Hypothermia for perinatal asphyxia: trial-based quality of life at 6-7 years
Hypothermia for perinatal asphyxia: trial-based quality of life at 6-7 years
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DOI：
10.1136/archdischild-2017-313733
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发表时间：
2018-07-01
影响因子：
5.2
通讯作者：
Rivero-Arias, Oliver
中科院分区：
文献类型：
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作者：
Campbell, Helen;Eddama, Oya;Rivero-Arias, Oliver
目的评估出生时低温神经抢救对儿童中期健康相关生活质量（HRQL）的影响。设计对来自全身低温治疗新生儿脑病（TOBY）试验的存活儿童进行6年至7年的随访。设置社区研究，包括单亲问卷调查，以收集儿童HRQL的信息。患者145名儿童（对照组70人，低温组75人），其父母同意并返回问卷。干预措施重症监护与身体冷却到33.5摄氏度72小时或重症监护单独。主要结果测量HRQL属性和效用得分使用健康效用指数（HUI）。与HRQL的其他方面相比，言语似乎受到不成比例的影响，但两组的正常情绪功能水平相似。平均（SE）HUI 3 HRQL评分在低温组为0.73（0.05），在对照组为0.62（0.06）;平均差异（95%CI）为0.11（-0.04至0.26）。结论非显著性差异的发现并不意外;该研究使用的数据来自新生儿试验中的长期存活者，效力不足。然而，结果有利于中度低温，因此补充了托比儿童研究的临床结果。这项工作提供了进一步了解围产期窒息性脑病的长期HRQL的影响，并提供了以前不可用的实用数据，以考虑低温神经抢救的长期成本效益。
Objective To assess the impact of hypothermic neural rescue at birth on health-related quality of life (HRQL) in middle childhood.Design Six-year to 7-year follow-up of surviving children from the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) Trial.Setting Community study including a single parental questionnaire to collect information on children's HRQL.Patients 145 children (70 in the control group, 75 in the hypothermia group) whose parents consented and returned the questionnaire.Interventions Intensive care with cooling of the body to 33.5 degrees C for 72 hours or intensive care alone.Main outcome measures HRQL attributes and utility scores using the Health Utilities Index (HUI).Results At 6-7 years, speech appeared disproportionately affected when compared with other aspects of HRQL but levels of normal emotional functioning were similar in both groups. The mean (SE) HUI3 HRQL scores were 0.73 (0.05) in the hypothermia group and 0.62 (0.06) in the control group; mean difference (95% CI) 0.11 (-0.04 to 0.26).Conclusions Findings of non-significant differences were not unexpected; the study used data from long-term survivors in a neonatal trial and was underpowered. However, results favoured moderate hypothermia and so complement the clinical results of the TOBY Children study. The work provides further insight into the long-term HRQL impact of perinatal asphyxial encephalopathy and provides previously unavailable utility data with which to contemplate the longer term cost-effectiveness of hypothermic neural rescue.