Lower versus higher oxygen concentration for delivery room stabilisation of preterm neonates: systematic review.
Lower versus higher oxygen concentration for delivery room stabilisation of preterm neonates: systematic review.
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DOI：
10.1371/journal.pone.0052033
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
McGuire W
中科院分区：
文献类型：
--
作者：
Brown JV;Moe-Byrne T;Harden M;McGuire W
新出现的证据表明，使用较低浓度的氧气而不是较高浓度的氧气对足月儿进行产房呼吸支持或复苏可降低死亡率和严重发病率的风险。与足月儿相比，早产儿呼吸窘迫的潜在原因和出生时的伤害风险不同，因此该策略对早产儿的适用性存在不确定性。我们对随机对照试验进行了系统回顾和荟萃分析，以确定早产儿使用较低（21- 50%）与较高（>50%）氧气浓度进行产房过渡支持对死亡率和发病率的影响。我们确定了6项随机对照试验，共有484名婴儿参加。大多数参与者是妊娠32周前出生的早产儿。一项试验是准随机的，在一项试验中没有描述分配隐藏。除了一项试验外，临床医生和研究人员都知道干预措施。荟萃分析发现死亡风险的统计学显著降低，合并风险比为0.65（95%置信区间0.43，0.98），但当仅纳入4项充分隐藏分配的试验时，这种效应消失[合并风险比1.0（95%置信区间0.45，2.24）]。这些试验均未评估任何神经发育结局。现有的试验数据没有提供强有力的证据表明，早产儿使用较低或较高的氧气浓度进行产房过渡支持会带来重要的益处或危害。缺乏分配隐藏和临床医生和评估者的盲法是现有试验中偏倚的主要来源。此外，还需要大型高质量的试验来解决持续的不确定性并为临床实践提供信息。
Emerging evidence suggests that initiating delivery room respiratory support or resuscitation for term infants using lower rather than higher concentrations of oxygen reduces mortality and the risk of serious morbidity. Uncertainty exists with regard to applicability of this strategy for preterm infants who have different underlying reasons for respiratory distress and risks for harm at birth than term infants. We performed a systematic review and meta-analysis of randomised controlled trials to determine the effect on mortality and morbidity of using lower (21– 50%) versus higher (>50%) oxygen concentrations for delivery room transition support of preterm infants. We identified six randomised controlled trials in which a total of 484 infants participated. Most participants were preterm infants born before 32 weeks’ gestation. One trial was quasi-randomised and in one trial allocation concealment was not described. Clinicians and investigators were aware of the interventions in all but one trial. Meta-analyses found a statistically significant reduction in the risk of death pooled risk ratio 0.65 (95% confidence interval 0.43, 0.98), but this effect disappeared when only the four trials with adequate allocation concealment were included [pooled risk ratio 1.0 (95% confidence interval 0.45, 2.24)]. None of the trials has evaluated any neuro-developmental outcomes. The available trial data do not provide strong evidence that using lower versus higher oxygen concentrations for delivery room transition support for preterm infants confers important benefits or harms. Lack of allocation concealment and blinding of clinicians and assessors are the major sources of bias in the existing trials. Further, large, good-quality trials are needed to resolve on-going uncertainties and inform clinical practice.
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影响因子：
15.8
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
影响因子：
2.5
作者：
Rook D;Schierbeek H;van der Eijk AC;Longini M;Buonocore G;Vento M;van Goudoever JB;Vermeulen MJ
通讯作者：
Vermeulen MJ
影响因子：
1.7
作者：
Bhola, Kavita;Lui, Kei;Oei, Ju Lee
通讯作者：
Oei, Ju Lee
影响因子：
5.1
作者：
O'Donnell, Colm P. F.;Kamlin, C. Omar F.;Morley, Colin J.
通讯作者：
Morley, Colin J.
影响因子：
8
作者：
Vento, Maximo;Moro, Manuel;Asensi, Miguel A.
通讯作者：
Asensi, Miguel A.