Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
Department of Neonatology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin 300100, China.
Chin Med J (Engl). 2021 Jun 16;134(13):1561-1568. doi: 10.1097/CM9.0000000000001499.
Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.
The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD.
A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082-4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606-3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044-1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061-2.424), DRI (OR, 2.094; 95% CI, 1.328-3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679-4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777-6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996-0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379-0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160-0.467) were preventive factors for BPD (all P < 0.05).
Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.
产房复苏有助于早产儿，尤其是极早产儿（EPI）和极低出生体重儿（ELBWI）呼吸支持，但可能对早产儿的肺部和预后产生负面影响。本研究旨在评估中国 EPI 和 ELBWI 的产房复苏和出院结局。
分析了 2017 年至 2018 年间华北五省市 33 个新生儿重症监护病房内出生后 72 小时内入院的 EPI（胎龄[GA]＜28 周）和 ELBWI（出生体重[BW]＜1000 g）的临床数据。主要结局为产房复苏和产房插管（DRI）的危险因素。次要结局为生存率、支气管肺发育不良（BPD）的发生率和 BPD 的危险因素。
共纳入 952 例早产儿。DRI、胸外按压和肾上腺素使用率分别为 55.9%（532/952）、12.5%（119/952）和 7.0%（67/952）。多变量分析显示，DRI 的危险因素为 GA＜28 周（比值比[OR]，3.147；95%置信区间[CI]，2.082-4.755）、BW＜1000 g（OR，2.240；95% CI，1.606-3.125）和产前感染（OR，1.429；95% CI，1.044-1.956）。生存率为 65.9%（627/952），依赖于 GA。BPD 发生率为 29.3%（181/627）。多变量分析显示，BPD 的危险因素为男性（OR，1.603；95% CI，1.061-2.424）、DRI（OR，2.094；95% CI，1.328-3.303）、暴露于≥2 剂肺表面活性剂的呼吸窘迫综合征（OR，2.700；95% CI，1.679-4.343）和机械通气≥7 天（OR，4.358；95% CI，2.777-6.837）。然而，较大的 BW（OR，0.998；95% CI，0.996-0.999）、产前类固醇（OR，0.577；95% CI，0.379-0.880）和产房 PS 使用（OR，0.273；95% CI，0.160-0.467）是 BPD 的预防因素（均 P＜0.05）。
在 EPI 和 ELBWI 的早期健康管理中，改进产房复苏和呼吸并发症的管理至关重要。
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