Texas Children's Fetal Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Pediatr Crit Care Med. 2012 Mar;13(2):188-90. doi: 10.1097/PCC.0b013e3182231060.
Neonates with an irreversible pulmonary dysplasia such as alveolar capillary dysplasia, surfactant protein deficiency, and pulmonary lymphangiectasis may have a deteriorating clinical course requiring cardiopulmonary support with extracorporeal membrane oxygenation. These neonates are often difficult to distinguish from those with persistent pulmonary hypertension of the newborn. The objective of this study was to identify clinical variables that distinguish infants with irreversible pulmonary dysplasia from those with persistent pulmonary hypertension of the newborn before, and while receiving, extracorporeal membrane oxygenation support.
A retrospective analysis of the Extracorporeal Life Support Registry from 2000 to 2010 was performed.
A total of 114 extracorporeal membrane oxygenation centers providing data to the Extracorporeal Life Support Registry.
All neonates day of life 0-31 reported to the Extracorporeal Life Support Registry with irreversible pulmonary dysplasia and persistent pulmonary hypertension of the newborn were identified.
None.
Patient demographics, pre-extracorporeal membrane oxygenation variables, and survival were analyzed. Univariate analysis was performed using Student's t test or Fisher's exact test, and variables found to be significant underwent multivariate analysis by logistic regression. Neonates with irreversible pulmonary dysplasia were placed on extracorporeal membrane oxygenation later (day of life 5.3 vs. 3.0, p = .045) and for a longer duration (11.1 vs. 6.8 days, p < .001) than those with persistent pulmonary hypertension of the newborn. Initiation of extracorporeal membrane oxygenation at day of life ≥5 (p = .026) and a duration of extracorporeal membrane oxygenation ≥10 days (p = .003) were independent predictors of irreversible pulmonary dysplasia by multivariate analysis. No differences in demographics, blood gas values, or vascular access were observed. Survival to discharge was significantly lower for neonates with irreversible pulmonary dysplasia (3%) vs. persistent pulmonary hypertension of the newborn (81%, p < .001).
Although neonates with irreversible pulmonary dysplasia and persistent pulmonary hypertension of the newborn have similar presentations, those with irreversible pulmonary dysplasia require extracorporeal membrane oxygenation support later in the perinatal period and for a longer duration. For neonates with a diagnosis of persistent pulmonary hypertension of the newborn, irreversible pulmonary dysplasia should be considered when extracorporeal membrane oxygenation is initiated on day of life ≥5 and/or the duration of extracorporeal membrane oxygenation ≥10 days.
患有肺泡毛细血管发育不良、表面活性蛋白缺乏和肺淋巴管扩张等不可逆性肺发育不良的新生儿可能会出现病情恶化，需要体外膜氧合心肺支持。这些新生儿通常很难与新生儿持续性肺动脉高压相区别。本研究的目的是在接受体外膜氧合支持之前和期间，确定可区分具有不可逆性肺发育不良的婴儿和具有持续性新生儿肺动脉高压的婴儿的临床变量。
对 2000 年至 2010 年期间的体外生命支持登记处进行了回顾性分析。
共有 114 个提供体外生命支持登记处数据的体外膜氧合中心。
所有报道至体外生命支持登记处的 0-31 天的患有不可逆性肺发育不良和持续性新生儿肺动脉高压的新生儿均被确定。
无。
分析患者的人口统计学特征、体外膜氧合前变量和存活率。使用学生 t 检验或 Fisher 精确检验进行单变量分析，对发现有意义的变量进行逻辑回归多变量分析。与患有持续性新生儿肺动脉高压的婴儿相比，患有不可逆性肺发育不良的婴儿接受体外膜氧合的时间较晚（第 5 天 vs. 第 3 天，p =.045），且持续时间更长（11.1 天 vs. 6.8 天，p <.001）。多变量分析显示，出生后第 5 天（p =.026）或体外膜氧合时间≥10 天（p =.003）开始体外膜氧合是不可逆性肺发育不良的独立预测因素。在人口统计学、血气值或血管通路方面均未观察到差异。不可逆性肺发育不良患儿的存活率明显低于持续性新生儿肺动脉高压患儿（3% vs. 81%，p <.001）。
尽管患有不可逆性肺发育不良和持续性新生儿肺动脉高压的新生儿表现相似，但前者在围产期后期和较长时间内需要体外膜氧合支持。对于诊断为持续性新生儿肺动脉高压的新生儿，如果在出生后第 5 天或体外膜氧合时间≥10 天开始体外膜氧合，应考虑不可逆性肺发育不良。
