Burguet A, Pez O, Debaene B, Untersteller M, Bettinger G, Kayemba-Kays S, Thiriez G, Bouthet M-F, Sanyas P, Menget A, Mulin B, Maillet R, Boisselier P, Pierre F, Gouyon J-B
CIE1, Inserm, Centre d'Investigation Clinique, d'Epidémiologie Clinique et d'Essais Cliniques, Université de Bourgogne, CHRU de Dijon, 21000 Dijon, France.
Arch Pediatr. 2009 Dec;16(12):1547-53. doi: 10.1016/j.arcped.2009.09.011. Epub 2009 Oct 23.
To assess the risk of tracheal intubation at birth in very premature neonates related to the type of maternal anesthesia in case of elective cesarean.
All 219 live-born very premature neonates (28-32 weeks of gestation), delivered after an elective cesarean in the 27 maternity wards of 2 French semi-rural neonatal networks. Eighty-three percent (182/219) were delivered in level III maternity wards in university hospitals.
Of the very preterm neonates, 33.3% (73/219) were intubated in the delivery room, either for respiratory distress syndrome or a low APGAR score. Very preterm neonates delivered after maternal general anesthesia were more often intubated than those delivered after spinal anesthesia (48.7% vs 25.2%; OR: 2.8; 95% CI: 1.8-5.1). The risk of intubation related to maternal general anesthesia remained statistically significant after an adjustment for gestational age, fetal growth retardation, respiratory distress syndrome, type of maternity ward, and a propensity score that took into account maternal sociodemographic characteristics and the causes of very preterm birth (aOR: 3.4; 95% CI: 1.4-8.2). The risk of intubation related to general anesthesia was lower after adjusting for the 5-min APGAR score (aOR: 2.8; 95% CI: 1.0-7.3).
Very preterm neonates delivered after cesarean with general anesthesia require tracheal intubation in the delivery room more often than those delivered with spinal anesthesia. This study cannot assess a causal link between anesthesia and the need for neonatal intubation. However, neonatologists have to be aware of the type of maternal anesthesia because it may interfere with the non-invasive ventilation support policy of the very preterm neonate.
评估择期剖宫产时，极早产儿出生时气管插管的风险与产妇麻醉类型的关系。
法国两个半乡村新生儿网络的27个产科病房中，所有219例择期剖宫产后出生的存活极早产儿（孕28 - 32周）。83%（182/219）在大学医院的三级产科病房分娩。
在极早产儿中，33.3%（73/219）在产房进行了气管插管，原因是呼吸窘迫综合征或阿氏评分低。产妇全身麻醉后出生的极早产儿比脊髓麻醉后出生的更常需要插管（48.7%对25.2%；比值比：2.8；95%置信区间：1.8 - 5.1）。在对胎龄、胎儿生长受限、呼吸窘迫综合征、产科病房类型以及考虑产妇社会人口学特征和极早产原因的倾向评分进行调整后，与产妇全身麻醉相关的插管风险仍具有统计学意义（校正后比值比：3.4；95%置信区间：1.4 - 8.2）。在对5分钟阿氏评分进行调整后，与全身麻醉相关的插管风险降低（校正后比值比：2.8；95%置信区间：1.0 - 7.3）。
剖宫产并接受全身麻醉后出生的极早产儿在产房比接受脊髓麻醉后出生的极早产儿更常需要气管插管。本研究无法评估麻醉与新生儿插管需求之间的因果关系。然而，新生儿科医生必须了解产妇麻醉的类型，因为它可能会干扰极早产儿的无创通气支持策略。
