Risk factors for pneumothorax in very low birth weight infants
Risk factors for pneumothorax in very low birth weight infants
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DOI：
10.1097/pcc.0b013e31816c6e55
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发表时间：
2008-07-01
影响因子：
4.1
通讯作者：
Linder, Neharna
中科院分区：
文献类型：
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作者：
Klinger, Gil;Ish-Hurwitz, Shany;Linder, Neharna
目的：确定极低出生体重婴儿气胸的危险因素。设计：回顾性病例对照研究。设置。儿科三级护理中心的新生儿重症监护室。患者。极低出生体重婴儿。干预措施：确定1997年1月至2002年12月期间出生的所有患有气胸的极低出生体重婴儿。这些婴儿与无气胸的婴儿的胎龄、出生体重和性别相匹配。收集所有婴儿的围产期、新生儿和治疗变量。测量和主要结果：将患有气胸的极低出生体重婴儿与没有气胸的婴儿进行比较。使用对连续变量的配对学生 t 检验和对分类变量的 McNemar 检验进行单变量分析。使用配对病例对照设计将所有变量输入逐步逻辑回归模型。统计显着性定义为 p < .05。入住新生儿重症监护病房的 679 名极低出生体重婴儿中，有 74 名（10.9%）出现气胸，并与 74 名对照婴儿进行匹配。多变量分析显示，只有气胸当天存在的因素与气胸相关。气胸风最大动脉CO2（OR 1.94，95% Cl 1.13，3.34），而风险降低与最大呼气末正压相关（OR 0.71，95% Cl 0.56，0.91）。结论。气胸与气胸当天存在的因素有关，与初始通气变量或肺部疾病的初始严重程度无关。降低气胸风险需要严格控制通气，包括优化呼气末正压和最小化吸气峰值压力。
Objectives: To identify risk factors for pneumothorax in very low birth weight infants.Design: Retrospective case-control study.Setting. Neonatal intensive care unit in a pediatric tertiary care center.Patients. Very low birth weight infants.Interventions: All very low birth weight infants with pneumothorax born during the period January 1997 through December 2002 were identified. These infants were matched to infants without pneumothorax for gestational age, birth weight, and gender. Perinatal, neonatal, and treatment variables were collected for all infants.Measurements and Main Results: Very low birth weight infants with pneumothorax were compared with those without. Univariate analysis was performed using the paired Student's t-test for continuous variables and the McNemar test for categorical variables. All variables were entered into a stepwise logistic regression model using a paired case-control design. Statistical significance was defined at p < .05. Seventy-four of 679 very low birth weight infants (10.9%) admitted to the neonatal intensive care unit developed a pneumothorax and were matched to 74 control infants. Multivariate analysis showed that only factors present on the day of pneumothorax were associated with pneumothorax. An increased risk of pneumothorax was associated with maximal, peak inspiratory pressure (odds ratio [OR] 1.33, 95% confidence interval [Cl] 1.07,1.66), minimal FIO2, (OR 2.18, 95% Cl 1.14, 4.17), pulmonary hemorrhage (OR 27.5, 95% Cl 2.3, 337), and maximal arterial CO2 (OR 1.94, 95% Cl 1.13, 3.34), while a decreased risk was associated with maximal positive end-expiratory pressure (OR 0.71, 95% Cl 0.56, 0.91).Conclusions. Pneumothorax is associated with factors present on day of pneumothorax and not with initial ventilation variables or initial severity of lung disease. Decreasing the risk of pneumothorax requires rigorous control of ventilation, including optimizing positive end-expiratory pressure and minimizing peak inspiratory pressure.