Department of Pediatrics, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, USA.
Division of Neonatology, University of Maryland School of Medicine, Baltimore, MD, USA.
J Perinatol. 2019 Jan;39(1):54-62. doi: 10.1038/s41372-018-0261-1. Epub 2018 Oct 22.
Changes in cerebrovascular hemodynamics associated with head position may be important in the pathogenesis of periventricular-intraventricular hemorrhage (PIVH) in premature infants. This study evaluated the effect of elevated midline head positioning on cardiopulmonary function and the incidence of PIVH.
ELBW infants were randomized to FLAT (flat, supine) or ELEV (supine, bed elevated 30 degrees) for 96 h. Cardiopulmonary function, complications of prematurity, and the occurrence of PIVH were documented.
Infants were randomized into FLAT (n = 90) and ELEV groups (n = 90). No significant differences were seen in the incidence of BPD or other respiratory complications. The ELEV group developed significantly fewer grade 4 hemorrhages (p = 0.036) and survival to discharge was significantly higher in the ELEV group (p = 0.037).
Managing ELBW infants in an elevated midline head position for the first 4 days of life appears safe and may decrease the likelihood of severe PIVH and improve survival.
与头部位置相关的脑血管血液动力学变化在早产儿脑室周围-脑室内出血（PIVH）的发病机制中可能很重要。本研究评估了中线头部抬高位置对心肺功能和 PIVH 发生率的影响。
ELBW 婴儿随机分为 FLAT（仰卧，仰卧）或 ELEV（仰卧，床抬高 30 度）96 小时。记录心肺功能、早产儿并发症和 PIVH 的发生情况。
婴儿随机分为 FLAT 组（n=90）和 ELEV 组（n=90）。BPD 或其他呼吸并发症的发生率无显著差异。ELEV 组的 4 级出血发生率明显较低（p=0.036），ELEV 组的存活率明显较高（p=0.037）。
在生命的头 4 天，将 ELBW 婴儿置于中线抬高的头部位置管理似乎是安全的，可能降低严重 PIVH 的可能性并提高存活率。
