Division of Neonatology, Department of Pediatrics, UBMD, University at Buffalo, Buffalo, New York;
Department of Pediatrics, University of California at Davis, Sacramento, California.
Pediatrics. 2020 Oct;146(4). doi: 10.1542/peds.2019-3318. Epub 2020 Sep 17.
To evaluate the survival and neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants at 18 to 26 months with early hypoxemic respiratory failure (HRF). We also assessed whether African American infants with early HRF had improved outcomes after exposure to inhaled nitric oxide (iNO).
ELBW infants ≤1000 g and gestational age ≤26 weeks with maximal oxygen ≥60% on either day 1 or day 3 were labeled as "early HRF" and born between 2007 and 2015 in the Neonatal Research Network were included. Using a propensity score regression model, we analyzed outcomes and effects of exposure to iNO overall and separately by race.
Among 7639 ELBW infants born ≤26 weeks, 22.7% had early HRF. Early HRF was associated with a mortality of 51.3%. The incidence of moderate-severe NDI among survivors was 41.2% at 18 to 26 months. Mortality among infants treated with iNO was 59.4%. Female sex (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI]: 1.8-3.3), birth weight ≥720 g (aOR: 2.3, 95% CI: 1.7-3.1) and complete course of antenatal steroids (aOR: 1.6, 95% CI: 1.1-2.2) were associated with intact survival. African American infants had a similar incidence of early HRF (21.7% vs 23.3%) but lower exposure to iNO (16.4% vs 21.6%). Among infants with HRF exposed to iNO, intact survival (no death or NDI) was not significantly different between African American and other races (aOR: 1.5, 95% CI: 0.6-3.6).
Early HRF in infants ≤26 weeks' gestation is associated with high mortality and NDI at 18 to 26 months. Use of iNO did not decrease mortality or NDI. Outcomes following iNO exposure were not different in African American infants.
评估患有早期低氧性呼吸衰竭（HRF）的极低出生体重（ELBW）婴儿在 18 至 26 个月时的存活率和神经发育损伤（NDI）。我们还评估了患有早期 HRF 的非裔美国婴儿在接触吸入性一氧化氮（iNO）后是否有更好的结局。
纳入 2007 年至 2015 年期间在新生儿研究网络中出生、胎龄≤26 周且出生体重≤1000g、第 1 天或第 3 天最大吸氧浓度≥60%的 ELBW 婴儿，将其标记为“早期 HRF”。通过倾向评分回归模型，我们分析了整体和按种族分别暴露于 iNO 的结果和影响。
在 7639 名出生胎龄≤26 周的 ELBW 婴儿中，22.7%患有早期 HRF。早期 HRF 与 51.3%的死亡率相关。18 至 26 个月时，幸存者中中重度 NDI 的发生率为 41.2%。接受 iNO 治疗的婴儿死亡率为 59.4%。女性（调整优势比[aOR]：2.4，95%置信区间[CI]：1.8-3.3）、出生体重≥720g（aOR：2.3，95% CI：1.7-3.1）和完整的产前类固醇疗程（aOR：1.6，95% CI：1.1-2.2）与完整的存活率相关。非裔美国婴儿的早期 HRF 发生率相似（21.7%比 23.3%），但接触 iNO 的比例较低（16.4%比 21.6%）。在接受 iNO 治疗的 HRF 婴儿中，非裔美国婴儿与其他种族婴儿的完整存活率（无死亡或 NDI）无显著差异（aOR：1.5，95% CI：0.6-3.6）。
胎龄≤26 周的婴儿患有早期 HRF 与 18 至 26 个月时的高死亡率和 NDI 相关。使用 iNO 并未降低死亡率或 NDI。接触 iNO 后的结局在非裔美国婴儿中没有差异。
