Investigation Of The Correlation Between Hemoglobin,anemia,blood Transfusion And Retinopathy Of Prematurity

Objective:To explore the correlation between hemoglobin,anemia,blood transfusion and the occurrence and progression of retinopathy of prematurity,so as to explore the risk factors of ROP and provide help for clinical prevention and treatment.Methods:This study was a retrospective case cohort study,which selected premature infants admitted to the neonatal department of the First Affiliated Hospital of Anhui Medical University from January 2015 to June 2019 who received regular fundus screening.According to the inclusion and exclusion criteria,a total of 465 premature infants were included in the study.According to the screening results,the examined premature infants were divided into the ROP-free group,the mild group and the severe group.Among them,328 cases of the former,accounting for 70.5% of the examined premature infants,101 cases of the mild group,accounting for 21.7%,and 36 cases of the severe ROP group(7.8%).All hemoglobin counts during treatment were collected,average weekly hemoglobin levels were calculated for each premature infant,and the date and number of transfusions were recorded.Univariate analysis of variance,Mann-Whitney U test,chi-square test,LSD method and limited cubic spline analysis of dose-response relationship were used to analyze the data statistically.Results:(1)Three groups of prematurity at birth,postnatal 1 and 5 weeks per week on average hemoglobin level differences statistically significant(P = 0.019,0.001 and 0.021)further found two more line,1 day and 1 week after birth after birth,mild and non ROP group and severe ROP than hemoglobin levels were statistically significant difference(P = 0.012,0.006,< 0.001,0.009);At 5 weeks postpartum,there was a statistically significant difference in hemoglobin level between the ROP-free group and the mild and severe ROP groups(P values were 0.035 and 0.029,respectively).(2)With the increase of hemoglobin level at birth(120-220g/L),the risk of severe ROP increased linearly(P=0.5301).At the first week after birth,there was a "U"-shaped curve relationship between hemoglobin level and the risk of severe ROP(P= 0.0349),and a positive correlation between low hemoglobin level(<135g/L)and the risk of severe ROP.The correlation direction changed between 135 and 145g/L,and the higher the hemoglobin level,the greater the risk of severe ROP.At the 5th week after birth,the risk of mild ROP increased linearly with the increase of hemoglobin level(60-140g/L)(P=0.6610).When hemoglobin was <100g/L,the risk of severe ROP was positively correlated with hemoglobin,but when hemoglobin level was >140g/L,the risk of severe ROP showed a downward trend with the increase of hemoglobin level,although statistical analysis did not observe a significant inverted u-shaped curve(P=0.4180)between the two.(3)Comparison between the mild group and the ROP-free group: At the first and second weeks after birth,the number of blood transfusions in the mild group was higher than that in the ROP-free group,and the difference was statistically significant(P =0.026,0.026,);however,the number of anemia in the first two weeks after birth was not statistically significant between the two groups.At 5 weeks after birth,there were statistically significant differences in the number of anemia patients and the number of blood transfusions between the two groups(P= 0.020,0.015),and anemia was a protective factor of ROP(OR(95%CI)0.580(0.341-0.989)).However,after multi-factor adjustment,there was no statistically significant difference between the two groups.Comparison between the severe group and the ROP-free group: At the first week after birth,the number of anemia patients in the severe group was significantly higher than that in the ROP-free group(P < 0.001).Anemia was a risk factor for ROP.From 2 weeks to 4 weeks after birth,the number of blood transfusions between the two groups was statistically significant,and the number of blood transfusions was mostly a risk factor for severe ROP.At the fifth week after birth,the number of anemia patients in the severe group was less than that in the ROP free group,and the difference was not statistically significant,but the correlation was significantly stronger than that in the first two weeks.Similarly,after multi-factor adjustment,there was no statistically significant difference between the two.Conclusions:The relationship between hemoglobin and ROP cannot be simply attributed to protective or risk factors,but may be curvy.Anemia is not simply attributable to the occurrence and progression of ROP protection or risk factors,but should be judged according to the period;In clinical treatment,for premature infants with frequent blood transfusions,eye screening should be performed actively to timely find reasonable treatment for mild ROP and avoid the occurrence of severe ROP as much as possible.