Outcomes of extremely low birthweight infants with acidosis at birth
Outcomes of extremely low birthweight infants with acidosis at birth
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DOI：
10.1136/archdischild-2013-304179
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发表时间：
2014-07-01
影响因子：
4.4
通讯作者：
Higgins, Rosemary D.
中科院分区：
文献类型：
--
作者：
Randolph, David A.;Nolen, Tracy L.;Higgins, Rosemary D.
目的验证出生时酸中毒与极低出生体重（ELBW）婴儿死亡或神经发育障碍（NDI）相关的假设，并建立一个以围产期酸中毒为预测变量的死亡/NDI预测模型。研究人群包括2002年至2007年在国家儿童健康与发展研究所（NICHD）新生儿研究网络医院出生的低体重婴儿。纳入了具有脐带血数据和出院前死亡率或18-22个月神经发育结局记录的婴儿。采用多元logistic回归分析来确定围产期酸中毒（定义为pH < 7或碱过量(BE) < -12的脐带血气体）对ELBW婴儿死亡/NDI的影响。此外，还建立了预测死亡/NDI的多变量模型。结果3979例患者中249例脐带气pH < 7或BE < -12 mEq/L。2124例（53%）患者的主要结局为死亡/NDI。校正混杂变量后，pH < 7和BE < -12 mEq/L均与死亡/NDI显著相关（OR=2.5（1.6, 4.2）和OR=1.5(1.1, 2.0)）。然而，纳入pH或BE并没有提高多变量模型预测死亡/NDI的能力。结论围产期酸中毒与ELBW婴儿死亡/NDI显著相关。然而，围产期酸中毒在新生儿中并不常见，其他因素在预测死亡/NDI方面更为重要。
Objectives To test the hypothesis that acidosis at birth is associated with the combined primary outcome of death or neurodevelopmental impairment (NDI) in extremely low birthweight (ELBW) infants, and to develop a predictive model of death/NDI exploring perinatal acidosis as a predictor variable.Study design The study population consisted of ELBW infants born between 2002 and 2007 at National Institute of Child Health and Development (NICHD) Neonatal Research Network hospitals. Infants with cord blood gas data and documentation of either mortality prior to discharge or 18-22 month neurodevelopmental outcomes were included. Multiple logistic regression analysis was used to determine the contribution of perinatal acidosis, defined as a cord blood gas with a pH < 7 or base excess (BE) < -12, to death/NDI in ELBW infants. In addition, a multivariable model predicting death/NDI was developed.Results 3979 patients were identified of whom 249 had a cord gas pH < 7 or BE < -12 mEq/L. 2124 patients (53%) had the primary outcome of death/NDI. After adjustment for confounding variables, pH < 7 and BE < -12 mEq/L were each significantly associated with death/NDI (OR=2.5 (1.6, 4.2) and OR=1.5 (1.1, 2.0), respectively). However, inclusion of pH or BE did not improve the ability of the multivariable model to predict death/NDI.Conclusions Perinatal acidosis is significantly associated with death/NDI in ELBW infants. Perinatal acidosis is infrequent in ELBW infants, however, and other factors are more important in predicting death/NDI.