Predicting death or tracheostomy placement in infants with severe bronchopulmonary dysplasia
Predicting death or tracheostomy placement in infants with severe bronchopulmonary dysplasia
复制标题
DOI：
10.1038/jp.2014.35
复制
发表时间：
2014-07-01
影响因子：
2.9
通讯作者：
Evans, J. R.
中科院分区：
文献类型：
--
作者：
Murthy, K.;Savani, R. C.;Evans, J. R.
目的：评估出生32周的重度支气管肺发育不良(SBPD)婴儿死亡或气管切开术(D/T)的风险。研究设计：采用儿童医院新生儿数据库，对2010-2011年出生32周的sBPD婴儿进行回顾性队列研究。SBPD定义为月经后36周需要FiO(2)和Gt；=0.3，鼻插管支持和Gt；2 L分钟(-1)或正压。主要结果是出院前的D/T。使用双变量分析中与D/T相关的预测因子(P<；0.2)，使用80%的队列建立多变量Logistic回归方程。结果：在793名符合条件的患者中，平均孕周为26周，转诊时的中位年龄为6.4周。D/T发生率为20%。多变量分析显示，出生时较晚的胎龄、转诊时较晚的年龄以及转诊时的肺部管理是转诊的主要原因，转诊时的机械通气、临床诊断的肺动脉高压、转诊后的全身皮质激素以及转诊后发生的血流感染都与D/T相关。模型的验证效果良好(曲线下面积0.86，拟合度CHI(2)，P=0.66)。结论：7个临床变量预测了与sBPD相关的D/T。这些结果可以用来通知为受影响婴儿的家庭提供咨询的临床医生，并帮助设计未来的前瞻性试验。
OBJECTIVE: To estimate the risk of death or tracheostomy placement (D/T) in infants with severe bronchopulmonary dysplasia (sBPD) born < 32 weeks' gestation referred to regional neonatal intensive care units.STUDY DESIGN: We conducted a retrospective cohort study in infants born < 32 weeks' gestation with sBPD in 2010-2011, using the Children's Hospital Neonatal Database. sBPD was defined as the need for FiO(2) >= 0.3, nasal cannula support > 2 l min(-1) or positive pressure at 36 weeks' post menstrual age. The primary outcome was D/T before discharge. Predictors associated with D/T in bivariable analyses (P < 0.2) were used to develop a multivariable logistic regression equation using 80% of the cohort. This equation was validated in the remaining 20% of infants.RESULT: Of 793 eligible patients, the mean gestational age was 26 weeks' and the median age at referral was 6.4 weeks. D/T occurred in 20% of infants. Multivariable analysis showed that later gestational age at birth, later age at referral along with pulmonary management as the primary reason for referal, mechanical ventilation at the time of referral, clinically diagnosed pulmonary hypertension, systemic corticosteroids after referral and occurrence of a bloodstream infection after referral were each associated with D/T. The model performed well with validation (area under curve 0.86, goodness-of-fit chi(2), P = 0.66).CONCLUSION: Seven clinical variables predicted D/T in this large, contemporary cohort with sBPD. These results can be used to inform clinicians who counsel families of affected infants and to assist in the design of future prospective trials.