University Children's Hospital Basel, Basel, Switzerland; Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
University Children's Hospital Basel, Basel, Switzerland.
J Pediatr. 2019 Feb;205:61-69.e1. doi: 10.1016/j.jpeds.2018.10.002. Epub 2018 Nov 8.
To test whether low variability of tidal volume (V) and capnographic indices are predictive of subsequent respiratory morbidity in preterm infants.
In a birth cohort of 133 preterm infants, lung function was performed at 44 weeks postmenstrual age. Associations between the coefficient of variation (CV) of V (CV) and of expired CO volume per breath (CV) with rehospitalization, wheeze, and inhalation therapy during infancy were assessed using logistic regression. Area under the curve (AUC) analysis was used to assess whether outcome prediction using bronchopulmonary dysplasia (BPD) classification was enhanced by CV or CV.
For each IQR decrease in CV (range, 4%-35%) and CV, (range, 5%-40%), the OR for rehospitalization increased by 2.25 (95% CI, 1.21-4.20) and 2.31 (95% CI, 1.20-4.45), respectively. The predictive value of BPD for rehospitalization was improved when CV or CV was added to the model, with the AUC increasing from 0.56 to 0.66 in both models. No association was found for the other outcomes.
Compared with BPD classification alone, including near-term variability of tidal breathing parameters improves the prediction of rehospitalization in infancy. These findings may inform parent counseling and monitoring strategies in preterm infants.
检验潮气量（V）和二氧化碳描记指数变化率是否可预测早产儿随后发生呼吸系统疾病的风险。
在一个由 133 名早产儿组成的出生队列中，于校正胎龄 44 周时进行肺功能检测。采用逻辑回归评估 V 变异系数（CV）和呼气 CO2 容积变异系数（CV）与婴儿期再入院、喘息和吸入治疗的相关性。曲线下面积（AUC）分析用于评估使用支气管肺发育不良（BPD）分类时，CV 或 CV 对结局预测的增强作用。
CV（范围为 4%至 35%）和 CV（范围为 5%至 40%）每降低一个 IQR，再入院的比值比（OR）分别增加 2.25（95%可信区间，1.21 至 4.20）和 2.31（95%可信区间，1.20 至 4.45）。将 CV 或 CV 添加到模型中可提高 BPD 对再入院的预测价值，两个模型的 AUC 分别从 0.56 增加到 0.66。其他结局与 CV 或 CV 无相关性。
与单独使用 BPD 分类相比，纳入接近足月时的潮气量呼吸参数变化率可改善婴儿期再入院的预测。这些发现可能为早产儿的家长咨询和监测策略提供信息。
