新生儿复苏期间持续肺膨胀对早产儿脑血容量有影响吗？一项随机对照试验性研究。
Do Sustained Lung Inflations during Neonatal Resuscitation Affect Cerebral Blood Volume in Preterm Infants? A Randomized Controlled Pilot Study.
作者信息
Schwaberger Bernhard, Pichler Gerhard, Avian Alexander, Binder-Heschl Corinna, Baik Nariae, Urlesberger Berndt
机构信息
Research Unit for Cerebral Development and Oximetry, Medical University of Graz, Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Medical University of Graz, Graz, Austria; Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria.
Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
出版信息
PLoS One. 2015 Sep 25;10(9):e0138964. doi: 10.1371/journal.pone.0138964. eCollection 2015.
BACKGROUND
Sustained lung inflations (SLI) during neonatal resuscitation may promote alveolar recruitment in preterm infants. While most of the studies focus on respiratory outcome, the impact of SLI on the brain hasn't been investigated yet.
OBJECTIVE
Do SLI affect cerebral blood volume (CBV) in preterm infants?
METHODS
Preterm infants of gestation 28 weeks 0 days to 33 weeks 6 days with requirement for respiratory support (RS) were included in this randomized controlled pilot trial. Within the first 15 minutes after birth near-infrared spectroscopy (NIRS) measurements using 'NIRO-200-NX' (Hamamatsu, Japan) were performed to evaluate changes in CBV and cerebral tissue oxygenation. Two groups were compared based on RS: In SLI group RS was given by applying 1-3 SLI (30 cmH2O for 15 s) continued by respiratory standard care. Control group received respiratory standard care only.
RESULTS
40 infants (20 in each group) with mean gestational age of 32 weeks one day (±2 days) and birth weight of 1707 (±470) g were included. In the control group ΔCBV was significantly decreasing, whereas in SLI group ΔCBV showed similar values during the whole period of 15 minutes. Comparing both groups within the first 15 minutes ΔCBV showed a tendency toward different overall courses (p = 0.051).
CONCLUSION
This is the first study demonstrating an impact of SLI on CBV. Further studies are warranted including reconfirmation of the present findings in infants with lower gestational age. Future investigations on SLI should not only focus on respiratory outcome but also on the consequences on the developing brain.
TRIAL REGISTRATION
German Clinical Trials Register DRKS00005161 https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do.
背景
新生儿复苏期间的持续肺膨胀（SLI）可能促进早产儿的肺泡复张。虽然大多数研究关注呼吸结局，但SLI对大脑的影响尚未得到研究。
目的
SLI是否会影响早产儿的脑血容量（CBV）？
方法
本随机对照试验纳入了妊娠28周0天至33周6天且需要呼吸支持（RS）的早产儿。在出生后的前15分钟内，使用“NIRO-200-NX”（日本滨松）进行近红外光谱（NIRS）测量，以评估CBV和脑组织氧合的变化。根据RS将两组进行比较：SLI组通过应用1-3次SLI（30 cmH₂O持续15秒）给予RS，然后进行呼吸标准护理。对照组仅接受呼吸标准护理。
结果
纳入了40例婴儿（每组20例），平均胎龄为32周1天（±2天），出生体重为1707（±470）g。在对照组中，CBV显著下降，而在SLI组中，CBV在整个15分钟期间显示出相似的值。在最初的15分钟内比较两组，CBV显示出总体变化趋势不同的倾向（p = 0.051）。
结论
这是第一项证明SLI对CBV有影响的研究。有必要进行进一步的研究，包括在胎龄较小的婴儿中重新确认本研究结果。未来对SLI的研究不仅应关注呼吸结局，还应关注对发育中大脑的影响。
试验注册
德国临床试验注册中心DRKS00005161 https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do 。
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