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持续性呼吸暂停对早产儿脑氧合的纵向影响。

The Longitudinal Effects of Persistent Apnea on Cerebral Oxygenation in Infants Born Preterm.

作者信息

Horne Rosemary S C, Fung Annie C H, NcNeil Scott, Fyfe Karinna L, Odoi Alexsandria, Wong Flora Y

机构信息

The Ritchie Center, Hudson Institute of Medical Research and Department of Pediatrics, Monash University, Melbourne, Australia.

Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China.

出版信息

J Pediatr. 2017 Mar;182:79-84. doi: 10.1016/j.jpeds.2016.11.081. Epub 2017 Jan 4.

Abstract

OBJECTIVE

To assess the incidence and impact of persistent apnea on heart rate (HR), oxygen saturation (SpO), and brain tissue oxygenation index (TOI) over the first 6 months after term equivalent age in ex-preterm infants.

STUDY DESIGN

Twenty-four preterm infants born between 27 and 36 weeks of gestational age were studied with daytime polysomnography at 2-4 weeks, 2-3 months, and 5-6 months post-term corrected age. Apneas lasting ≥3 seconds were included and maximal percentage changes (nadir) in HR, SpO and tissue oxygenation index (TOI, NIRO-200 Hamamatsu) from baseline were analyzed.

RESULTS

A total of 253 apneas were recorded at 2-4 weeks, 203 at 2-3 months, and 148 at 5-6 months. There was no effect of gestational age at birth, sleep state, or sleep position on apnea duration, nadir HR, SpO, or TOI. At 2-4 weeks, the nadirs in HR (-11.1 ± 1.2 bpm) and TOI (-4.4 ± 1.0%) were significantly less than at 2-3 months (HR: -13.5 ± 1.2 bpm, P < .05; TOI: -7.5 ± 1.1 %, P < .05) and at 5-6 months (HR: -13.2 ± 1.3 bpm, P < .01; TOI: -9.3 ± 1.2%, P < .01).

CONCLUSIONS

In ex-preterm infants, apneas were frequent and associated with decreases in heart rate and cerebral oxygenation, which were more marked at 2-3 months and 5-6 months than at 2-4 weeks. Although events were short, they may contribute to the adverse neurocognitive outcomes that are common in ex-preterm children.

摘要

目的

评估晚期早产儿在足月等效年龄后的前6个月内持续性呼吸暂停对心率(HR)、血氧饱和度(SpO)和脑组织氧合指数(TOI)的发生率及影响。

研究设计

对24例胎龄在27至36周之间出生的早产儿,在矫正胎龄2 - 4周、2 - 3个月和5 - 6个月时进行白天多导睡眠图检查。纳入持续时间≥3秒的呼吸暂停,分析HR、SpO和组织氧合指数(TOI,滨松NIRO - 200)相对于基线的最大百分比变化(最低点)。

结果

在2 - 4周记录到253次呼吸暂停,2 - 3个月记录到203次,5 - 6个月记录到148次。出生胎龄、睡眠状态或睡眠姿势对呼吸暂停持续时间、最低心率、SpO或TOI均无影响。在2 - 4周时,HR(-11.1±1.2次/分)和TOI(-4.4±1.0%)的最低点显著低于2 - 3个月时(HR:-13.5±1.2次/分,P <.05;TOI:-7.5±1.1%,P <.05)和5 - 6个月时(HR:-13.2±1.3次/分,P <.01;TOI:-9.3±1.2%,P <.01)。

结论

在晚期早产儿中,呼吸暂停频繁发生,并伴有心率和脑氧合下降,在2 - 3个月和5 - 6个月时比2 - 4周时更明显。尽管这些事件持续时间较短,但它们可能导致晚期早产儿常见的不良神经认知结局。

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