Department of Neonatology, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands.
Department of Neonatology, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands.
J Pediatr. 2019 Apr;207:109-116.e2. doi: 10.1016/j.jpeds.2018.11.038. Epub 2018 Dec 18.
To assess whether high and low levels of cerebral oxygenation (regional cerebral oxygenation [rScO]) in infants born at <32 weeks of gestation were associated with adverse long-term outcome.
Observational cohort study including preterm infants born at <32 weeks of gestation at the Wilhelmina Children's Hospital, The Netherlands, between April 2006 and April 2013. The rScO was continuously monitored for 72 hours after birth using near-infrared spectroscopy. Outcome was assessed at 15 and 24 months of corrected age by certified investigators. An unfavorable composite outcome was defined as an outcome score below -1 SD or death. Various rScO thresholds were explored.
In total, 734 infants were eligible for analysis, 60 of whom died. Associations with an unfavorable cognitive outcome in multivariable analysis were comparable for time spent with a rScO below 55% and -1.5 SD (according to published reference values), with an OR of 1.4 (CI 1.1-1.7) for 20% of time below either threshold. Results at 15 months were comparable with results at 24 months. Results were not statistically significant for thresholds defining high values of rScO. The composite motor outcome was not significantly related to either low or high values or rScO.
Low, but not high, rScO was associated with an unfavorable cognitive outcome. This suggests the use of a threshold of rScO <55% for future clinical studies when using adult near-infrared sensors (rScO <65% for neonatal sensors, approximately).
评估极低出生体重儿（<32 周）脑氧合（局部脑氧合[rScO]）水平高低与不良长期预后的相关性。
这是一项观察性队列研究，纳入了 2006 年 4 月至 2013 年 4 月在荷兰威廉敏娜儿童医院出生的<32 周的早产儿。使用近红外光谱仪连续监测出生后 72 小时的 rScO。由认证调查员在矫正年龄 15 个月和 24 个月时评估结局。不良复合结局定义为结局评分低于-1 个标准差或死亡。探索了各种 rScO 阈值。
共有 734 名婴儿符合分析条件，其中 60 名死亡。多变量分析显示，rScO 低于 55%和-1.5 个标准差（根据已发表的参考值）的时间与认知结局不良相关，20%的时间低于任一阈值的比值比（OR）为 1.4（95%CI 1.1-1.7）。15 个月时的结果与 24 个月时的结果相似。rScO 高值的阈值与结局无统计学显著相关性。复合运动结局与 rScO 低值或高值均无显著相关性。
低 rScO 但不是高 rScO 与认知结局不良相关。这表明，当使用成人近红外传感器时（新生儿传感器约为 rScO<65%），rScO<55%可作为未来临床研究的阈值。
