Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia.
Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia; Robinson Institute, University of Adelaide, Adelaide, SA, Australia.
J Pediatr. 2014 Mar;164(3):475-80.e1. doi: 10.1016/j.jpeds.2013.10.041. Epub 2013 Dec 19.
To evaluate the relationship between cerebral fractional tissue oxygen extraction (cFTOE), a measure of oxygen delivery-consumption equilibrium, and the risk of early poor outcome in very preterm infants.
Cerebral blood flow, tissue oxygenation index (by near-infrared spectroscopy), and arterial oxygen content were measured, and cerebral oxygen delivery, consumption, and cFTOE were calculated at 3 intervals in the first 72 hours of life in infants ≤ 30 weeks gestational age (GA). A receiver operating characteristic curve was derived with an a priori defined dichotomized outcome of good or poor, defined as death or sonographic brain injury (grade ≥ II intraventricular hemorrhage) by day 7.
Seventy-one infants were enrolled, with a mean (SD) GA of 27 (2) weeks. cFTOE demonstrated better discrimination for the study outcome at <24 hours of age than at 48 or 72 hours of age (P = .01). The area under the curve for cFTOE at the initial measurement was no different from that for GA alone (0.87; 95% CI, 0.77-0.95 vs 0.81; 95% CI, 0.69-0.92), but the combined measure of cFTOE and GA had better discrimination (0.96; 95% CI, 0.91-1.0) than either cFTOE (P = .03) or GA (P = .016) alone. A cFTOE of 0.4 had a sensitivity of 82% and specificity of 75% for risk of early poor outcome.
Elevated cFTOE values are associated with increased risk of early poor outcome in very preterm infants. Its predictive value is further improved with the addition of GA.
评估脑氧摄取分数（cFTOE），一种衡量氧输送-消耗平衡的指标，与极早产儿早期不良结局风险之间的关系。
对胎龄≤30 周的婴儿在生命最初 72 小时内的 3 个时间间隔内测量脑血流、组织氧指数（近红外光谱法）和动脉氧含量，并计算脑氧输送、消耗和 cFTOE。根据预先定义的良好或不良结局的二分类结果（定义为第 7 天死亡或超声脑损伤（脑室内出血 II 级及以上）），得出接受者操作特征曲线。
共纳入 71 例婴儿，平均胎龄（标准差）为 27（2）周。cFTOE 在生后<24 小时比 48 小时或 72 小时对研究结局的区分度更好（P =.01）。初始测量时 cFTOE 的曲线下面积与单独胎龄的差异无统计学意义（0.87；95%CI，0.77-0.95 与 0.81；95%CI，0.69-0.92），但 cFTOE 和胎龄联合测量的区分度优于 cFTOE（P =.03）或胎龄（P =.016）单独测量。cFTOE 为 0.4 时，早期不良结局风险的敏感性为 82%，特异性为 75%。
极早产儿 cFTOE 值升高与早期不良结局风险增加相关。与单独胎龄相比，其预测价值随着胎龄的增加而进一步提高。
