Joye Sébastien, Kharrat Ashraf, Zhu Faith, Deshpande Poorva, Baczynski Michelle, Jasani Bonny, Lee Seungwoo, Mertens Luc L, McNamara Patrick J, Shah Prakesh S, Weisz Dany E, Jain Amish
Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
Arch Dis Child Fetal Neonatal Ed. 2025 Feb 21;110(2):200-206. doi: 10.1136/archdischild-2024-327347.
Preterm neonates needing rescue treatments with inotropes and/or inhaled nitric oxide (iNO) (acute critical illnesses, ACIs) in neonatal intensive care units (NICUs) are at high risk of mortality. While targeted neonatal echocardiography consultations (TNE) are increasingly used to guide management, its clinical impact need evaluation.
To investigate clinical outcomes in relation to TNE utilisation during episodes of ACIs among preterm neonates.
This retrospective cohort study, conducted at two tertiary NICUs over 10 years, included neonates<37 weeks gestational age (GA) who developed ACIs. Patients receiving TNE-guided care (TNE within 24 hours of treatment initiation) were compared with non-TNE management. Outcomes included predischarge mortality, episode-related mortality (<7 days) and a new diagnosis of intraventricular haemorrhage≥grade 3 (IVH-3). Inverse probability of treatment weighting (IPTW) using propensity score was used to account for confounders, including site, birth years and baseline illness severity.
Of 622 included patients, 297 (48%) had TNE; median (IQR) GA at ACI was 26.4 (25.0-28.4) weeks. TNE group demonstrated higher baseline mean airway pressure, oxygen requirement and heart rate and frequently received both inotrope and iNO during ACI. IPTW analysis revealed TNE was associated with lower mortality (adjusted OR (95% CI) 0.75 (0.59 to 0.95)), episode-related mortality (0.54 (0.40 to 0.72)) and death or IVH-3 (0.78 (0.62 to 0.99)). TNE group received more varied inotropic agents, demonstrated earlier improvements in blood pressures, without increasing overall inotrpoic burden.
Among preterm neonates requiring rescue treatments with inotropes/iNO, TNE utilisation to guide clinical management may be associated with improved survival.
在新生儿重症监护病房（NICU）中，需要使用血管活性药物和/或吸入一氧化氮（iNO）进行抢救治疗（急性危重症，ACIs）的早产儿死亡风险很高。虽然有针对性的新生儿超声心动图会诊（TNE）越来越多地用于指导治疗，但仍需评估其临床影响。
研究早产儿ACIs发作期间TNE使用情况与临床结局的关系。
这项回顾性队列研究在两家三级NICU进行，为期10年，纳入了胎龄<37周且发生ACIs的新生儿。将接受TNE指导治疗（治疗开始后24小时内进行TNE）的患者与非TNE管理的患者进行比较。结局指标包括出院前死亡率、与发作相关的死亡率（<7天）以及新诊断的≥3级脑室内出血（IVH-3）。使用倾向评分的治疗逆概率加权法（IPTW）来处理混杂因素，包括地点、出生年份和基线疾病严重程度。
在622例纳入患者中，297例（48%）接受了TNE；ACIs时的胎龄中位数（IQR）为26.4（25.0-28.4）周。TNE组在基线时平均气道压力、氧需求和心率更高，在ACIs期间经常同时接受血管活性药物和iNO治疗。IPTW分析显示，TNE与较低的死亡率（调整后的OR（95%CI）0.75（0.59至0.95））、与发作相关的死亡率（0.54（0.40至0.72））以及死亡或IVH-3（0.78（0.62至0.99））相关。TNE组使用了更多种类的血管活性药物，血压改善更早，且未增加总体血管活性药物负担。
在需要使用血管活性药物/iNO进行抢救治疗的早产儿中，利用TNE指导临床管理可能会提高生存率。
