患有缺氧缺血性脑病和持续性新生儿肺动脉高压的婴儿的结局：来自三个 NICHD 研究的结果。
Outcomes of infants with hypoxic ischemic encephalopathy and persistent pulmonary hypertension of the newborn: results from three NICHD studies.
机构信息
Department of Pediatrics, Wayne State University, Detroit, MI, USA.
Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA.
出版信息
J Perinatol. 2021 Mar;41(3):502-511. doi: 10.1038/s41372-020-00905-7. Epub 2021 Jan 6.
OBJECTIVE
To determine the association of persistent pulmonary hypertension of the newborn (PPHN) with death or disability among infants with moderate or severe hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia.
METHODS
We compared infants with and without PPHN enrolled in the hypothermia arm from three randomized controlled trials (RCTs): Induced Hypothermia trial, "usual care" arm of Optimizing Cooling trial, and Late Hypothermia trial. Primary outcome was death or disability at 18-22 months adjusted for severity of HIE, center, and RCT.
RESULTS
Among 280 infants, 67 (24%) were diagnosed with PPHN. Among infants with and without PPHN, death or disability was 47% vs. 29% (adjusted OR: 1.65, 0.86-3.14) and death was 26% vs. 12% (adjusted OR: 2.04, 0.92-4.53), respectively.
CONCLUSIONS
PPHN in infants with moderate or severe HIE was not associated with a statistically significant increase in primary outcome. These results should be interpreted with caution given the limited sample size.
目的
确定在接受治疗性低温治疗的中重度缺氧缺血性脑病（HIE）婴儿中，持续性肺动脉高压（PPHN）与死亡或残疾的相关性。
方法
我们比较了来自三项随机对照试验（RCT）的低温治疗组中存在和不存在 PPHN 的婴儿：诱导性降温试验、优化冷却试验的“常规治疗”组和晚期降温试验。主要结局是校正 HIE 严重程度、中心和 RCT 后 18-22 个月的死亡或残疾。
结果
在 280 名婴儿中，有 67 名（24%）被诊断为 PPHN。在存在和不存在 PPHN 的婴儿中，死亡或残疾的发生率分别为 47%和 29%（调整后的 OR：1.65，0.86-3.14），死亡的发生率分别为 26%和 12%（调整后的 OR：2.04，0.92-4.53）。
结论
在中重度 HIE 婴儿中，PPHN 与主要结局的显著增加无关。鉴于样本量有限，这些结果应谨慎解释。
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