脑室出血的隐藏后果：早产儿脑室出血后持续脑缺氧。
The hidden consequence of intraventricular hemorrhage: persistent cerebral desaturation after IVH in preterm infants.
机构信息
Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University, St. Louis, MO, USA.
出版信息
Pediatr Res. 2021 Mar;89(4):869-877. doi: 10.1038/s41390-020-01189-5. Epub 2020 Oct 10.
BACKGROUND
Previous studies describe a short-term decrease in cerebral oxygen saturation (StO2) after intraventricular hemorrhage (IVH) in premature infants; little is known about long-term implications.
METHODS
Infants born <30 weeks gestational age (GA) were included. Clinical characteristics, hemoglobin measurements, the highest grade of IVH, and white matter injury (WMI) were noted. NIRS monitoring occurred daily or every other day for 4 weeks; weekly through 36 weeks GA. Recordings were error-corrected before calculation of mean StO2 and fractional tissue oxygen extraction (FTOE). Mean StO2 and FTOE were plotted by postnatal age and injury group (IVH/no IVH; WMI/no WMI). Non-linear regression by locally estimated scatterplot smoothing was used to generate the best-fit line and CI.
RESULTS
A total of 1237 recordings from 185 infants were included; mean length = 6.5 h; mean GA = 26.3 w; mean BW = 951 g; overall/severe IVH incidence was 29/8%, WMI incidence was 16%. IVH was independently associated with an acute drop in StO2, which remained lower for 68 d. Severe IVH was associated with lower StO2 values than mild IVH. WMI was associated with early and persistent elevation of FTOE.
CONCLUSION
IVH of any grade is associated with a prolonged cerebral desaturation and WMI is associated with prolonged elevation of FTOE. This finding is exacerbated for infants with severe IVH.
IMPACT
The longitudinal impact of IVH on cerebral oxygenation has not been previously studied. IVH is associated with persistent cerebral desaturation, months in length, and is independent of anemia. More severe IVH is associated with worsened cerebral hypoxia. Infants later diagnosed with white matter injury have an early and persistent elevation of cerebral oxygen extraction (cFTOE). This cerebral desaturation, below previously identified normative ranges, may provide insight into the mechanistic link between IVH and white matter injury.
背景
先前的研究描述了早产儿脑室出血（IVH）后脑氧饱和度（StO2）的短期下降；但对于长期影响知之甚少。
方法
纳入胎龄（GA）<30 周的婴儿。记录临床特征、血红蛋白测量值、IVH 最高分级和脑白质损伤（WMI）。NIRS 监测每天或隔天进行 4 周；每周持续至 36 周 GA。在计算平均 StO2 和组织氧提取分数（FTOE）之前，对记录进行了误差校正。根据出生后年龄和损伤组（IVH/无 IVH；WMI/无 WMI）绘制平均 StO2 和 FTOE 图。通过局部估计散点平滑进行非线性回归，生成最佳拟合线和置信区间。
结果
共纳入 185 例婴儿的 1237 次记录；平均时长=6.5 小时；平均 GA=26.3 周；平均 BW=951 克；总发生率/严重 IVH 发生率为 29%/8%，WMI 发生率为 16%。IVH 与 StO2 的急性下降独立相关，这种下降持续了 68 天。严重 IVH 与轻度 IVH 相比，StO2 值更低。WMI 与 FTOE 的早期和持续升高相关。
结论
任何分级的 IVH 都与脑饱和度延长有关，WMI 与 FTOE 的持续升高有关。对于严重 IVH 的婴儿，这种情况更为严重。
影响
IVH 对脑氧合的长期影响以前没有研究过。IVH 与持续的脑缺氧有关，持续时间长达数月，且与贫血无关。更严重的 IVH 与更严重的脑缺氧有关。后来被诊断为脑白质损伤的婴儿有早期和持续的脑氧摄取（cFTOE）升高。这种脑饱和度下降，低于之前确定的正常范围，可能为 IVH 和脑白质损伤之间的机制联系提供了见解。
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