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急性呼吸障碍早产儿早期血氧合与儿童发育的关联。

The association of early blood oxygenation with child development in preterm infants with acute respiratory disorders.

作者信息

Smith Karen E, Keeney Susan, Zhang Lifang, Perez-Polo J Regino, Rassin David K

机构信息

The University of Texas Medical Branch, Department of Neurology, Galveston, TX 77555-0319, USA.

出版信息

Int J Dev Neurosci. 2008 Feb;26(1):125-31. doi: 10.1016/j.ijdevneu.2007.09.006. Epub 2007 Sep 29.

Abstract

The potential negative impact of early blood oxygenation on development of specific cognitive and motor outcomes in children born at very low birth weight (VLBW; 1000-1500g) has not been examined even though these infants are exposed to varying durations and amounts of oxygen as part of their neonatal care. While this is the largest group of preterm infants, they receive much less research attention than extremely low birth weight infants (ELBW<1000g). Although neonatologists are questioning the routine use of oxygen therapy for all neonates, research has focused primarily on the more medically fragile ELBW infants. To date there are no systematic studies available to guide decision making for oxygen supplementation for a large segment of the preterm infant population. The aim of the present study was to determine if there is an association between blood oxygenation in the first 4h of life and specific cognitive and motor skills in preterm infants with acute respiratory disorders but no severe intracranial insult using a selected cohort from a longitudinal study children recruited in 1991 and 1992 designed to examine the role of biological immaturity as defined by gestational age and parenting in development. From this cohort, 55 children had acute respiratory disorders without severe intracranial insult. Of these, 35 children had at least one partial pressure of oxygen obtained from arterial blood (PaO2) during the first 4h of life as part of their clinical care. Higher early PaO2 values were associated with lower impulse control and attention skills in the elementary school age period. Models that were examined for relations between PaO2 values that also included birth weight and parenting quality across the first year of life revealed that higher PaO2 remained associated with impulse control but not attention skills. Birth weight was not associated with any outcomes. These results suggest that hyperoxia may be a risk factor for developmental problems that are not expressed until school age.

摘要

极低出生体重(VLBW;1000 - 1500克)儿在新生儿护理过程中会接触到不同时长和剂量的氧气,但早期血氧水平对其特定认知和运动发育结果的潜在负面影响尚未得到研究。尽管这是最大的一组早产儿群体,但与超低出生体重儿(ELBW<1000克)相比,他们受到的研究关注要少得多。虽然新生儿科医生对所有新生儿常规使用氧疗提出了质疑,但研究主要集中在医学上更脆弱的超低出生体重儿身上。迄今为止,尚无系统研究可用于指导大部分早产儿群体的氧疗决策。本研究的目的是,利用1991年和1992年招募的一个纵向研究队列中的特定亚组,确定出生后4小时内的血氧水平与患有急性呼吸系统疾病但无严重颅内损伤的早产儿的特定认知和运动技能之间是否存在关联,该队列研究旨在探讨胎龄和养育方式所定义的生物不成熟在发育中的作用。在这个队列中,55名儿童患有急性呼吸系统疾病且无严重颅内损伤。其中,35名儿童在出生后4小时内作为临床护理的一部分,至少有一次从动脉血中获取的氧分压(PaO2)测量值。较高的早期PaO2值与小学年龄段较低的冲动控制和注意力技能相关。对包括出生体重和一岁内养育质量在内的PaO2值之间关系进行检验的模型显示,较高的PaO2仍与冲动控制相关,但与注意力技能无关。出生体重与任何发育结果均无关联。这些结果表明,高氧血症可能是直到学龄期才表现出来的发育问题的一个风险因素。

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