Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA 19104, USA.
J Pediatr. 2011 Oct;159(4):546-50.e1. doi: 10.1016/j.jpeds.2011.03.025. Epub 2011 May 17.
To examine the relationships between intensity of delivery room resuscitation and short- and long-term outcomes of very low birth weight infants enrolled in the Caffeine for Apnea of Prematurity (CAP) Trial.
The CAP Trial enrolled 2006 infants with birthweights between 500 and 1250 g who were eligible for caffeine therapy. All levels of delivery room resuscitation were recorded in study participants. We divided infants in 4 groups of increasing intensity of resuscitation: minimal, n = 343; bag-mask ventilation, n = 372; endotracheal intubation, n = 1205; and cardiopulmonary resuscitation (chest compressions/epinephrine), n = 86. We used multivariable logistic regression models to compare outcomes across the 4 groups.
The observed rates of death or disability, death, cerebral palsy, cognitive deficit, and hearing loss at 18 months increased with higher levels of resuscitation. Risk of bronchopulmonary dysplasia, severe retinopathy of prematurity, and brain injury also increased with higher levels of resuscitation. Adjustment for prognostic variables reduced the differences between the groups for most outcomes. Only the adjusted rates of bronchopulmonary dysplasia and severe retinopathy remained significantly higher after more intense resuscitation.
In CAP Trial participants, the risk of death or neurodevelopmental disability at 18 months did not increase substantially with increasing intensity of delivery room resuscitation.
研究产房复苏强度与参加早产儿咖啡因治疗（CAP）试验的极低出生体重儿短期和长期结局的关系。
CAP 试验纳入了出生体重在 500 至 1250 克之间、有接受咖啡因治疗资格的 2006 名婴儿。研究参与者的所有产房复苏水平均有记录。我们将婴儿分为复苏强度递增的 4 组：最低限度复苏组（n=343）、气囊面罩通气组（n=372）、气管插管组（n=1205）和心肺复苏组（胸外按压/肾上腺素）（n=86）。我们使用多变量逻辑回归模型比较了 4 组的结局。
观察到的死亡率或残疾率、死亡率、脑瘫、认知缺陷和 18 个月时听力损失的发生率随着复苏强度的增加而增加。支气管肺发育不良、严重早产儿视网膜病变和脑损伤的风险也随着复苏强度的增加而增加。调整预后变量后，大多数结局的组间差异有所缩小。只有在更强烈的复苏后，支气管肺发育不良和严重早产儿视网膜病变的调整发生率仍显著升高。
在 CAP 试验参与者中，18 个月时的死亡率或神经发育残疾风险并未随着产房复苏强度的增加而显著增加。
