Neurodevelopmental outcomes of extremely low birthweight infants randomised to different PCO2 targets: the PHELBI follow-up study
Neurodevelopmental outcomes of extremely low birthweight infants randomised to different PCO2 targets: the PHELBI follow-up study
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随机分配至不同 PCO2 目标的极低出生体重婴儿的神经发育结果：PHELBI 后续研究
DOI：
10.1136/archdischild-2016-311581
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Rascher W
中科院分区：
文献类型：
--
作者：
Thome UH;Genzel-Boroviczeny O;Bohnhorst B;Schmid M;Fuchs H;Rohde O;Avenarius S;Topf HG;Zimmermann A;Faas D;Timme K;Kleinlein B;Buxmann H;Schenk W;Segerer H;Teig N;Bläser A;Hentschel R;Heckmann M;Schlösser R;Peters J;Rossi R;Rascher W
背景对机械通气的极低出生体重婴儿耐受较高的二氧化碳分压（PCO2）以减少呼吸机引起的肺损伤可能会产生长期的神经发育副作用。本研究分析了一项随机多中心试验的婴儿神经发育随访结果。方法将出生体重 400 至 1000 g、胎龄 23 0/7–28 6/7 周、在出生 24 小时内需要气管插管和机械通气的婴儿 (n=359) 随机分配到高 PCO2 组或对照组轻度升高 PCO2 目标。 85% 的入组婴儿可以使用贝利婴儿发育量表 II、粗大运动功能分类系统 (GMFCS) 和儿童发育量表 (CDI) 进行神经发育随访检查。结果两个 PCO2 目标组之间的体重、身长和头围没有差异。智力发育指数 (MDI) 中位数为 82（60-96，高目标）和 84（58-96，p=0.79）。精神运动发育指数 (PDI) 值分别为 84 (57–100) 和 84 (65–96, p=0.73)。此外，MDI或PDI<70或<85的婴儿数量以及死亡或MDI<70和死亡或PDI<70的综合结果的婴儿数量没有差异。 GMFCS 和 CDI 的结果之间没有发现差异。 MDI<70或PDI<70的危险因素是颅内出血、支气管肺发育不良、脑室周围白质软化、坏死性小肠结肠炎和氢化可的松治疗。结论较高的PCO2目标并不影响机械通气极早产儿的神经发育结局。调整 PCO2 目标以优化短期结果是一个安全的选择。试验注册号ISRCTN56143743。
BackgroundTolerating higher partial pressures of carbon dioxide (PCO2) in mechanically ventilated extremely low birthweight infants to reduce ventilator-induced lung injury may have long-term neurodevelopmental side effects. This study analyses the results of neurodevelopmental follow-up of infants enrolled in a randomised multicentre trial.MethodsInfants (n=359) between 400 and 1000 g birth weight and 23 0/7–28 6/7 weeks gestational age who required endotracheal intubation and mechanical ventilation within 24 hours of birth were randomly assigned to high PCO2or to a control group with mildly elevated PCO2targets. Neurodevelopmental follow-up examinations were available for 85% of enrolled infants using the Bayley Scales of Infant Development II, the Gross Motor Function Classification System (GMFCS) and the Child Development Inventory (CDI).ResultsThere were no differences in body weight, length and head circumference between the two PCO2target groups. Median Mental Developmental Index (MDI) values were 82 (60–96, high target) and 84 (58–96, p=0.79). Psychomotor Developmental Index (PDI) values were 84 (57–100) and 84 (65–96, p=0.73), respectively. Moreover, there was no difference in the number of infants with MDI or PDI <70 or <85 and the number of infants with a combined outcome of death or MDI<70 and death or PDI<70. No differences were found between results for GMFCS and CDI. The risk factors for MDI<70 or PDI<70 were intracranial haemorrhage, bronchopulmonary dysplasia, periventricular leukomalacia, necrotising enterocolitis and hydrocortisone treatment.ConclusionsA higher PCO2target did not influence neurodevelopmental outcomes in mechanically ventilated extremely preterm infants. Adjusting PCO2targets to optimise short-term outcomes is a safe option.Trial registration numberISRCTN56143743.
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影响因子：
2
作者：
SOOD, S;GIACOIA, GP
通讯作者：
GIACOIA, GP
影响因子：
8
作者：
Stoll BJ;Hansen NI;Bell EF;Shankaran S;Laptook AR;Walsh MC;Hale EC;Newman NS;Schibler K;Carlo WA;Kennedy KA;Poindexter BB;Finer NN;Ehrenkranz RA;Duara S;Sánchez PJ;O'Shea TM;Goldberg RN;Van Meurs KP;Faix RG;Phelps DL;Frantz ID 3rd;Watterberg KL;Saha S;Das A;Higgins RD;Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
DOI：
10.1097/01.aoa.0000460415.48906.43
发表时间：
2014
期刊：
Obstetric Anesthesia Digest
影响因子：
--
作者：
S. Zivanovic;J. Peacock;Mireia Alcazar;J. Lo;A. Lunt;N. Marlow;S. Calvert;A. Greenough
通讯作者：
A. Greenough
早产儿允许性高碳酸血症的随机试验
影响因子：
--
作者：
Mariani G;C. J;Carlo Wa
通讯作者：
Carlo Wa
影响因子：
76.2
作者：
Thome, Ulrich H.;Genzel-Boroviczeny, Orsolya;Hummler, Helmut D.
通讯作者：
Hummler, Helmut D.