早产儿延迟脐带结扎与使用强心剂
Delayed cord clamping and inotrope use in preterm infants.
作者信息
Vesoulis Zachary A, Rhoades Janine, Muniyandi Pournika, Conner Shayna, Cahill Alison G, Mathur Amit M
机构信息
a Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics , Washington University School of Medicine , St. Louis , MO , USA.
b Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Washington University School of Medicine , St. Louis , MO , USA.
出版信息
J Matern Fetal Neonatal Med. 2018 May;31(10):1327-1334. doi: 10.1080/14767058.2017.1315663. Epub 2017 Apr 20.
OBJECTIVE
To evaluate the impact of delayed cord clamping (DCC) on need for inotropic support and mean arterial blood pressure (MABP).
METHODS
This is a single-center, prospective case-control study of premature infants, born <32 weeks gestation, who underwent DCC in comparison to a matched control group who underwent immediate cord clamping (ICC). The primary outcomes were the differences in MABP and inotropic medication used over the first week of life. Secondary outcomes included the admission hemoglobin, need for blood transfusion, and rates of intraventricular hemorrhage (IVH). Infants were matched on EGA, birth weight, sex, antenatal corticosteroid and magnesium exposure, and presence of chorioamnionitis.
RESULTS
Hundred and fifty-eight infants (DCC n = 79, ICC n = 79) were included. Demographic factors were similar between groups. DCC infants had a higher admission hemoglobin (p < .01), reduced incidence of high-grade IVH (p = .03), fewer median transfusions (p = .03), and were discharged at an earlier post-menstrual age (p = .04). When controlling for other factors, DCC was not associated with a reduction in inotrope use (p = .22) but was associated with a reduction in high-grade IVH (p = .01). There was no difference in MABP between the groups.
CONCLUSIONS
DCC is not associated with a reduction in the use of inotropes or a difference in MABP.
目的
评估延迟脐带结扎（DCC）对使用血管活性药物支持的需求及平均动脉血压（MABP）的影响。
方法
这是一项针对孕周小于32周的早产儿的单中心前瞻性病例对照研究，将接受DCC的婴儿与接受即刻脐带结扎（ICC）的匹配对照组进行比较。主要结局是出生后第一周内MABP和使用血管活性药物的差异。次要结局包括入院时血红蛋白水平、输血需求及脑室内出血（IVH）发生率。根据估计孕周（EGA）、出生体重、性别、产前使用糖皮质激素和镁的情况以及绒毛膜羊膜炎的存在对婴儿进行匹配。
结果
共纳入158例婴儿（DCC组n = 79，ICC组n = 79）。两组间人口统计学因素相似。DCC组婴儿入院时血红蛋白水平较高（p < 0.01），重度IVH发生率较低（p = 0.03），输血中位数较少（p = 0.03），且在月经龄较小的时候出院（p = 0.04）。在控制其他因素后，DCC与血管活性药物使用减少无关（p = 0.22），但与重度IVH减少有关（p = 0.01）。两组间MABP无差异。
结论
DCC与血管活性药物使用减少或MABP差异无关。
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