Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):4969-4975. doi: 10.1080/14767058.2021.1873941. Epub 2021 Feb 21.
(1) To investigate whether neonates with perinatal asphyxia and therapeutic hypothermia more often developed PPHN compared to a control group with perinatal asphyxia not treated with hypothermia; (2) To identify risk factors for severe PPHN during hypothermia and evaluate short-term outcome.
This single-center retrospective cohort study included (near-)term neonates with perinatal asphyxia admitted between 2004 and 2016. Neonates with perinatal asphyxia and hypothermia were compared to a historical control group without hypothermia. Primary outcome was PPHN, defined as severe hypoxemia requiring mechanical ventilation and inhaled nitric oxide, confirmed by echocardiography. Short-term adverse outcome was defined as mortality within one month and/or severe brain injury on MRI.
Incidence of PPHN was 23% (26/114) in the hypothermia group and 11% (8/70) in controls. In multivariate analysis, PPHN was 2.5 times more common among neonates with hypothermia. Neonates developing PPHN during hypothermia often had higher fraction of inspired oxygen at baseline. PPHN was not associated with a higher risk of severe brain injury. However, early mortality was higher and three infants died due to severe refractory PPHN during hypothermia.
In this study PPHN occurred more often since the introduction of therapeutic hypothermia. This was usually reversible and did not lead to overall increased adverse outcome. However, in individual cases with PPHN deterioration occurred rapidly. In such cases the benefits of hypothermia should be weighed against the risk of a complicated, fatal course.
(1) 研究在接受低温治疗的新生儿与未接受低温治疗的新生儿相比，是否围产期窒息并接受治疗性低温的新生儿更常发生持续性肺动脉高压（PPHN）；(2) 确定低温治疗期间发生严重 PPHN 的危险因素，并评估短期结局。
这是一项单中心回顾性队列研究，纳入了 2004 年至 2016 年间因围产期窒息而入院的（近）足月新生儿。将接受围产期窒息和低温治疗的新生儿与未接受低温治疗的历史对照组进行比较。主要结局为 PPHN，定义为严重低氧血症需要机械通气和吸入一氧化氮，并通过超声心动图证实。短期不良结局定义为 1 个月内死亡和/或 MRI 证实严重脑损伤。
在低温组中，PPHN 的发生率为 23%（26/114），在对照组中为 11%（8/70）。在多变量分析中，低温组新生儿发生 PPHN 的几率是对照组的 2.5 倍。在低温治疗期间发生 PPHN 的新生儿在基线时通常需要更高的吸入氧分数。PPHN 与严重脑损伤的风险增加无关。然而，早期死亡率较高，有 3 例婴儿因低温治疗期间严重难治性 PPHN 而死亡。
在这项研究中，自开始使用治疗性低温以来，PPHN 的发生率更高。这种情况通常是可逆的，不会导致总体不良结局增加。然而，在个别情况下，PPHN 会迅速恶化。在这种情况下，应权衡低温治疗的益处与复杂、致命病程的风险。
