Henderson-Smart D J, Osborn D A
NSW Centre for Perinatal Health Services Research, Queen Elizabeth II Institute for Mothers and Infants, Building DO2, University of Sydney, Sydney, NSW, Australia, 2006.
Cochrane Database Syst Rev. 2000;2002(2):CD000373. doi: 10.1002/14651858.CD000373.
Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia, which may be severe enough to require resuscitation including use of positive pressure ventilation or other treatments. Physical stimulation is often used to restart breathing and it is possible that repeated stimulation, such as with an oscillating mattress (kinesthetic stimulation), might prevent apnea and its consequences.
In preterm infants at risk for apnea, does prophylactic use of kinesthetic stimulation lead to a clinically important reduction in apnea and bradycardia, and use of intemittent positive preswsure ventilation (IPPV).
The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language.
All trials in preterm infants at risk of developing clinical apnea which utilised random or quasi-random allocation to treatment with an oscillating mattress or control, were eligible.
Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality and data extraction by each author and synthesis of the data using relative risk.
There were no differences in short term effects (apnea /bradycardia, IVH, use of IPPV, sleep/wake cycles and neurological status at discharge) or longterm effects (in one trial - growth and development to one year).
REVIEWER'S CONCLUSIONS: Implications for practice. Prophylactic use of kinesthetic stimulation cannot be recommended to reduce apnea/bradycardia in preterm infants. Implications for research. There are currently no clear research questions regarding prophylactic use of kinesthetic stimulation to prevent apnea in preterm infants.
反复呼吸暂停在早产儿中很常见，尤其是在极早孕期。这些有效呼吸丧失的发作可导致低氧血症和心动过缓，严重程度可能足以需要复苏，包括使用正压通气或其他治疗。物理刺激常被用于恢复呼吸，反复刺激，如使用振荡床垫（动觉刺激），有可能预防呼吸暂停及其后果。
对于有呼吸暂停风险的早产儿，预防性使用动觉刺激是否能在临床上显著减少呼吸暂停和心动过缓以及间歇性正压通气（IPPV）的使用。
采用了新生儿综述组的标准检索策略。这包括检索牛津围产期试验数据库、Cochrane对照试验注册库、MEDLINE、以前的综述，包括交叉参考文献、摘要、会议和专题讨论会记录、专家提供的信息，主要以英文进行期刊手工检索。
所有针对有发生临床呼吸暂停风险的早产儿进行的试验，采用随机或半随机分配接受振荡床垫治疗或对照，均符合条件。
采用Cochrane协作网及其新生儿综述组的标准方法，每位作者分别对试验质量进行评估和数据提取，并使用相对风险对数据进行综合分析。
在短期效应（呼吸暂停/心动过缓、脑室内出血、IPPV的使用、出院时的睡眠/觉醒周期和神经状态）或长期效应（一项试验中——至一岁时的生长发育）方面没有差异。
对实践的影响。不建议预防性使用动觉刺激来减少早产儿的呼吸暂停/心动过缓。对研究的影响。目前关于预防性使用动觉刺激来预防早产儿呼吸暂停没有明确的研究问题。
