Abman S H, Burchell M F, Schaffer M S, Rosenberg A A
Department of Pediatrics, University of Colorado School of Medicine, Denver.
Am J Dis Child. 1989 Jul;143(7):815-9. doi: 10.1001/archpedi.1989.02150190065022.
To determine the relative contribution of sudden death as a cause of late inpatient mortality in newborns after prolonged mechanical ventilation, we reviewed the charts of 348 patients who received ventilation assistance and who were admitted to the neonatal intensive care unit during a 26-month period. The overall mortality rate for these patients was 25%, with 88% (77/88) of these deaths occurring within 30 days of birth. Eleven infants died after more than 60 days of mechanical ventilation. Seven of these late deaths were sudden, unexpected in-hospital deaths. Sudden deaths occurred at a mean (uncorrected) age of 12 months (range, 4 to 27 months), during periods when infants appeared to be stable or clinically improving, were unrelated to recent respiratory exacerbations, and occurred despite prompt resuscitative efforts. Four infants still required mechanical ventilation, and 4 had tracheostomies at the time of death. All of the infants had chronic hypercarbia (greater than 50 mm Hg) and an elevated serum bicarbonate level (greater than 30 mmol/L), but not hyponatremia, hypochloremia (less than 80 mmol/L), or alkalemia. Left and right ventricular hypertrophy, multiple drug therapy, recurrent cyanotic episodes, and frequent unexplained fevers were common. In comparison with 17 bronchopulmonary dysplasia survivors who required longer than 60 days of ventilation therapy, the late deaths group more frequently had left ventricular hypertrophy and received prolonged combination theophylline anhydrous and beta-adrenergic agonist therapy. We report that sudden death can occur in infants with severe bronchopulmonary dysplasia despite in-hospital cardiopulmonary monitoring and the rapid institution of cardiopulmonary resuscitation, and is a significant cause of late mortality in infants who receive ventilation therapy for longer than 2 months.
为了确定在长时间机械通气后新生儿晚期住院死亡率中猝死作为死因的相对贡献，我们回顾了348例接受通气辅助并在26个月期间入住新生儿重症监护病房的患者病历。这些患者的总体死亡率为25%，其中88%（77/88）的死亡发生在出生后30天内。11例婴儿在机械通气超过60天后死亡。其中7例晚期死亡为猝死，是意外的院内死亡。猝死发生时的平均（未校正）年龄为12个月（范围4至27个月），发生在婴儿看似稳定或临床状况正在改善的时期，与近期呼吸加重无关，且尽管进行了及时的复苏努力仍发生了死亡。4例婴儿死亡时仍需要机械通气，4例有气管造口术。所有婴儿均有慢性高碳酸血症（大于50 mmHg）和血清碳酸氢盐水平升高（大于30 mmol/L），但无低钠血症、低氯血症（小于80 mmol/L）或碱血症。左心室和右心室肥厚、多种药物治疗、反复发绀发作和频繁不明原因发热很常见。与17例需要通气治疗超过60天的支气管肺发育不良幸存者相比，晚期死亡组左心室肥厚更为常见，且接受了更长时间的无水茶碱和β-肾上腺素能激动剂联合治疗。我们报告，尽管进行了院内心肺监测并迅速实施了心肺复苏，但严重支气管肺发育不良的婴儿仍可能发生猝死，并且是接受通气治疗超过2个月的婴儿晚期死亡的一个重要原因。
