Lee Juyoung, Hong Mee, Yum Sook Kyung, Lee Jung Hyun
Department of Pediatrics, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea.
Childs Nerv Syst. 2018 Nov;34(11):2215-2222. doi: 10.1007/s00381-018-3868-9. Epub 2018 Jun 18.
Severe acidosis is one of the strongest predictors of neurologic outcomes in full-term infants with suspected hypoxic-ischemic encephalopathy. However, the relative importance of acidosis as a predictor of outcomes in preterm infants is much less clear. The goals of the present study were to examine the association between postnatal acidosis and severe intraventricular hemorrhage (IVH) and to establish a new score model including acid-base status after birth for predicting the risk of this morbidity.
The study sample was very low birth weight (VLBW) infants in the Korean Neonatal Network (KNN) cohort registry, collected prospectively from January 2013 to December 2014. Infants with blood pH and base deficit (BD) values collected within the first hour after birth, and documentation of severe IVH, were included. Multivariate stepwise logistic regression analysis was used to determine the contribution of postnatal acidosis to predicting severe IVH in VLBW infants. In addition, a prediction model was developed.
Data from 2518 VLBW infants were analyzed. Infants with postnatal acidosis had a higher incidence of severe IVH. The clinical model plus blood BD values improved predictive performance, compared with models using only perinatal data or blood pH.
A prediction model for severe IVH was developed using the KNN registry of VLBW infants. Immediate postnatal acidosis, defined based on blood BD, was associated with a higher-risk-adjusted incidence of severe IVH.
严重酸中毒是足月疑似缺氧缺血性脑病婴儿神经学预后的最强预测指标之一。然而，酸中毒作为早产儿预后预测指标的相对重要性尚不清楚。本研究的目的是探讨出生后酸中毒与重度脑室内出血（IVH）之间的关联，并建立一个包含出生后酸碱状态的新评分模型，以预测这种疾病的风险。
研究样本为韩国新生儿网络（KNN）队列登记中的极低出生体重（VLBW）婴儿，于2013年1月至2014年12月前瞻性收集。纳入出生后第一小时内收集了血pH值和碱缺失（BD）值且有重度IVH记录的婴儿。采用多变量逐步逻辑回归分析来确定出生后酸中毒对预测VLBW婴儿重度IVH的作用。此外，还开发了一个预测模型。
分析了2518例VLBW婴儿的数据。出生后酸中毒的婴儿重度IVH发生率更高。与仅使用围产期数据或血pH值的模型相比，临床模型加上血BD值提高了预测性能。
利用KNN登记的VLBW婴儿建立了重度IVH的预测模型。基于血BD定义的出生后即刻酸中毒与经风险调整后的重度IVH较高发生率相关。
