Luo Ningxin, Jiang Siyuan, McNamara Patrick J, Li Xiaoying, Guo Yan, Wang Yang, Han Junyan, Deng Yingping, Yang Yi, Lee Shoo K, Cao Yun
Children's Hospital of Fudan University, Shanghai, China.
Department of Pediatrics and Internal Medicine, University of Iowa, Iowa City, IA, United States.
Front Pediatr. 2021 Apr 22;9:638540. doi: 10.3389/fped.2021.638540. eCollection 2021.
To describe cardiovascular pharmacological support in infants born at <34 weeks' gestation within the first postnatal week in Chinese neonatal intensive care units (NICUs). A secondary analysis of data from a multicenter randomized controlled study (REIN-EPIQ). A questionnaire regarding cardiovascular support practices was also completed by all participating NICUs. Twenty-five tertiary hospitals from 19 provinces in China. All infants born at <34 weeks' gestation and admitted to participating NICUs within the first postnatal week from May 2015 to April 2018 were included. Infants who were discharged against medical advice were excluded. Among the 26,212 preterm infants <34 weeks, 16.1% received cardiovascular pharmacological support. The use rates increased with decreasing gestational age and birth weight, with 32.5% among infants <28 weeks and 35.9% among infants <1,000 g. Cardiovascular pharmacological support was independently associated with higher risks of death (aOR 2.8; 95% CI 2.4-3.3), severe intraventricular hemorrhage (IVH) (aOR 2.1; 95% CI 1.8-2.5) and bronchopulmonary dysplasia (BPD) (aOR 2.2; 95% CI 2.0-2.5). Overall 63.1% courses of cardiovascular pharmacological support were >3 days. Prolonged cardiovascular pharmacological support (>3 days) was independently associated with lower rates of survival without morbidity in very-low-birth-weight infants, compared with infants with shorter durations. Dopamine was the most commonly used cardiovascular agent. The cardiovascular pharmacological support rates varied from 1.9 to 65.8% among the participating NICUs. The rate of cardiovascular pharmacological support within the first postnatal week was high with prolonged durations in Chinese NICUs. Marked variation in cardiovascular support existed among participating NICUs. Cardiovascular pharmacological support during the early postnatal period, especially prolonged, may be associated with adverse neonatal outcomes. The original trial was registered as "Reduction of Infection in Neonatal Intensive Care Units using the Evidence-based Practice for Improving Quality" (ID: NCT02600195) on clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT02600195?term=NCT02600195&draw=2&rank=1.
描述中国新生儿重症监护病房（NICU）中孕龄小于34周且出生后第一周内的婴儿的心血管药物支持情况。对一项多中心随机对照研究（REIN-EPIQ）的数据进行二次分析。所有参与的NICU还完成了一份关于心血管支持实践的问卷。来自中国19个省份的25家三级医院。纳入2015年5月至2018年4月期间孕龄小于34周且出生后第一周内入住参与研究的NICU的所有婴儿。拒绝医嘱出院的婴儿被排除。在26212例孕龄小于34周的早产儿中，16.1%接受了心血管药物支持。使用率随着孕龄和出生体重的降低而增加，孕龄小于28周的婴儿中使用率为32.5%，体重小于1000g的婴儿中使用率为35.9%。心血管药物支持与更高的死亡风险（调整后比值比[aOR]2.8；95%置信区间[CI]2.4-3.3）、重度脑室内出血（IVH）（aOR 2.1；95%CI 1.8-2.5）和支气管肺发育不良（BPD）（aOR 2.2；95%CI 2.0-2.5）独立相关。总体而言，63.1%的心血管药物支持疗程超过3天。与疗程较短的婴儿相比，延长的心血管药物支持（>3天）与极低出生体重婴儿无并发症存活的较低发生率独立相关。多巴胺是最常用的心血管药物。参与研究的NICU中，心血管药物支持率从1.9%到65.8%不等。中国NICU出生后第一周内的心血管药物支持率较高且持续时间较长。参与研究的NICU之间在心血管支持方面存在显著差异。出生后早期的心血管药物支持，尤其是延长支持，可能与不良新生儿结局相关。原试验在clinicaltrials.gov上注册为“使用循证实践提高新生儿重症监护病房质量以减少感染”（编号：NCT02600195）。https://clinicaltrials.gov/ct2/show/NCT02600195?term=NCT02600195&draw=2&rank=1
