Perinatal Asphyxia with Hyperoxemia within the First Hour of Life Is Associated with Moderate to Severe Hypoxic-Ischemic Encephalopathy
Perinatal Asphyxia with Hyperoxemia within the First Hour of Life Is Associated with Moderate to Severe Hypoxic-Ischemic Encephalopathy
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DOI：
10.1016/j.jpeds.2013.04.043
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发表时间：
2013-10-01
影响因子：
5.1
通讯作者：
Wyckoff, Myra H.
中科院分区：
文献类型：
--
作者：
Kapadia, Vishal S.;Chalak, Lina F.;Wyckoff, Myra H.
目的探讨重度围产期酸血症新生儿早期高氧血症是否与缺氧缺血性脑病（hypoxic-ischemic encephalopathy，HIE.Study design）的发生有关。我们对出生于帕克兰医院的120名胎龄≥ 36周的围产期酸中毒婴儿进行了神经系统筛查，以进行降温治疗。根据出生后第一个小时内的PaO 2测量结果，将队列分为高氧血症（PaO 2>100 mmHg）和无高氧血症（PaO 2>100 mmHg）的婴儿。患有和不患有高氧血症的婴儿具有相似的基线母体和婴儿特征。有高氧血症的新生儿比无高氧血症的新生儿有更高的HIE发生率（58%比27%; P = 0.003）。入院时高氧血症与HIE的高风险相关（OR，4; 95%CI，1.4-10.5;校正后P = 0.01）。在出生后6小时内有中重度HIE的新生儿中，与无高氧血症的新生儿相比，有高氧血症的新生儿有更高的脑磁共振成像结果异常发生率，与缺氧缺血性损伤一致（79%vs 33%，P = 0.015）。结论在有围产期酸血症的新生儿中，入院时高氧血症与更高的HIE发生率相关。在新生儿缺氧缺血性脑病中，入院时高氧血症与脑磁共振成像异常相关。在复苏过程中和复苏后明智地使用氧气是必要的。
Objective To determine whether early hyperoxemia in neonates with severe perinatal acidemia is associated with the development of hypoxic-ischemic encephalopathy (HIE).Study design We identified 120 infants at >= 36 weeks gestational age with perinatal acidosis born at Parkland Hospital who qualified for a screening neurologic exam for cooling therapy. Based on a PaO2 measurement during the first hour of life, the cohort was divided into infants with hyperoxemia (PaO2 >100 mmHg) and those without hyperoxemia (PaO2 100 mmHg. Infants with and without hyperoxemia had similar baseline maternal and infant characteristics. Infants with hyperoxemia had a higher incidence of HIE than those without hyperoxemia (58% vs 27%; P = .003). Admission hyperoxemia was associated with a higher risk of HIE (OR, 4; 95% CI, 1.4-10.5; adjusted P = .01). Among the neonates with moderate-severe HIE during the first 6 hours of life, those with hyperoxemia had a higher incidence of abnormal brain magnetic resonance imaging results, consistent with hypoxic ischemic injury, compared with those without hyperoxemia (79% vs 33%; P = .015).Conclusion In neonates with perinatal acidemia, admission hyperoxemia is associated with a higher incidence of HIE. Among neonates with HIE, admission hyperoxemia is associated with abnormal brain magnetic resonance imaging findings. The judicious use of oxygen during and after resuscitation is warranted.