大量胎母输血综合征致新生儿重度贫血临床救治分析

Clinical treatment analysis of severe neonatal anemia caused by massive fetomaternal hemorrhage

摘要

目的 分析大量胎母输血综合征(FMH)导致新生儿重度贫血的临床特点及诊治过程,以期提高对该疾病的认识及救治能力.方法 回顾分析2012年1月至2021年12月首都医科大学附属北京妇产医院新生儿重症监护病房(NICU)收治的大量FMH导致新生儿重度贫血病例的母婴基本情况、疾病进程、治疗经过及结局.结果 期间共39例孕妇确诊为大量FMH,发病率为0.28‰(39/140727);最终有16例因大量FMH致新生儿重度贫血患儿纳入研究,足月儿8例,早产儿8例.在16例大量FMH孕妇的临床表现中,胎心监护均显示异常,8例有胎动减少表现;对16例孕妇进行的Kleihauer-Betke酸洗脱试验(KB试验)中,14例为阳性,2例为阴性(KB试验值分别为2.3%和1.2%).在16例新生儿中,15例为急性剖宫产出生,1例自然分娩出生;新生儿出生后初始血红蛋白(Hb)为20~70g/L;15例出生后积极进行输血治疗,1例因家属放弃治疗未输血;其中4例合并新生儿颅内出血2级,2例合并重度新生儿血小板减少,1例合并失血性休克,1例合并胸腹腔积液和心力衰竭;有2例因家属考虑预后不良放弃治疗,其余14例均预后良好.结论 大量FMH是导致新生儿重度贫血的病因之一,在临床中应加强对孕妇胎动的评估及宣教,孕晚期及时进行胎心监护,及早发现、尽早处理大量FMH,以及新生儿紧急输血是改善围产期儿预后的关键.

Abstract

Objective To analyze the clinical characteristics, diagnosis and treatment of severe neonatal anemia caused by massive fetomaternal hemorrhage (FMH), aim to improve understanding and treatment capabilities of this disease. Methods We retrospectively analyzed the basic information, disease progression, treatment process, and outcomes of newborns with severe anemia due to massive FMH admitted to the neonatal intensive care unit (NICU) of Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from January 2012 to December 2021. Results During the study period, 39 pregnant women were diagnosed massive FMH, with an incidence rate of 0.28‰ (39/140,727). Ultimately, 16 newborns with severe anemia due to massive FMH were included in the study, including 8 full-term and 8 preterm infants. Among the clinical manifestations of the 16 pregnant women with massive FMH, 8 exhibited reduced fetal movements, and abnormal fetal heart monitoring was observed in all cases. Among the 16 pregnant women who underwent Kleihauer-Betke acid elution tests (KB tests), 14 were positive, and 2 were negative (with KB test values of 2.3% and 1.2%, respectively). Among the 16 newborns, 15 were born via emergency cesarean section, and 1 was delivered vaginally. Initial hemoglobin (Hb) levels at birth ranged from 20 to 70 g/L. 15 newborns received blood transfusion therapy after birth, while 1 did not due to treatment refusal by the family. Among them, 4 cases were complicated by grade 2 intracranial hemorrhage, 2 cases by severe neonatal thrombocytopenia, 1 case by hemorrhagic shock, and 1 case by pleural and abdominal effusion and heart failure. 2 cases discontinued treatment due to poor prognosis consideration by the family, while the remaining 14 cases had a good prognosis. Conclusion Massive FMH is one of the causes of severe anemia in newborns. Strengthening assessment and education on fetal movements in pregnant women, timely fetal heart monitoring in late pregnancy, early detection, and management of massive FMH, as well as emergency blood transfusion in newborns, are crucial for improving perinatal outcomes.

关键词

胎母输血综合征 / 新生儿贫血 / 输血 / 机械通气

Key words

fetomaternal hemorrhage / neonatal anemia / blood transfusion / mechanical ventilation

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