Olivier François, Nadeau Sophie, Caouette Georges, Piedboeuf Bruno
Service of Neonatology, Department of Pediatrics, CHU de Québec-Université Laval , Quebec, QC , Canada.
Front Pediatr. 2016 Sep 26;4:105. doi: 10.3389/fped.2016.00105. eCollection 2016.
Late preterm infants (34-36 weeks' gestation) remain a population at risk for apnea of prematurity (AOP). As infants affected by respiratory distress syndrome (RDS) have immature lungs, they might also have immature control of breathing. Our hypothesis is that an association exists between RDS and AOP in late preterm infants.
The primary objective of this study was to assess the association between RDS and AOP in late preterm infants. The secondary objective was to evaluate if an association exists between apparent RDS severity and AOP.
This retrospective observational study was realized in a tertiary care center between January 2009 and December 2011. Data from late preterm infants who presented an uncomplicated perinatal evolution, excepted for RDS, were reviewed. Information related to AOP and RDS was collected using the medical record. Odds ratios were calculated using a binary logistic regression adjusted for gestational age and sex.
Among the 982 included infants, 85 (8.7%) had an RDS diagnosis, 281 (28.6%) had AOP diagnosis, and 107 (10.9%) were treated with caffeine for AOP. There was a significant association between AOP treated with caffeine and RDS for all infants (OR = 3.3, 95% CI: 2.0-5.7). There was no association between AOP and RDS in 34 weeks infants [AOR: 1.6 (95% CI: 0.7-3.8)], but an association remains for 35 [AOR: 5.7 (95% CI: 2.5-13.4)] and 36 [OR = 7.8 (95% CI: 3.2-19.4)] weeks infants. No association was found between apparent RDS severity and AOP, regarding mean oxygen administration duration or complications associated with RDS.
The association between RDS and AOP in late preterm infants reflects that patients affected by RDS are not only presenting lung immaturity but also respiratory control immaturity. Special consideration should be given before discontinuing monitoring after RDS resolution in those patients.
晚期早产儿（妊娠34 - 36周）仍然是发生早产儿呼吸暂停（AOP）的高危人群。由于患有呼吸窘迫综合征（RDS）的婴儿肺部不成熟，他们对呼吸的控制可能也不成熟。我们的假设是晚期早产儿的RDS与AOP之间存在关联。
本研究的主要目的是评估晚期早产儿中RDS与AOP之间的关联。次要目的是评估明显的RDS严重程度与AOP之间是否存在关联。
这项回顾性观察研究于2009年1月至2011年12月在一家三级医疗中心开展。对除RDS外围产期情况无并发症的晚期早产儿的数据进行了回顾。使用病历收集与AOP和RDS相关的信息。使用针对胎龄和性别的二元逻辑回归计算比值比。
在纳入的982名婴儿中，85名（8.7%）被诊断为RDS，281名（28.6%）被诊断为AOP，107名（10.9%）因AOP接受了咖啡因治疗。所有婴儿中，接受咖啡因治疗的AOP与RDS之间存在显著关联（比值比 = 3.3，95%置信区间：2.0 - 5.7）。在34周的婴儿中，AOP与RDS之间无关联[调整后比值比：1.6（95%置信区间：0.7 - 3.8）]，但在35周[调整后比值比：5.7（95%置信区间：2.5 - 13.4）]和36周[比值比 = 7.8（95%置信区间：3.2 - 19.4）]的婴儿中仍存在关联。在平均吸氧持续时间或与RDS相关的并发症方面，未发现明显的RDS严重程度与AOP之间存在关联。
晚期早产儿中RDS与AOP之间的关联反映出受RDS影响的患者不仅存在肺部不成熟，还存在呼吸控制不成熟。对于这些患者，在RDS缓解后停止监测之前应给予特别考虑。
