Kanaan U, Srivatsa B, Huckaby J, Kelleman M
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Children's Healthcare of Atlanta, Atlanta, GA, USA.
J Perinatol. 2018 Feb;38(2):148-153. doi: 10.1038/jp.2017.166. Epub 2017 Oct 19.
Assess the effect of increasing pulse oximetry targets on incidence of pulmonary hypertension in very low birthweight premature infants.
Retrospective cohort study comparing pulmonary hypertension incidence among three cohorts of premature infants exposed to varying oxygen saturation targets (Cohort 1: n=459, 1 May 2009 to 30 April 2011, 85-94%; Cohort 2: n=474, 1 May 2011 to 31 May 2013, 88-94%; Cohort 3: n=387, 1 June 2013 to 31 May 2015, 90-95%). Subjects had birth weight <1500 g and gestational age 23-32 weeks. Chi-square, Kruskall-Wallis and Anderson-Darling tests were used, as well as multivariable logistic regression.
Incidence of pulmonary hypertension declined with higher oxygen saturation targets (19.0% Cohort 1, 7.9% Cohort 2, 9.6% Cohort 3, P<0.001). Other parameters were largely not different between cohorts though rates of chorioamnionitis and prenatal steroids increased and oxygen use, inhaled nitric oxide use, necrotizing enterocolitis and patent ductus arteriosus ligation decreased over time.
Higher oxygen saturation targets for very low-birthweight premature infants were associated with reduced rates of pulmonary hypertension in this retrospective cohort study.
评估提高脉搏血氧饱和度目标值对极低出生体重早产儿肺动脉高压发生率的影响。
回顾性队列研究，比较三组暴露于不同氧饱和度目标值的早产儿的肺动脉高压发生率（队列1：n = 459，2009年5月1日至2011年4月30日，85 - 94%；队列2：n = 474，2011年5月1日至2013年5月31日，88 - 94%；队列3：n = 387，2013年6月1日至2015年5月31日，90 - 95%）。研究对象出生体重<1500g，胎龄23 - 32周。采用卡方检验、克鲁斯卡尔 - 沃利斯检验和安德森 - 达林检验，以及多变量逻辑回归分析。
随着氧饱和度目标值升高，肺动脉高压发生率下降（队列1为19.0%，队列2为7.9%，队列3为9.6%，P<0.001）。尽管绒毛膜羊膜炎和产前使用类固醇的比例随时间增加，而氧疗、吸入一氧化氮治疗、坏死性小肠结肠炎和动脉导管未闭结扎的比例随时间下降，但各队列间的其他参数在很大程度上并无差异。
在这项回顾性队列研究中，极低出生体重早产儿较高的氧饱和度目标值与肺动脉高压发生率降低相关。
