Leikin Zach Viktoria, Riskin Arieh, Raizberg Irina, Hochwald Ori, Dinur Gil, Breuer Michal, Christopher Farah Fady, Kugelman Amir, Borenstein-Levin Liron
Technion-Israel Institute of Technology, Rappaport Faculty of Medicine, Haifa, Israel.
Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.
Acta Paediatr. 2025 Sep;114(9):2337-2345. doi: 10.1111/apa.70116. Epub 2025 May 5.
Oxygenation instability is common among very-low-birthweight premature infants (VLBW) and is correlated with morbidities of prematurity. We aimed to study the association of oxygenation instability of VLBW premature infants during the first week of life, as documented by the SpO histogram, with short-term neonatal morbidities.
VLBW infants requiring respiratory support were included. 24-h SpO histograms were documented once daily. A classification system, based on the distribution of the histogram, was used to classify the histograms into stable/unstable categories.
Seventy-seven infants with mean (SD) gestational age-28.5 (2.1) weeks and birth weight-1040 (243) g were included in our study. 2063 histograms were recorded. Mean (SD) length of follow-up-27.5 (20.1) days per infant. 62% of infants remained stable during the follow-up period, while 38% experienced instability. 52% entered the unstable period during the first week of life. These infants had a higher risk of bronchopulmonary dysplasia (BPD)/death after adjusting for gestational age (OR [95% CI] 17.5 [4.0, 77.2]; p < 0.001), and for a variety of demographic and clinical variables (OR [95% CI] 32.4 [2.5, 418.5]; p = 0.008).
VLBW premature infants demonstrate a distinct instability pattern. Entry into the unstable phase during the first week of life is associated with BPD/death, making it a potential predictive tool. Hypoxemia burden during the first week of life is correlated with BPD or death, while iatrogenic hyperoxemia is not.
氧合不稳定在极低出生体重早产儿（VLBW）中很常见，且与早产相关疾病有关。我们旨在研究出生后第一周内通过脉搏血氧饱和度（SpO）直方图记录的VLBW早产儿氧合不稳定与新生儿短期疾病之间的关联。
纳入需要呼吸支持的VLBW婴儿。每天记录一次24小时SpO直方图。基于直方图分布的分类系统用于将直方图分为稳定/不稳定类别。
我们的研究纳入了77例平均（标准差）胎龄为28.5（2.1）周、出生体重为1040（243）克的婴儿。记录了2063个直方图。每个婴儿的平均（标准差）随访时间为27.5（20.1）天。62%的婴儿在随访期间保持稳定，而38%的婴儿出现不稳定。52%的婴儿在出生后第一周进入不稳定期。在调整胎龄后，这些婴儿发生支气管肺发育不良（BPD）/死亡的风险更高（比值比[95%可信区间]17.5[4.0,77.2]；p<0.001），在调整各种人口统计学和临床变量后也是如此（比值比[95%可信区间]32.4[2.5,418.5]；p=0.008）。
VLBW早产儿表现出独特的不稳定模式。出生后第一周进入不稳定期与BPD/死亡相关，使其成为一种潜在的预测工具。出生后第一周的低氧血症负担与BPD或死亡相关，而医源性高氧血症则不然。
