Vliegenthart Roseanne J S, Onland Wes, van Wassenaer-Leemhuis Aleid G, De Jaegere Anne P M, Aarnoudse-Moens Cornelieke S H, van Kaam Anton H
Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Neonatology. 2017;112(2):172-179. doi: 10.1159/000471841. Epub 2017 Jun 10.
Restrictive use of invasive mechanical ventilation (IMV) in preterm infants reduces the risk of bronchopulmonary dysplasia (BPD). Our objective was to determine its effect on neurodevelopmental impairment (NDI) at 24 months' corrected age (CA).
This retrospective single-center cohort study included all patients with a gestational age <30 weeks born in 2004/2005 (epoch 1) and 2010/2011 (epoch 2). In epoch 2, we introduced a policy of restriction on IMV and liberalized the use of respiratory stimulants in the delivery room and neonatal intensive care. Data on patient characteristics, respiratory management, short-term outcomes, mortality, BPD, and NDI at 24 months' CA were collected.
Four hundred and four preterm infants were included. Compared to those in epoch 1, infants in epoch 2 were less likely to be intubated and the duration of IMV was shorter. Other noninvasive adjuvant therapies such as caffeine, doxapram, and nasal ventilation were more often used during epoch 2. There was a trend to less BPD in epoch 2 compared to epoch 1 (17 vs. 23%, adjusted OR = 0.75, 95% CI: 0.48, 1.16). Mortality did not change over time. The combined outcome death or NDI at 24 months' CA was significantly lower in epoch 2 compared to epoch 1 (24.7 vs. 33.9%, adjusted OR = 0.71, 95% CI: 0.53, 0.97).
Restricted use of IMV is feasible in preterm infants and might be associated with a reduced risk of the combined outcome death or NDI at 24 months' CA. Larger studies are needed to confirm these findings.
限制对早产儿使用有创机械通气（IMV）可降低支气管肺发育不良（BPD）的风险。我们的目的是确定其对矫正年龄（CA）24个月时神经发育障碍（NDI）的影响。
这项回顾性单中心队列研究纳入了2004/2005年（第1阶段）和2010/2011年（第2阶段）出生的所有孕周<30周的患者。在第2阶段，我们引入了IMV限制政策，并放宽了产房和新生儿重症监护室中呼吸兴奋剂的使用。收集了患者特征、呼吸管理、短期结局、死亡率、BPD以及矫正年龄24个月时NDI的数据。
共纳入404例早产儿。与第1阶段的婴儿相比，第2阶段的婴儿插管的可能性较小，IMV持续时间较短。在第2阶段，咖啡因、多沙普仑和鼻通气等其他无创辅助治疗的使用更为频繁。与第1阶段相比，第2阶段BPD有减少的趋势（17%对23%，校正比值比=0.75，95%可信区间：0.48，1.16）。死亡率未随时间变化。与第1阶段相比，第2阶段矫正年龄24个月时死亡或NDI的综合结局显著降低（24.7%对33.9%，校正比值比=0.71，95%可信区间：0.53，0.97）。
对早产儿限制使用IMV是可行的，可能与矫正年龄24个月时死亡或NDI综合结局风险降低有关。需要更大规模的研究来证实这些发现。
