Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia; Newborn Research Center, The Royal Women's Hospital, Melbourne, Australia.
Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia.
J Pediatr. 2020 Dec;227:135-141.e1. doi: 10.1016/j.jpeds.2020.07.037. Epub 2020 Jul 15.
To evaluate demographic and clinical variables as predictors of nasal high-flow treatment success in newborn infants with respiratory distress cared for in Australian nontertiary special care nurseries.
A secondary analysis of the HUNTER trial, a multicenter, randomized controlled trial evaluating nasal high-flow as primary respiratory support for newborn infants with respiratory distress who were born ≥31 weeks of gestation and with birth weight ≥1200 g, and cared for in Australian nontertiary special care nurseries. Treatment success within 72 hours after randomization to nasal high-flow was determined using objective criteria. Univariable screening and multivariable analysis was used to determine predictors of nasal high-flow treatment success.
Infants (n = 363) randomized to nasal high-flow in HUNTER were included in the analysis; the mean gestational age was 36.9 ± 2.7 weeks and birth weight 2928 ± 782 g. Of these infants, 290 (80%) experienced nasal high-flow treatment success. On multivariable analysis, nasal high-flow treatment success was predicted by higher gestational age and lower fraction of inspired oxygen immediately before randomization, but not strongly. The final model was found to have an area under the curve of 0.65, which after adjustment for optimism was found to be 0.63 (95% CI, 0.57-0.70).
Gestational age and supplemental oxygen requirement may be used to guide decisions regarding the most appropriate initial respiratory support for newborn infants in nontertiary special care nurseries. Further prospective research is required to better identify which infants are most likely to be successfully treated with nasal high-flow.
ACTRN12614001203640.
评估人口统计学和临床变量作为澳大利亚非三级特殊护理病房呼吸窘迫新生儿接受鼻高流量治疗成功的预测因素。
对 HUNTER 试验的二次分析，这是一项多中心、随机对照试验，评估了鼻高流量作为呼吸窘迫新生儿的主要呼吸支持，这些新生儿出生胎龄≥31 周，出生体重≥1200g，并在澳大利亚非三级特殊护理病房接受治疗。通过客观标准确定随机分配到鼻高流量后 72 小时内的治疗成功。使用单变量筛选和多变量分析来确定鼻高流量治疗成功的预测因素。
HUNTER 试验中随机分配到鼻高流量的婴儿（n=363）被纳入分析；平均胎龄为 36.9±2.7 周，出生体重为 2928±782g。在这些婴儿中，290 名（80%）经历了鼻高流量治疗成功。多变量分析表明，鼻高流量治疗成功与较高的胎龄和随机前较低的吸入氧分数有关，但不强烈。最终模型的曲线下面积为 0.65，经调整后发现为 0.63（95%置信区间，0.57-0.70）。
胎龄和补充氧气需求可用于指导非三级特殊护理病房新生儿初始呼吸支持的最佳选择决策。需要进一步的前瞻性研究，以更好地确定哪些婴儿最有可能通过鼻高流量成功治疗。
ACTRN12614001203640。
