Cerebral oxygenation during skin-to-skin care in preterm infants not receiving respiratory support
Cerebral oxygenation during skin-to-skin care in preterm infants not receiving respiratory support
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DOI：
10.1136/archdischild-2016-312471
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发表时间：
2018-03-01
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;Marulli, Adriana;Kamlin, C. Omar F.
客观 皮肤接触护理 (SSC) 已被证明对早产儿有益，但也有报道称缺氧和心动过缓事件增加。这可能会让临床医生犹豫是否推荐 SSC 作为标准治疗。我们假设，与标准培养箱护理相比，在 SSC 期间用近红外光谱测量的局部脑氧合 (rStO(2)) 并不差。设计 前瞻性、观察性、非劣效性研究。在澳大利亚设置单一三级围产期中心。患者 40 名未接受呼吸支持的早产儿（中位 (IQR) 30.6 (29.1-31.7) 孕周）在第 14 天进行了研究(8-38). 90 分钟培养箱护理期间的干预记录，随后是 90 分钟的 SSC。每个婴儿充当自己的对照，护理人员对 rStO(2) 测量值不知情。 主要结果测量 主要结果是 SSC 和培养箱护理之间 rStO(2) 的平均差异。预先指定的非劣效性幅度为-1.5%。次要结局包括心率 (HR)、外周氧饱和度 (SpO(2))、安静睡眠时间、体温和低氧 (SpO(2) 5 s) 或心动过缓事件（HR < 80 bpm 持续 > 5 s）以及脑缺氧 (rStO2 < 55%) 和高氧 (rStO(2) > 85%) 所花费的时间。 结果 与 SSC 期间相比，平均 (SD) rStO(2) 较低使用培养箱护理：73.6 (6.0)% vs 74.8 (4.6)%，平均差异 (95% CI) 1.3 (2.2 至 0.4)%。 SSC 期间，HR 升高 5 bpm，SpO(2) 降低 1%，安静睡眠时间延长 24%。几乎没有观察到温度差异的证据。两个时期缺氧或心动过缓事件的数量以及脑缺氧和高氧所花费的时间比例都非常低。 结论 SSC期间平均rStO(2)略低，没有观察到缺氧或心动过缓事件的差异，但安静睡眠的时间有所增加。
Objective Skin-to-skin care (SSC) has proven benefits in preterm infants, but increased hypoxic and bradycardic events have been reported. This may make clinicians hesitant to recommend SSC as standard care. We hypothesised that regional cerebral oxygenation (rStO(2)) measured with near infrared spectroscopy is not worse during SSC compared with standard incubator care.Design Prospective, observational, non-inferiority study.Setting Single tertiary perinatal centre in Australia.Patients Forty preterm infants (median (IQR) 30.6 (29.1-31.7) weeks' gestation) not receiving respiratory support were studied on day 14 (8-38).Interventions Recordings during 90 min of incubator care, followed by 90 min of SSC. Each infant acted as their own control and caregivers were blinded to the rStO(2) measurements.Main outcome measures The primary outcome was the mean difference in rStO(2) between SSC and incubator care. The prespecified margin of non-inferiority was -1.5%. Secondary outcomes included heart rate (HR), peripheral oxygen saturation (SpO(2)), time in quiet sleep, temperature and hypoxic (SpO(2) 5 s) or bradycardic events (HR < 80 bpm for >5 s) and time spent in cerebral hypoxia (rStO2 < 55%) and hyperoxia (rStO(2) > 85%).Results Mean (SD) rStO(2) was lower during SSC compared with incubator care: 73.6 (6.0)% vs 74.8 (4.6)%, mean difference (95% CI) 1.3 (2.2 to 0.4)%. HR was 5 bpm higher, SpO(2) 1% lower and time in quiet sleep 24% longer during SSC. Little evidence of a difference was observed in temperature. The number of hypoxic or bradycardic events as well as the proportion of time spent in cerebral hypoxia and hyperoxia was very low in both periods.Conclusions Mean rStO(2) was marginally lower during SSC without observed differences in hypoxic or bardycardic events but an increase in time spent in quiet sleep.