Neonatal Intensive Care Unit, St Orsola-Malpighi University Hospital, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC).
Neonatal Intensive Care Unit, St Orsola-Malpighi University Hospital, Bologna, Italy.
J Pediatr. 2020 Jun;221:32-38.e2. doi: 10.1016/j.jpeds.2020.02.037.
To investigate the features of cardiorespiratory events in infants born preterm during the transitional period, and to evaluate whether different neonatal characteristics may correlate with event type, duration, and severity.
Infants with gestational age (GA) <32 weeks and/or birth weight <1500 g were enrolled in this observational prospective study. Heart rate (HR) and peripheral oxygen saturation (SpO) were recorded continuously over the first 72 hours. Cardiorespiratory events of ≥10 seconds were clustered into isolated desaturation (SpO <85%), isolated bradycardia (HR <100 bpm or <70% of baseline), or combined desaturation/bradycardia and classified as mild, moderate, or severe. The daily incidences of isolated desaturation, isolated bradycardia, and combined desaturation and bradycardia were analyzed. The effects of relevant clinical variables on cardiorespiratory event type and severity were assessed using generalized estimating equations.
Among the 1050 events analyzed, isolated desaturations were the most frequent (n = 625) and isolated bradycardias the least common (n = 171). The number of cardiorespiratory events increased significantly from day 1 to day 2 (P = .028). One in 5 events had severe characteristics; event severity was highest for combined desaturation and bradycardia (P < .001). Compared with other event types, the incidence of combined desaturation and bradycardia was inversely correlated with GA (P = .029) and was higher with the use of continuous positive airway pressure (P = .002). The presence of a hemodynamically significant patent ductus arteriosus was associated with the occurrence of isolated desaturations (P = .001) and with a longer duration of cardiorespiratory events (P = .003).
Cardiorespiratory events during transition exhibit distinct types, duration, and severity. Neonatal characteristics are associated with the clinical features of these events, indicating that a tailored clinical approach may reduce the hypoxic burden in preterm infants aged 0-72 hours.
研究早产儿过渡期心呼吸事件的特征，并评估不同新生儿特征是否与事件类型、持续时间和严重程度相关。
本观察性前瞻性研究纳入了胎龄（GA）<32 周和/或出生体重<1500g 的婴儿。连续 72 小时记录心率（HR）和外周血氧饱和度（SpO2）。持续时间≥10 秒的心呼吸事件被聚类为单纯性低氧血症（SpO2<85%）、单纯性心动过缓（HR<100bpm 或<基线的 70%）或混合性低氧血症/心动过缓，并分为轻度、中度和重度。分析了单纯性低氧血症、单纯性心动过缓以及混合性低氧血症和心动过缓的日发生率。使用广义估计方程评估相关临床变量对心呼吸事件类型和严重程度的影响。
在分析的 1050 次事件中，单纯性低氧血症最常见（n=625），单纯性心动过缓最不常见（n=171）。心呼吸事件数量从第 1 天到第 2 天显著增加（P=0.028）。五分之一的事件为重度；混合性低氧血症和心动过缓的事件严重程度最高（P<0.001）。与其他事件类型相比，混合性低氧血症和心动过缓的发生率与 GA 呈反比（P=0.029），与持续气道正压通气的使用呈正相关（P=0.002）。存在有临床意义的动脉导管未闭与单纯性低氧血症的发生（P=0.001）和心呼吸事件的持续时间较长有关（P=0.003）。
过渡期间的心呼吸事件表现出不同的类型、持续时间和严重程度。新生儿特征与这些事件的临床特征相关，表明针对特定人群的临床方法可能会降低 0-72 小时龄早产儿的低氧负担。
