Skin-to-skin care in preterm infants receiving respiratory support does not lead to physiological instability
Skin-to-skin care in preterm infants receiving respiratory support does not lead to physiological instability
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DOI：
10.1136/archdischild-2016-311752
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发表时间：
2017-07-01
影响因子：
4.4
通讯作者：
Kamlin, C. Omar F.
中科院分区：
文献类型：
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作者：
Lorenz, Laila;Dawson, Jennifer A.;Kamlin, C. Omar F.
目的为早产儿提供皮肤对皮肤护理(SSC)是许多新生儿重症监护病房的标准做法。关于SSC期间血氧饱和度(SpO(2))的稳定性，有相互矛盾的报道，这可能会对SSC在接受呼吸支持的婴儿中的更广泛实施造成障碍。用近红外光谱仪测量的局部脑氧合(RCO(2))可作为脑氧输送和消耗的替代参数。设计前瞻性观察性非劣势研究，在澳大利亚设立单一的三级围产期中心。对40例在第8天(5-18周)接受呼吸支持的早产儿(胎龄27.6(26.0-28.9)周)进行研究。采用配对t检验比较两组RCO(2)、心率(HR)、SpO(2)、吸氧分数(FiO(2))和体温。结果SSC组RCO(2)平均值(SD)74.9(6.5%)%与孵化器组(74.7(6.1)%，平均差值(95%CI)0.2(-0.8~1.1)%，p=0.71)。两组患儿的HR、SpO(2)、FiO(2)及体温均无显著差异。结论SSC和保温箱护理对早产儿的脑氧合等生理指标无明显影响。
Objective Providing skin-to-skin care (SSC) to preterm infants is standard practice in many neonatal intensive care units. There are conflicting reports on the stability of oxygen saturation (SpO(2)) during SSC, which may create a barrier to a wider implementation of SSC to infants receiving respiratory support. Regional cerebral oxygenation (rcO(2)) measured using near-infrared spectroscopy can serve as a surrogate parameter for cerebral oxygen delivery and consumption. We hypothesised that rcO(2) during SSC would be similar to standard care in preterm infants receiving respiratory support.Design Prospective observational non-inferiority study.Setting Single tertiary perinatal centre in Australia.Patients Forty preterm infants (median (IQR) of 27.6 (26.0-28.9) weeks' gestation) receiving respiratory support were studied on day 8 (5-18).Interventions Ninety minutes of SSC, with infants in incubators acting as their own control. Parents and caregivers were blinded to the measurements.Main outcome measures Mean difference in rcO(2) between SSC and incubator care; as well as heart rate (HR), SpO(2), fraction of inspired oxygen (FiO(2)) and temperature, were compared using a paired t-test.Results rcO(2) was similar during SSC (mean (SD) 74.9 (6.5)%)% compared with incubator care (74.7 (6.1)%, mean difference (95% CI) 0.2 (-0.8 to 1.1)%, p=0.71). No clinically important differences in HR, SpO(2), FiO(2) or temperature were observed in the whole cohort and by mode of respiratory support (endotracheal tube mechanical ventilation, continuous positive airway pressure and high-flow nasal cannulae).Conclusions Cerebral oxygenation and other physiological measurements in ventilated preterm infants did not differ between SSC and incubator care.