Division of Neonatology, Hurley Children's Hospital, Flint, MI, 48503, USA.
Division of Neonatology, Children's Mercy Hospital, 2401 Gillham Road, Kansas, MO, 64108, USA.
Pediatr Res. 2019 Mar;85(4):494-501. doi: 10.1038/s41390-018-0269-4. Epub 2019 Jan 14.
To examine the correlation between interval vital signs recorded by nursing staff and continuous monitor recordings, and to determine whether aggregated monitor recordings can better predict impending escalation of respiratory support in premature infants.
Preterm infants on noninvasive respiratory support or room air (RA) were prospectively enrolled. Nursing-and monitor-recorded pulse oximetry (SpO2) and respiratory rates (RR) data were recorded daily.
Ninety four infants were recruited with median gestational age of 32 weeks and birth weight of 1848 g. > 3 × 10 data points were analyzed over 2204 patient days. Median events/day recorded was 8 (nursing) and 1424 (monitor) per infant. We did not find a strong correlation between monitor- and nursing events of tachypnea (RR > 70) and hypoxia (SpO2 < 90%). Infants with monitor-recorded hypoxia for > 5%/day (p < 0.0001) or tachypnea for > 30%/day (p < 0.0001) were more likely to require an increase in respiratory support within next 3 days. Monitor-recorded hypoxia and tachypnea were also associated with poor weight gain.
Monitor-recorded trends for tachypnea and oxygen saturations < 90% were able to predict short-term respiratory outcomes, and were associated with growth outcomes. This study emphasizes the potential for monitor-recorded data to augment clinical decision making at the bedside.
本研究旨在检验护理人员记录的间断生命体征与连续监护仪记录之间的相关性，并确定监护仪汇总记录是否能更好地预测早产儿呼吸支持的升级。
前瞻性纳入接受无创呼吸支持或空气（RA）治疗的早产儿。每日记录护理人员和监护仪记录的脉搏血氧饱和度（SpO2）和呼吸频率（RR）数据。
共纳入 94 例胎龄中位数为 32 周、出生体重中位数为 1848g 的早产儿，共分析了 2204 个患者日的 >3×10 个数据点。中位数显示，每名婴儿每天记录的事件数为 8 次（护理人员）和 1424 次（监护仪）。我们未发现监护仪和护理人员记录的呼吸急促（RR>70）和缺氧（SpO2<90%）事件之间存在强相关性。监护仪记录的每天 >5%的时间发生缺氧（p<0.0001）或 >30%的时间发生呼吸急促（p<0.0001）的婴儿，在接下来的 3 天内更有可能需要增加呼吸支持。监护仪记录的缺氧和呼吸急促也与体重增长不良相关。
监护仪记录的呼吸急促和氧饱和度 <90%的趋势能够预测短期呼吸结局，并与生长结局相关。本研究强调了监护仪记录数据在床边辅助临床决策的潜力。
