早期吸入一氧化氮在非裔早产儿中的应用效果。
Outcomes of early inhaled nitric oxide use in premature African American neonates.
机构信息
Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
出版信息
J Perinatol. 2018 Dec;38(12):1657-1665. doi: 10.1038/s41372-018-0232-6. Epub 2018 Oct 1.
OBJECTIVE
Meta-analysis of individual-patient clinical trial data suggests that inhaled nitric oxide (iNO) improves respiratory outcomes in premature African American neonates. We hypothesized that early iNO therapy would be associated with lower mortality and less chronic lung disease (CLD) in extremely premature African American neonates.
STUDY DESIGN
We conducted a retrospective cohort study of propensity score- and race-matched neonates 22-29 weeks gestation who were mechanically ventilated for treatment of respiratory distress and associated pulmonary hypertension (RDS + PPHN). We evaluated the association of iNO within 7 days of life with in-hospital mortality and CLD, using Cox proportional hazards regression and logistic regression, respectively.
RESULT
Among 178 matched pairs of African American patients, iNO was not associated with lower mortality (HR = 0.94, 95% CI 0.69-1.30) or less CLD (OR = 0.94, 95% CI 0.47-1.87).
CONCLUSIONS
Early, off-label iNO use is not associated with improved outcomes in premature African American neonates with RDS + PPHN.
目的
对个体患者临床试验数据进行的荟萃分析表明，吸入一氧化氮（iNO）可改善早产儿中非裔美国儿的呼吸结局。我们假设，早期 iNO 治疗与极低出生体重早产儿中非裔美国儿的死亡率降低和慢性肺病（CLD）减少相关。
研究设计
我们对接受机械通气治疗呼吸窘迫和相关肺动脉高压（RDS+PPHN）的胎龄 22-29 周的具有倾向评分和种族匹配的早产儿进行了回顾性队列研究。我们分别使用 Cox 比例风险回归和 logistic 回归评估了出生后 7 天内使用 iNO 与院内死亡率和 CLD 的相关性。
结果
在 178 对匹配的非裔美国儿患者中，iNO 与较低的死亡率（HR=0.94，95%CI 0.69-1.30）或较少的 CLD（OR=0.94，95%CI 0.47-1.87）无关。
结论
对于患有 RDS+PPHN 的早产儿中非裔美国儿，早期、超适应证使用 iNO 并不能改善其结局。
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