Weisz Dany E, Shivananda Sandesh, Asztalos Elizabeth, Yee Wendy, Synnes Anne, Lee Shoo K, Shah Prakesh S
Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada.
Department of Paediatrics, McMaster Children's Hospital, Hamilton, Canada.
Arch Dis Child Fetal Neonatal Ed. 2015 Jan;100(1):F59-65. doi: 10.1136/archdischild-2013-305884. Epub 2014 Sep 17.
To evaluate the association of intrapartum magnesium sulfate for fetal neuroprotection (MgSO4-FN) with the delivery room resuscitation and neonatal outcomes of preterm infants in an era of minimisation of invasive mechanical ventilation.
Retrospective cohort study.
Neonatal intensive care units in the Canadian Neonatal Network.
Preterm infants (23(0) to 31(6) weeks gestational age) born in 2011 or 2012. Resuscitation requirements and neonatal outcomes were compared between infants exposed and unexposed to intrapartum MgSO4-FN.
The primary outcome was a composite outcome of 'intensive resuscitation', defined as the need for intubation and ventilation or chest compressions or epinephrine administration in the delivery room. Secondary outcomes included mortality and major neonatal morbidities.
Of 6015 eligible infants, 1387 (23.1%) were exposed to intrapartum MgSO4-FN. Significantly fewer MgSO4-FN infants (41.0% vs 44.6%, p=0.02) required intensive resuscitation. However, after adjustment for confounders, this difference was no longer significant (adjusted OR (AOR) 0.88; 95% CI 0.66 to 1.17). Infants exposed to MgSO4-FN had decreased odds of death (AOR 0.61; 95% CI 0.40 to 0.94), but there was no difference in neonatal morbidities compared with the unexposed infants.
Intrapartum MgSO4 for fetal neuroprotection was not associated with an increased need for intensive delivery room resuscitation in this cohort of preterm infants.
在尽量减少有创机械通气的时代，评估产时硫酸镁用于胎儿神经保护（MgSO4-FN）与早产儿产房复苏及新生儿结局之间的关联。
回顾性队列研究。
加拿大新生儿网络中的新生儿重症监护病房。
2011年或2012年出生的早产儿（胎龄23(0)至31(6)周）。比较暴露于和未暴露于产时MgSO4-FN的婴儿的复苏需求及新生儿结局。
主要结局是“强化复苏”的复合结局，定义为在产房需要插管通气、胸外按压或使用肾上腺素。次要结局包括死亡率和主要新生儿疾病。
在6015名符合条件的婴儿中，1387名（23.1%）暴露于产时MgSO4-FN。需要强化复苏的MgSO4-FN婴儿明显更少（41.0%对44.6%，p = 0.02）。然而，在对混杂因素进行调整后，这种差异不再显著（调整后的比值比（AOR）为0.88；95%可信区间为0.66至1.17）。暴露于MgSO4-FN的婴儿死亡几率降低（AOR 0.61；95%可信区间为0.40至0.94），但与未暴露婴儿相比，新生儿疾病方面没有差异。
在这组早产儿中，产时使用硫酸镁进行胎儿神经保护与产房强化复苏需求增加无关。
