Ohio Perinatal Research Network, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, 700 Children's Drive, Research Building III, WB 5245, Columbus, OH 43205, USA.
Eur J Pediatr. 2013 Sep;172(9):1173-80. doi: 10.1007/s00431-013-2016-5. Epub 2013 May 5.
We tested the hypothesis that the use of supplemental oxygen (sO2) at discharge from the NICU in extremely preterm neonates is associated with a greater risk of neurodevelopmental impairment (NDI) at 18 months corrected gestational age (CGA) than the risk of NDI of those neonates discharged in room air. Four hundred twenty-four charts were retrospectively reviewed from infants born at <27 weeks and transferred to Nationwide Children's Hospital from December 1, 2004 to June 14, 2010. Use of sO2 was evaluated on day of life (dol) 28, at 36 weeks post-menstrual age (PMA), and at discharge. Logistic regression was used to identify postnatal risk factors associated with sO2 at discharge and NDI. At dol 28, 96 % of surviving patients received sO2, and therefore had bronchopulmonary dysplasia (BPD) by definition from a National Institutes of Child Health and Human Development workshop. At 36 weeks PMA, 89 % continued on sO2 (moderate/severe BPD), and at discharge, 74 % continued on sO2. When factors associated with NDI were examined, the need for mechanical ventilation ≥28 days (adjOR = 3.21, p = 0.01), grade III-IV intraventricular hemorrhage (IVH) (adjOR = 4.61, p < 0.01), and discharge at >43 weeks PMA (adjOR = 2.12, p = 0.04) were the strongest predictors of NDI at 18 months CGA. There was no difference in Bayley Scales of Infant Development, third edition composite scores between patients with no/mild BPD and patients with moderate/severe BPD (cognitive p = 0.60, communication p = 0.53, motor p = 0.19) or those scores between patients on and off oxygen at discharge (cognitive p = 0.58, communication p = 0.70, motor p = 0.62).
The need for sO2 at discharge is not associated with an increased risk of NDI in these patients. The strongest predictors of poor neurodevelopmental outcome in this population were prolonged positive pressure support, grade III-IV IVH, and discharge at >43 weeks PMA.
本研究旨在检验如下假设，即与在室温空气中出院的早产儿相比，极低出生体重儿在新生儿重症监护病房（NICU）出院时使用补充氧气（sO2）与 18 个月校正胎龄（CGA）时神经发育障碍（NDI）的风险增加有关。
回顾性分析 2004 年 12 月 1 日至 2010 年 6 月 14 日期间从 Nationwide Children's Hospital 转入的胎龄<27 周的婴儿的 424 份病历。sO2 的使用情况在出生后第 28 天（dol）、胎龄 36 周（PMA）和出院时进行评估。使用逻辑回归来确定与出院时 sO2 和 NDI 相关的产后危险因素。在 dol 28 时，96%的存活患儿接受了 sO2 治疗，因此根据美国国立儿童健康与人类发育研究所的研讨会定义患有支气管肺发育不良（BPD）。在 36 周 PMA 时，89%的患儿继续使用 sO2（中重度 BPD），而在出院时，74%的患儿继续使用 sO2。当检查与 NDI 相关的因素时，需要机械通气≥28 天（调整后的优势比[adjOR] = 3.21，p = 0.01）、III-IV 级脑室内出血（IVH）（adjOR = 4.61，p<0.01）和>43 周 PMA 出院（adjOR = 2.12，p = 0.04）是 18 个月 CGA 时 NDI 的最强预测因素。无/轻度 BPD 患儿与中重度 BPD 患儿之间（认知 p = 0.60，交流 p = 0.53，运动 p = 0.19）或出院时吸氧与不吸氧患儿之间（认知 p = 0.58，交流 p = 0.70，运动 p = 0.62）的贝利婴儿发展量表第三版综合评分无差异。
在这些患者中，出院时需要 sO2 与 NDI 风险增加无关。该人群神经发育结局不良的最强预测因素是长时间的正压通气支持、III-IV 级 IVH 和>43 周 PMA 出院。
