Dept of Neonatology, Charité University Medical Center, Berlin, Germany.
Early Hum Dev. 2011 Oct;87(10):677-81. doi: 10.1016/j.earlhumdev.2011.05.008. Epub 2011 Jun 11.
In asphyxiated term and near-term infants, therapeutic hypothermia increases survival without neurologic morbidity, and extending this new treatment to preterm infants is being debated.
To investigate the association of low pH and base excess (BE) at birth or admission, as used as entry criteria in cooling trials, and evolving brain damage in preterm infants.
Rates of death and neurodevelopmental impairment at 12 and 20 months corrected age were assessed in a cohort of 1137 preterm infants with a gestational age <35 weeks and birth weight <1500 g in relation to severe perinatal acidosis (umbilical artery pH≤7.0, pH at admission ≤7.0, BE at admission ≤-16 mmol/l, lowest BE during first 12 h of life ≤-16 mmol/l).
Umbilical artery pH was not linked to death or neurodevelopmental impairment. There was only weak predictive power of pH or BE at admission for death (positive predictive values [PPV] 0.36/0.30, receiver operator characteristics [ROC] areas 0.591/0.701), and lowest 12-h BE for death or neurodevelopmental impairment at 12 or 20 months (PPV 0.29/0.30/0.27, ROC 0.720/0.656/0.658).
In very preterm infants, there is little association between laboratory markers of severe perinatal acidosis and neurodevelopmental outcome at 12 or 20 months.
在窒息和近足月的婴儿中，治疗性低温可提高生存率而不伴神经系统后遗症，目前正在争论是否将这种新的治疗方法扩展到早产儿。
研究出生时或入院时低 pH 值和碱剩余（BE）作为冷却试验纳入标准与早产儿进行性脑损伤的关系。
在一项包括 1137 名胎龄<35 周、出生体重<1500g 的早产儿队列中，评估了严重围产期酸中毒（脐动脉 pH 值≤7.0、入院时 pH 值≤7.0、入院时 BE 值≤-16mmol/l、出生后 12 小时内最低 BE 值≤-16mmol/l）与死亡率和神经发育障碍之间的关系，采用校正年龄 12 个月和 20 个月时的死亡和神经发育障碍发生率来评估。
脐动脉 pH 值与死亡或神经发育障碍无关。入院时 pH 值或 BE 值预测死亡率的能力较弱（阳性预测值[PPV]0.36/0.30，受试者工作特征[ROC]曲线下面积 0.591/0.701），12 小时内最低 BE 值预测死亡或神经发育障碍的能力在 12 个月或 20 个月时同样较弱（PPV 0.29/0.30/0.27，ROC 0.720/0.656/0.658）。
在极早产儿中，严重围产期酸中毒的实验室标志物与校正年龄 12 个月或 20 个月的神经发育结局之间关联较少。
