Monash Children's Hospital, Melbourne, Victoria, Australia
Department of Paediatrics, Monash University, Clayton, Victoria, Australia.
Arch Dis Child Fetal Neonatal Ed. 2024 Oct 18;109(6):628-633. doi: 10.1136/archdischild-2023-326748.
To evaluate whether kangaroo mother care (KMC) in preterm infants on non-invasive respiratory support improves indices of cardiorespiratory wellbeing.
Prospective quasi-experimental observational study.
Tertiary perinatal neonatal unit.
50 very preterm infants being managed with nasal continuous positive airway pressure.
Continuous high-resolution preductal pulse-oximetry recordings using Masimo Radical-7 oximeter for 1 hour (incubator care) followed by 1 hour during KMC performed on the same day.
Measures of cardiorespiratory stability (dips in oxygen saturations (SpO)) of ≥5% less than baseline, % time spent with oxygen saturations <90%, SpO variability and heart rate fluctuation and incidence of bradycardias.
The gestational age and birth weight of the cohort were 28.4±2.1 weeks and 1137±301 g, respectively. Dips in SpO of ≥5% less than baseline were significantly fewer with KMC, median (IQR) 24 (12 to 42) vs 13 (3 to 25), p=0.001. SpO variability (Delta 12 s and 2 s), (1.24±0.6 vs 0.9±0.4, p=0.005 and 4.1±1.7 vs 2.8±1.2, p<0.0001) and rapid resaturation and desaturation indices were significantly lower during KMC, compared with incubator care. Percentage time spent in oxygen saturations <90% was less with KMC (7.5% vs 2.7%, p=0.04). Mean heart rate was comparable although fluctuations in heart rate (rise by >8 bpm) were lower with KMC (43±22 vs 33±20, p=0.03). Seven (14%) infants had bradycardias during incubator care and none during KMC, p=0.012.
KMC improves cardiorespiratory stability in ventilated preterm infants. Regular KMC has the potential to improve clinical outcomes in this vulnerable cohort.
评估袋鼠式护理（KMC）对接受无创呼吸支持的早产儿是否能改善心肺健康相关指标。
前瞻性准实验观察性研究。
三级围产新生儿病房。
50 名接受经鼻持续气道正压通气（NCPAP）治疗的极早产儿。
使用 Masimo Radical-7 脉搏血氧仪连续 1 小时（在保温箱中）进行高分辨率的经皮氧饱和度监测，然后在同一天进行 1 小时 KMC。
心肺稳定性指标（氧饱和度下降≥5%且低于基线、氧饱和度＜90%的时间百分比、氧饱和度变异性、心率波动和心动过缓的发生率）。
该队列的胎龄和出生体重分别为 28.4±2.1 周和 1137±301g。KMC 时，氧饱和度下降≥5%且低于基线的情况明显减少，中位数（IQR）为 24（12 至 42）比 13（3 至 25），p=0.001。KMC 时，氧饱和度变异性（Delta 12s 和 2s）（1.24±0.6 比 0.9±0.4，p=0.005 和 4.1±1.7 比 2.8±1.2，p＜0.0001）和快速复氧及脱氧指数均明显低于保温箱中，差异有统计学意义。KMC 时，氧饱和度＜90%的时间百分比较少（7.5%比 2.7%，p=0.04）。平均心率相当，但 KMC 时心率波动（上升＞8bpm）较低（43±22 比 33±20，p=0.03）。保温箱中 7 名（14%）婴儿发生心动过缓，KMC 时无一例，p=0.012。
KMC 可改善接受通气治疗的早产儿的心肺稳定性。定期 KMC 有可能改善这一脆弱队列的临床结局。
