Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Pediatrics, Rocky Mountain Hospital for Children, Denver, Colorado, USA.
Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina, USA.
Arch Dis Child Fetal Neonatal Ed. 2014 Jul;99(4):F263-8. doi: 10.1136/archdischild-2013-304179. Epub 2014 Feb 19.
To test the hypothesis that acidosis at birth is associated with the combined primary outcome of death or neurodevelopmental impairment (NDI) in extremely low birthweight (ELBW) infants, and to develop a predictive model of death/NDI exploring perinatal acidosis as a predictor variable.
The study population consisted of ELBW infants born between 2002 and 2007 at National Institute of Child Health and Development (NICHD) Neonatal Research Network hospitals. Infants with cord blood gas data and documentation of either mortality prior to discharge or 18-22 month neurodevelopmental outcomes were included. Multiple logistic regression analysis was used to determine the contribution of perinatal acidosis, defined as a cord blood gas with a pH<7 or base excess (BE) <-12, to death/NDI in ELBW infants. In addition, a multivariable model predicting death/NDI was developed.
3979 patients were identified of whom 249 had a cord gas pH<7 or BE<-12 mEq/L. 2124 patients (53%) had the primary outcome of death/NDI. After adjustment for confounding variables, pH<7 and BE<-12 mEq/L were each significantly associated with death/NDI (OR=2.5 (1.6, 4.2) and OR=1.5 (1.1, 2.0), respectively). However, inclusion of pH or BE did not improve the ability of the multivariable model to predict death/NDI.
Perinatal acidosis is significantly associated with death/NDI in ELBW infants. Perinatal acidosis is infrequent in ELBW infants, however, and other factors are more important in predicting death/NDI.
验证出生时酸中毒与极低出生体重儿（ELBW）死亡或神经发育障碍（NDI）复合主要结局相关的假设，并建立一个探索围产期酸中毒作为预测变量的死亡/NDI 预测模型。
研究人群由 2002 年至 2007 年在国家儿童健康与发展研究所（NICHD）新生儿研究网络医院出生的 ELBW 婴儿组成。纳入有脐血血气数据和出院前死亡或 18-22 个月神经发育结果记录的婴儿。采用多因素逻辑回归分析确定围产期酸中毒（定义为脐血血气 pH 值<7 或碱剩余（BE）<-12）对 ELBW 婴儿死亡/NDI 的影响。此外，还建立了预测死亡/NDI 的多变量模型。
共确定 3979 例患者，其中 249 例有脐动脉血气 pH 值<7 或 BE 值<-12mEq/L。2124 例（53%）患者的主要结局为死亡/NDI。调整混杂变量后，pH 值<7 和 BE 值<-12mEq/L 均与死亡/NDI 显著相关（OR=2.5（1.6，4.2）和 OR=1.5（1.1，2.0））。然而，pH 值或 BE 值的纳入并不能提高多变量模型预测死亡/NDI 的能力。
围产期酸中毒与 ELBW 婴儿的死亡/NDI 显著相关。然而，ELBW 婴儿的围产期酸中毒并不常见，其他因素在预测死亡/NDI 中更为重要。
