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PPT丨早产儿贫血诊断与治疗的临床实践指南(2025年)

  • 2026-04-06 12:09:29
PPT丨早产儿贫血诊断与治疗的临床实践指南(2025年)
指南速览
  1. AOP 的危险因素
    ：医源性失血、低胎龄、小于胎龄儿、产前母亲血红蛋白（Hb）低、出生时 Hb 低、有血流动力学意义的动脉导管未闭、严重脑室周围 - 脑室内出血是 AOP 的危险因素（C 级证据，强推荐）。
  2. AOP 的早期识别
    • 建议采集母婴病史，评估症状体征，早期识别 AOP （GPS）。
    • 建议所有急诊分娩的早产儿常规评估脐动脉血气 Hb，早期识别 AOP （A 级证据，强推荐）。
    • 建议开展近红外光谱（NIRS）监测局部脑氧饱和度和脑组织氧摄取分数，对相关指标异常的早产儿警惕发生贫血（B 级证据，强推荐）。
  3. AOP 的病因诊断
    • 对于网织红细胞计数升高的 AOP 患儿，建议进行常规直接抗人球蛋白试验，以鉴别免疫性溶血病和非免疫性溶血病（GPS）。
    • 对于网织红细胞计数升高、直接抗人球蛋白试验阴性，且血涂片红细胞形态正常的 AOP 患儿，建议进行常规超声检查以排除脑室内出血导致的失血性贫血（A 级证据，强推荐）。
    • 对于网织红细胞计数降低的 AOP 患儿，建议常规检查 Hb 和血清铁蛋白以排除铁缺乏和缺铁性贫血 ，必要时行骨髓穿刺等检查，排除罕见病（A 级证据，强推荐；GPS）。
  4. 不同胎龄 AOP 的诊断标准
    • 建议采用住院早产儿全血细胞计数建立的参考区间作为 AOP 的标准化定义（A 级证据，强推荐）。
    • 不建议根据孕妇居住的海拔对早产儿 Hb 和 Hct 的参考区间进行调整（C 级证据，强推荐）。
    • 建议采用静脉血或动脉血而非毛细血管血诊断 AOP （A 级证据，强推荐）。
  5. AOP 的早期预防
    • 建议有活力的早产儿延迟脐带结扎至少 60s 增加胎盘输血；对需要复苏的早产儿，脐带挤压可作为胎龄 > 28 周早产儿胎盘输血的替代方案（A 级证据，强推荐）。
    • 建议最大限度减少抽血导致的医源性失血（A 级证据，强推荐）。
    • 建议开展脐带血检测、连续皮下血糖及经皮氧分压和二氧化碳分压监测，减少医源性失血（D 级证据，弱推荐）。
    • 不建议常规使用 EPO 预防 AOP （A 级证据，强推荐）。
    • 建议未致敏的 RhD 阴性孕妇妊娠 28 周时接受预防性应用抗 D 免疫球蛋白，产后根据情况处理（A 级证据，强推荐）。
    • 对于母乳喂养或母乳喂养为主的早产儿，建议达到全肠道喂养时开始肠道补铁 ，并定期监测血清铁蛋白（A 级证据，强推荐）。
    • 对于配方粉喂养的早产儿，建议达到全肠道喂养时开始强化铁配方粉喂养 ，并定期监测血清铁蛋白（D 级证据，强推荐；A 级证据，强推荐）。
    • 建议所有早产儿，不论喂养方式，从生后 6 月龄开始引入富含铁辅食（A 级证据，强推荐）。
  6. AOP 的输血治疗
    • 建议快速失血导致低血容量性休克的贫血早产儿紧急输血，正常血容量者根据呼吸支持情况选择输血阈值，每次输血量 10 - 20mL/kg （A 级证据，强推荐）。
    • 建议根据临床和实验室指标评价输血效果，必要时再次输血（A 级证据，强推荐）。
    • 建议储存期内的红细胞可安全用于输血，大量换血和高钾血症早产儿除外（A 级证据，强推荐）。
    • 建议胎龄≥35 周的溶血性贫血早产儿换血适应证采用 2022 美国儿科学会推荐的胎龄小时龄总胆红素阈值（A 级证据，强推荐）。
    • 建议权衡输血的获益和风险，尽可能避免输血或减少输血次数，以减少输血相关并发症（A 级证据，强推荐）。
  7. 如何改善贫血早产儿的预后
    • 建议开展 NIRS 监测相关指标评估脑损伤（A 级证据，强推荐）。
    • 建议早期预防 AOP，降低多种疾病及神经发育障碍的发生风险（B 级证据，强推荐）。
    • 建议早期肠道补铁，降低铁缺乏和缺铁性贫血患病率，改善远期神经认知和精神运动发育（A 级证据，强推荐）。
  8. 贫血早产儿的出院随访
    • 建议矫正月龄 1 - 3 个月时检测血常规，根据情况复查并进一步检查营养性贫血的其他相关指标（A 级证据，强推荐）。
    • 建议对未输血和输血的贫血早产儿进行长期神经发育随访（C 级证据，强推荐）。
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  1. CONNECT:[ UseTime:0.000878s ] mysql:host=127.0.0.1;port=3306;dbname=h_sjds;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.001415s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.000711s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.036157s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.001546s ]
  6. SELECT * FROM `set` [ RunTime:0.015731s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.001609s ]
  8. SELECT * FROM `article` WHERE `id` = 476953 LIMIT 1 [ RunTime:0.000414s ]
  9. UPDATE `article` SET `lasttime` = 1775587340 WHERE `id` = 476953 [ RunTime:0.006454s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 64 LIMIT 1 [ RunTime:0.000271s ]
  11. SELECT * FROM `article` WHERE `id` < 476953 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.000527s ]
  12. SELECT * FROM `article` WHERE `id` > 476953 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.002702s ]
  13. SELECT * FROM `article` WHERE `id` < 476953 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.017769s ]
  14. SELECT * FROM `article` WHERE `id` < 476953 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.028636s ]
  15. SELECT * FROM `article` WHERE `id` < 476953 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.050536s ]
0.320963s