Gire Catherine, Fournier Ninon, Pirrello Johanna, Marret Stéphane, Patural Hugues, Flamant Cyril, Pierrat Véronique, Kaminski Monique, Ancel Pierre-Yves, Tosello Barthélémy, Berbis Julie
Department of Neonatology, North Hospital, APHM University Hospital, Chemin des Bourrely, 13015 Marseille, France.
EA3279, Self-Perceived Health Assessment Research Unit, Faculty of Medicine, Aix Marseille University, 13385 Marseille, France.
Children (Basel). 2023 Jan 25;10(2):209. doi: 10.3390/children10020209.
To evaluate, in very preterm infants, the hemoglobin (Hb) levels during the first 24 h and the neurodevelopment outcomes at 24 months of corrected age.
DESIGN, SETTING, AND PATIENTS: We conducted a secondary analysis of the French national prospective and population-based cohort EPIPAGE-2. The eligible study participants were live-born singletons who were born before 32 weeks of gestational age, with early Hb levels who were admitted to the neonatal intensive care unit.
The early Hb levels for an outcome survival at 24 months of corrected age without neurodevelopmental impairment were measured. The secondary outcomes were survival at discharge and without severe neonatal morbidity.
Of the 2158 singletons of <32 weeks with mean early Hb levels of 15.4 (±2.4) g/dL, 1490 of the infants (69%) had a follow-up at two years of age. An early Hb of 15.2 g/dL is the minimum receiving operating characteristic curve at the 24 months risk-free level, but the area under the curve at 0.54 (close to 50%) indicates that this rate was not informative. In logistic regression, no association was found between early Hb levels and outcomes at two years of age (aOR 0.966; 95% CI [0.775-1.204]; = 0.758) but rather there was a correlation found with severe morbidity (aOR 1.322; 95% CI [1.003-1.743]; = 0.048). A risk stratification tree showed that male newborns of >26 weeks with Hb of <15.5 g/dL (n = 703) were associated with a poor outcome at 24 months (OR 1.9; CI: [1.5-2.4] < 0.01).
Early low Hb levels are associated with major neonatal morbidities in VP singletons, but not with neurodevelopment outcomes at two years of age, except in male infants of >26 Weeks GA.
评估极早产儿出生后24小时内的血红蛋白（Hb）水平以及矫正年龄24个月时的神经发育结局。
设计、背景和患者：我们对法国全国性前瞻性人群队列研究EPIPAGE-2进行了二次分析。符合条件的研究参与者为单胎活产儿，其胎龄小于32周，出生后早期血红蛋白水平异常，并入住新生儿重症监护病房。
测量矫正年龄24个月时无神经发育障碍存活这一结局的早期血红蛋白水平。次要结局为出院时存活且无严重新生儿疾病。
在2158名单胎胎龄小于32周、平均早期血红蛋白水平为15.4（±2.4）g/dL的婴儿中，1490名婴儿（69%）在两岁时接受了随访。早期血红蛋白水平为15.2 g/dL是24个月无风险水平下的最小接受操作特征曲线，但曲线下面积为0.54（接近50%）表明该比率并无参考价值。在逻辑回归分析中，未发现早期血红蛋白水平与两岁时的结局之间存在关联（调整优势比0.966；95%置信区间[0.775 - 1.204]；P = 0.758），但发现与严重疾病存在相关性（调整优势比1.322；95%置信区间[1.003 - 1.743]；P = 0.048）。风险分层树显示，胎龄大于26周、血红蛋白水平低于15.5 g/dL的男婴（n = 703）在24个月时预后较差（优势比1.9；置信区间：[1.5 - 2.4]，P < 0.01）。
早期低血红蛋白水平与极早产单胎婴儿的主要新生儿疾病相关，但与两岁时的神经发育结局无关，胎龄大于26周的男婴除外。
