早产儿自动氧控与 2 岁时神经发育结局的回顾性队列研究。
Automated oxygen control for very preterm infants and neurodevelopmental outcome at 2 years-a retrospective cohort study.
机构信息
Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, PO Box 9600, Leiden, the Netherlands.
Department of Paediatrics, Division of Psychology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands.
出版信息
Eur J Pediatr. 2023 Apr;182(4):1593-1599. doi: 10.1007/s00431-023-04809-4. Epub 2023 Jan 25.
UNLABELLED
Faster resolution of hypoxaemic or hyperoxaemic events in preterm infants may reduce long-term neurodevelopmental impairment. Automatic titration of inspiratory oxygen increases time within the oxygen saturation target range and may provide a more prompt response to hypoxic and hyperoxic events. We assessed routinely performed follow-up at 2 years of age after the implementation of automated oxygen control (AOC) as standard care and compared this with a historical cohort. Neurodevelopmental outcomes at 2 years of age were compared for infants born at 24-29 weeks gestational age before (2012-2015) and after (2015-2018) the implementation of AOC as standard of care. The primary outcome was a composite outcome of either mortality or severe neurodevelopmental impairment (NDI), and other outcomes assessed were mild-moderate NDI, Bayley-III composite scores, cerebral palsy GMFCS, and CBCL problem behaviour scores. A total of 289 infants were included in the pre-AOC epoch and 292 in the post-AOC epoch. Baseline characteristics were not significantly different. Fifty-one infants were lost to follow-up (pre-AOC 6.9% (20/289), post-implementation 10.6% (31/292). The composite outcome of mortality or severe NDI was observed in 17.9% pre-AOC (41/229) vs. 24.0% (47/196) post-AOC (p = 0.12). No significant differences were found for the secondary outcomes such as mild-moderate NDI, Bayley-III composite scores, cerebral palsy GMFCS, and problem behaviour scores, with the exception of parent-reported readmissions until the moment of follow-up which was less frequent post-AOC than pre-AOC.
CONCLUSION
In this cohort study, the implementation of automated oxygen control in our NICU as standard of care for preterm infants led to no statistically significant difference in neurodevelopmental outcome at 2 years of age.
WHAT IS KNOWN
• Neurodevelopmental outcome is linked to hypoxemia, hyperoxaemia and choice of SpO2 target range. • Automated titration of inspired oxygen may provide a faster resolution of hypoxaemic and hyperoxaemic events.
WHAT IS NEW
• This cohort study did not find a significant difference in neurodevelopmental outcome at two years of age after implementing automated oxygen control as standard of care.
目的
评估实施自动氧控（AOC）作为标准治疗后，2 年时的神经发育结局，并与历史队列进行比较。
方法
本研究为前瞻性队列研究，纳入 2012 年至 2015 年（AOC 实施前）和 2015 年至 2018 年（AOC 实施后）在 24-29 周胎龄出生的婴儿。主要结局为死亡率或严重神经发育障碍（NDI）的复合结局，次要结局为轻度至中度 NDI、贝利-III 综合评分、脑瘫 GMFCS 和 CBCL 问题行为评分。
结果
共纳入 289 例婴儿（AOC 实施前）和 292 例婴儿（AOC 实施后）。AOC 实施前后，基线特征无显著差异。51 例婴儿失访（AOC 实施前 6.9%（20/289），AOC 实施后 10.6%（31/292）。AOC 实施前，死亡率或严重 NDI 的复合结局发生率为 17.9%（41/229），AOC 实施后为 24.0%（47/196），差异无统计学意义（p=0.12）。次要结局如轻度至中度 NDI、贝利-III 综合评分、脑瘫 GMFCS 和问题行为评分，差异均无统计学意义，但 AOC 实施后直至随访时的父母报告再入院率低于 AOC 实施前。
结论
在这项队列研究中，AOC 作为我们新生儿重症监护病房（NICU）的标准治疗方法，在 2 岁时的神经发育结局方面，没有统计学上的显著差异。
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