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极早产儿5分钟血氧饱和度与新生儿死亡及脑室内出血之间的关联。

Association between 5-minute oxygen saturation and neonatal death and intraventricular hemorrhage among extremely preterm infants.

作者信息

Jiang Siyuan, Cui Xin, Katheria Anup, Finer Neil N, Bennett Mihoko V, Profit Jochen, Lee Henry C

机构信息

Division of Neonatology, University of California San Diego, La Jolla, CA, USA.

Division of Neonatology, Children's Hospital of Fudan University, Shanghai, China.

出版信息

J Perinatol. 2024 Dec 11. doi: 10.1038/s41372-024-02194-w.

DOI:10.1038/s41372-024-02194-w
PMID:39663396
Abstract

OBJECTIVE

To assess the relationship between 5-min oxygen saturation (SpO2) and outcomes in extremely preterm infants.

STUDY DESIGN

This cohort study included infants ≤28 weeks' gestation across nine hospitals from 2020 to 2022. Death and / or severe intraventricular hemorrhage (IVH) were compared between infants with 5-min SpO2 < 80% and 80-100% using Poisson regression models. Receiver Operating Characteristic (ROC) curve and optimal breakpoint analysis were used to estimate the optimal breakpoint of 5-min SpO2 in relation to outcomes.

RESULT

Of 390 infants, 184 (47.2%) had 5-min SpO2 < 80%. A 5-min SpO2 < 80% was independently associated with increased risks of death and / or severe IVH, early death, and severe IVH. ROC analysis of 5-min SpO2 identified optimal breakpoint at 81-85%, above which no additional benefit in outcomes was observed.

CONCLUSION

Our findings support the current recommendation of 5-min SpO2 target of ≥80% for extremely preterm infants.

摘要

目的

评估极早产儿5分钟血氧饱和度(SpO2)与预后之间的关系。

研究设计

这项队列研究纳入了2020年至2022年期间9家医院中孕周≤28周的婴儿。使用泊松回归模型比较5分钟SpO2<80%和80-100%的婴儿的死亡和/或重度脑室内出血(IVH)情况。采用受试者工作特征(ROC)曲线和最佳断点分析来估计与预后相关的5分钟SpO2的最佳断点。

结果

在390名婴儿中,184名(47.2%)的5分钟SpO2<80%。5分钟SpO2<80%与死亡和/或重度IVH、早期死亡以及重度IVH风险增加独立相关。对5分钟SpO2进行的ROC分析确定最佳断点为81-85%,高于此值未观察到预后有额外益处。

结论

我们的研究结果支持目前对极早产儿5分钟SpO2目标≥80%的建议。

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本文引用的文献

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JAMA Pediatr. 2024 Aug 1;178(8):774-783. doi: 10.1001/jamapediatrics.2024.1848.
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Neurodevelopmental outcomes of preterm infants after randomisation to initial resuscitation with lower (FiO 0.3) or higher (FiO 0.6) initial oxygen levels. An individual patient meta-analysis.随机分组后初始复苏时采用较低(FiO2 0.3)或较高(FiO2 0.6)初始氧浓度的早产儿的神经发育结局。一项个体患者荟萃分析。
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Oxygen in the First Minutes of Life in Very Preterm Infants.极低出生体重儿生后早期的氧疗
Neonatology. 2021;118(2):218-224. doi: 10.1159/000516261. Epub 2021 Apr 26.
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Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.新生儿生命支持:2020 国际心肺复苏与紧急心血管急救科学共识及治疗推荐。
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Is There a "Right" Amount of Oxygen for Preterm Infant Stabilization at Birth?出生时用于稳定早产儿状况的氧气量有“合适”的标准吗?
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