, N., McDougall, T., Mukerji, A., et al. (2021) Necrotizing Enterocolitis and Mortality after Transfusion of abo Non‐Identical Blood. Transfusion, 61, 3094-3103. https://doi.org/10.1111/trf.16638 |
| [32] | Valieva, O.A., Strandjord, T.P., Mayock, D.E. and Juul, S.E. (2009) Effects of Transfusions in Extremely Low Birth Weight Infants: A Retrospective Study. The Journal of Pediatrics, 155, 331-337.e1. https://doi.org/10.1016/j.jpeds.2009.02.026 |
| [33] | DeRienzo, C., Smith, P.B., Tanaka, D., Bandarenko, N., Campbell, M.L., Herman, A., et al. (2014) Feeding Practices and Other Risk Factors for Developing Transfusion-Associated Necrotizing Enterocolitis. Early Human Development, 90, 237-240. https://doi.org/10.1016/j.earlhumdev.2014.02.003 |
| [34] | Mally, P., Golombek, S., Mishra, R., Nigam, S., Mohandas, K., Depalhma, H., et al. (2006) Association of Necrotizing Enterocolitis with Elective Packed Red Blood Cell Transfusions in Stable, Growing, Premature Neonates. American Journal of Perinatology, 23, 451-458. https://doi.org/10.1055/s-2006-951300 |
