Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada.
JSS Medical Research, Montreal, Québec, Canada.
Am J Perinatol. 2018 Aug;35(10):951-958. doi: 10.1055/s-0038-1632368. Epub 2018 Feb 16.
To determine if illness severity during the first days of life predicts adverse outcome in asphyxiated newborns treated with hypothermia.
We conducted a retrospective cohort study of asphyxiated newborns treated with hypothermia. Illness severity was calculated daily during the first 4 days of life using the Score for Neonatal Acute Physiology II (SNAP-II score). Adverse outcome (death and/or brain injury) was recorded. Differences in SNAP-II scores between the newborns with and without adverse outcome were assessed.
214 newborns were treated with hypothermia. The average SNAP-II score over the first 4 days of life was significantly worse in newborns developing adverse outcome. The average SNAP-II score was an excellent predictor of death (area under the curve [AUC]: 0.93; < 0.001) and a fair predictor of adverse outcome (AUC: 0.73; < 0.001). The average SNAP-II score remained a significant predictor of adverse outcome (odds ratio [95% confidence interval]: 1.08 [1.04-1.12]; < 0.001), after adjusting for baseline characteristics, degree of initial asphyxial event, and initial severity of encephalopathy.
In asphyxiated newborns treated with hypothermia, not only the initial asphyxial event but also the illness severity during the first days of life was a significant predictor of death or brain injury.
确定新生儿出生后最初几天的疾病严重程度是否可以预测接受低温治疗的窒息新生儿的不良结局。
我们对接受低温治疗的窒息新生儿进行了回顾性队列研究。使用新生儿急性生理学评分Ⅱ（SNAP-Ⅱ评分）在出生后最初的 4 天内每天计算疾病严重程度。记录不良结局（死亡和/或脑损伤）。评估有不良结局和无不良结局新生儿的 SNAP-Ⅱ评分差异。
214 名新生儿接受了低温治疗。出现不良结局的新生儿在出生后最初 4 天的平均 SNAP-Ⅱ评分明显更差。平均 SNAP-Ⅱ评分是死亡的优秀预测指标（曲线下面积 [AUC]：0.93；<0.001），也是不良结局的良好预测指标（AUC：0.73；<0.001）。在调整基线特征、初始窒息事件严重程度和初始脑病严重程度后，平均 SNAP-Ⅱ评分仍然是不良结局的显著预测指标（比值比[95%置信区间]：1.08[1.04-1.12]；<0.001）。
在接受低温治疗的窒息新生儿中，不仅初始窒息事件，而且出生后最初几天的疾病严重程度也是死亡或脑损伤的重要预测指标。
