Glenn Tara, Fischer Linnea, Markowski Ashley, Carr Cara Beth, Malay Sindhoosha, Hibbs Anna Maria
Department of Pediatrics, Division of Neonatology, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio.
Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Am J Perinatol. 2023 Aug;40(11):1245-1252. doi: 10.1055/s-0041-1736130. Epub 2021 Sep 9.
This study aimed to evaluate the association between desaturation <60% (severe desaturation) during intubation and a total number of intubation attempts in the first week of life in very low birth weight (VLBW) infants with adverse long-term outcomes including bronchopulmonary dysplasia (BPD) and severe periventricular/intraventricular hemorrhage grade 3 or 4 (PIVH).
A retrospective chart review was performed on VLBW infants intubated in the neonatal intensive care unit during the first week of life between January 2017 and July 2020. Descriptive tables were generated for two outcomes including BPD and PIVH. Multivariable logistic regression was performed for each outcome including significant predictors that differed between groups with a -value of <0.2.
A total of 146 patients were included. Patients with BPD or PIVH had a lower gestational age, and patients with BPD had a lower BW. Patients with BPD had a greater number of intubation attempts in the first week of life (4 vs. 3, < 0.001). In multivariable logistic regression controlling for confounding variables, the odds developing BPD were higher for patients with increased cumulative number of intubation attempts in the first week of life (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.03-1.62, = 0.029). Post hoc analyses revealed increased odds of developing BPD with increased number of intubation encounters in the first week of life (OR: 2.20, 95% CI: 1.04-4.82, = 0.043). In this post hoc analysis including intubation encounters in the model; desaturation <60% during intubation in the first week of life was associated with increased odds of developing BPD (OR: 2.35, 95% CI: 1.02-5.63, = 0.048).
The odds of developing BPD for VLBW infants were higher with increased intubation attempts and intubation encounters. In a post hoc analysis, the odds of developing BPD were also higher with desaturation during intubation. Further research is needed to determine mechanisms of the relationship between complicated intubations and the development of BPD.
· Neonatal intubations often require multiple attempts.. · Neonates frequently desaturate during intubation.. · Intubation attempts are positively associated with BPD.. · Severe desaturation may be positively associated with BPD..
本研究旨在评估极低出生体重（VLBW）婴儿出生后第一周内插管期间血氧饱和度<60%（严重低氧血症）与插管总次数之间的关联，这些婴儿具有包括支气管肺发育不良（BPD）和3级或4级严重脑室周围/脑室内出血（PIVH）等不良长期预后。
对2017年1月至2020年7月期间在新生儿重症监护病房出生后第一周内行插管术的VLBW婴儿进行回顾性病历审查。针对BPD和PIVH这两种结局生成描述性表格。对每个结局进行多变量逻辑回归分析，纳入组间差异有统计学意义且P值<0.2的显著预测因素。
共纳入146例患者。患有BPD或PIVH的患者胎龄较低，患有BPD的患者出生体重较低。患有BPD的患者在出生后第一周的插管尝试次数更多（4次对3次，P<0.001）。在控制混杂变量的多变量逻辑回归分析中，出生后第一周插管尝试累积次数增加的患者发生BPD的几率更高（优势比[OR]：1.29，95%置信区间[CI]：1.03 - 1.62，P = 0.029）。事后分析显示，出生后第一周插管次数增加，发生BPD的几率增加（OR：2.20，95%CI：1.04 - 4.82，P = 0.043）。在该纳入插管次数的事后分析模型中，出生后第一周插管期间血氧饱和度<60%与发生BPD的几率增加相关（OR：2.35，95%CI：1.02 - 5.63，P = 0.048）。
VLBW婴儿插管尝试次数和插管次数增加时，发生BPD的几率更高。在事后分析中，插管期间低氧血症时发生BPD的几率也更高。需要进一步研究以确定复杂插管与BPD发生之间关系的机制。
·新生儿插管通常需要多次尝试。·新生儿插管期间经常出现低氧血症。·插管尝试次数与BPD呈正相关。·严重低氧血症可能与BPD呈正相关。
