出生时接受有创与无创通气的纳米早产儿的医院和神经发育结局。

Hospital and Neurodevelopmental Outcomes in Nano-Preterm Infants Receiving Invasive vs Noninvasive Ventilation at Birth.

机构信息

Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham.

School of Medicine, University of Alabama at Birmingham, Birmingham.

出版信息

JAMA Netw Open. 2022 Aug 1;5(8):e2229105. doi: 10.1001/jamanetworkopen.2022.29105.

DOI:10.1001/jamanetworkopen.2022.29105

PMID:36036932

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9425146/

Abstract

IMPORTANCE

Infants with gestational age between 22 0/7 and 23 6/7 weeks (referred to as nano-preterm infants) are at very high risk of adverse outcomes. Noninvasive respiratory support at birth improves outcomes in infants born at 24 0/7 to 27 6/7 weeks' gestational age. Evidence is limited on whether similar benefits of non-invasive respiratory support at birth extend to nano-preterm infants.

OBJECTIVE

To evaluate the hypothesis that intubation at 10 minutes or earlier after birth is associated with a higher incidence of bronchopulmonary dysplasia (BPD) or death by 36 weeks' postmenstrual age (PMA) in nano-preterm infants.

DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study included all nano-preterm infants at a level IV neonatal intensive care unit who were delivered from January 1, 2014, to June 30, 2021. Infants receiving palliative or comfort care at birth were excluded.

EXPOSURES

Infants were grouped based on first intubation attempt timing after birth (>10 minutes after birth and ≤10 minutes as noninvasive and invasive respiratory support at birth groups, respectively).

MAIN OUTCOMES AND MEASURES

The primary outcome was the composite outcome of BPD (physiological definition) or death by 36 weeks' PMA.

RESULTS

All 230 consecutively born, eligible nano-preterm infants were included, of whom 88 (median [IQR] gestational age, 23.6 [23.4-23.7] weeks; 45 [51.1%] female; 54 [62.1%] Black) were in the noninvasive respiratory support at birth group and 142 (median [IQR] gestational age, 23.0 [22.4-23.3] weeks; 71 [50.0%] female; 94 [66.2%] Black) were in the invasive respiratory support at birth group. The incidence of BPD or death by 36 weeks' PMA did not differ between the noninvasive and invasive respiratory support groups (83 of 88 [94.3%] in the noninvasive group vs 129 of 142 [90.9%] in the invasive group; adjusted odds ratio, 2.09; 95% CI, 0.60-7.25; P = .24). Severe intraventricular hemorrhage or death by 36 weeks' PMA was lower in the invasive respiratory support at birth group (adjusted odds ratio, 2.20; 95% CI, 1.07-4.51; P = .03).

CONCLUSIONS AND RELEVANCE

This cohort study's findings suggest that noninvasive respiratory support in the first 10 minutes after birth is feasible but is not associated with a decrease in the risk of BPD or death compared with intubation and early surfactant delivery in nano-preterm infants.

摘要

重要性

胎龄在 22 0/7 至 23 6/7 周之间的婴儿（称为纳米早产儿）有很高的不良后果风险。出生时进行非侵入性呼吸支持可改善 24 0/7 至 27 6/7 周胎龄婴儿的结局。关于出生时非侵入性呼吸支持是否能为纳米早产儿带来类似的益处，证据有限。

目的

评估假设，即在出生后 10 分钟或更短时间内进行插管与纳米早产儿在 36 周校正胎龄（PMA）时发生支气管肺发育不良（BPD）或死亡的发生率更高。

设计、地点和参与者：本观察性队列研究纳入了 2014 年 1 月 1 日至 2021 年 6 月 30 日期间在 IV 级新生儿重症监护病房出生的所有纳米早产儿。出生时接受姑息或舒适护理的婴儿被排除在外。

暴露因素

婴儿根据出生后首次插管尝试的时间分组（>10 分钟后和≤10 分钟分别为非侵入性和侵入性呼吸支持出生组）。

主要结局和测量指标

主要结局是 BPD（生理定义）或 36 周 PMA 时死亡的复合结局。

结果

共纳入 230 名连续出生的符合条件的纳米早产儿，其中 88 名（中位数[IQR]胎龄，23.6[23.4-23.7]周；45[51.1%]女性；54[62.1%]黑人）在非侵入性呼吸支持出生组，142 名（中位数[IQR]胎龄，23.0[22.4-23.3]周；71[50.0%]女性；94[66.2%]黑人）在侵入性呼吸支持出生组。非侵入性呼吸支持组和侵入性呼吸支持组的 BPD 或 36 周 PMA 时死亡发生率无差异（非侵入性组 83/88[94.3%] vs 侵入性组 129/142[90.9%]；调整后比值比，2.09；95%CI，0.60-7.25；P=0.24）。侵入性呼吸支持组的严重脑室出血或 36 周 PMA 时死亡发生率较低（调整后比值比，2.20；95%CI，1.07-4.51；P=0.03）。