Tsuda Kennosuke, Shibasaki Jun, Takeuchi Akihito, Mukai Takeo, Sugiyama Yuichiro, Isayama Tetsuya, Ioroi Tomoaki, Takahashi Akihito, Yutaka Nanae, Iwata Osuke
Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan.
Acta Paediatr. 2023 Apr;112(4):734-741. doi: 10.1111/apa.16687. Epub 2023 Feb 7.
We evaluated the predictive ability of prolonged requirements for mechanical ventilation or tube feeding support for 18-month composite outcomes in infants with hypoxic-ischaemic encephalopathy treated with hypothermia.
This retrospective, nationwide, observational study focused on newborn infants registered in Japan's Baby Cooling Registry between 1 January 2012 and 31 December 2016. The adverse outcomes were defined as death or survival with cerebral palsy, visual or auditory impairment or the requirement for mechanical ventilation or tube feeding at 18 months of age.
Adverse outcomes occurred in 165 (28%) of the 591 children in the final cohort. These were predicted by prolonged dependence on mechanical ventilation or tube feeding for more than seven and more than 14 days. The respective values were positive predictive value 0.34 (95% CI 0.33-0.34) and 0.60 (95% CI 0.56-0.62), negative predictive value 0.97 (95% CI 0.91-0.99) and 0.93 (95% CI 0.90-0.95) and area under the curve 0.59 (95% CI 0.54-0.64) and 0.81 (95% CI 0.77-0.85).
Prolonged dependence on mechanical ventilation or tube feeding for more than 14 days may be useful in predicting 18-month outcomes in newborn infants who have received therapeutic hypothermia.
我们评估了低温治疗的缺氧缺血性脑病患儿对机械通气或管饲支持的长期需求对18个月综合结局的预测能力。
这项回顾性、全国性的观察性研究聚焦于2012年1月1日至2016年12月31日在日本婴儿低温治疗登记处登记的新生儿。不良结局定义为死亡或存活但伴有脑瘫、视觉或听觉障碍，或在18个月大时需要机械通气或管饲。
最终队列中的591名儿童中有165名（28%）出现了不良结局。对机械通气或管饲的长期依赖超过7天和超过14天可预测这些不良结局。各自的值为阳性预测值0.34（95%置信区间0.33 - 0.34）和0.60（95%置信区间0.56 - 0.62），阴性预测值0.97（95%置信区间0.91 - 0.99）和0.93（95%置信区间0.90 - 0.95），曲线下面积0.59（95%置信区间0.54 - 0.64）和0.81（95%置信区间0.77 - 0.85）。
对机械通气或管饲的长期依赖超过14天可能有助于预测接受治疗性低温的新生儿18个月时的结局。
