首页>
外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics
>Decreased Incidence of Bronchopulmonary Dysplasia After Early Management Changes, Including Surfactant and Nasal Continuous Positive Airway Pressure Treatment at Delivery, Lowered Oxygen Saturation Goals, and Early Amino Acid Administration: A Historical Cohort Study
【24h】
Decreased Incidence of Bronchopulmonary Dysplasia After Early Management Changes, Including Surfactant and Nasal Continuous Positive Airway Pressure Treatment at Delivery, Lowered Oxygen Saturation Goals, and Early Amino Acid Administration: A Historical Cohort Study
OBJECTIVE. The goal was to investigate the clinical impact of 3 early management practice changes for infants of ≤1000 g.METHODS. We performed an historical cohort study of appropriately sized, preterm infants without congenital anomalies who were born between January 2001 and June 2002 (pre–early management practice change group; n = 87) and between July 2004 and December 2005 (post–early management practice change group; n = 76).RESULTS. Only 1 (1%) of 87 infants in the pre–early management practice change group received continuous positive airway pressure treatment in the first 24 hours of life, compared with 61 (80%) of 76 infants in the post–early management practice change group. The proportions of infants who required any synchronized intermittent mandatory ventilation during their hospital stays were 98.8% and 59.5%, respectively. The mean durations of synchronized intermittent mandatory ventilation were 35 days and 15 days, respectively. The combined incidence rates of moderate and severe bronchopulmonary dysplasia at corrected gestational age of 36 weeks were 43% and 24%, respectively. The use of vasopressor support for hypotension in the first 24 hours of life decreased from 39.1% (before early management practice changes) to 19.7% (after practice changes), the cumulative days of oxygen therapy decreased from 77 ± 52 days to 56 ± 47 days, and the proportions of infants discharged with home oxygen therapy decreased from 25.7% to 10.1%; the incidence of patent ductus arteriosus requiring surgical ligation increased from 1% to 10%.There were no differences in rates of death, intraventricular hemorrhage, periventricular leukomalacia, pneumothorax, necrotizing enterocolitis, or retinopathy of prematurity.CONCLUSIONS. Successful early management of extremely preterm infants with surfactant treatment followed by continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid supplementation is possible and is associated with reductions in the incidence and severity of bronchopulmonary dysplasia.
展开▼
机译：目的。目的是研究3种早期治疗实践变化对≤1000 g.METHODS的婴儿的临床影响。我们对2001年1月至2002年6月之间（早期管理实践变更组; n = 87）和2004年7月至2005年12月之间（早期管理实践）出生的，适当大小的无先天异常的早产儿进行了历史队列研究。变更组; n = 76）。结果。早期管理实践改变组中的87名婴儿中，只有1（1％）的婴儿在出生后的头24小时接受了持续的气道正压通气治疗，相比之下，早期管理实践改变中的76婴儿中的61（80％）组。在住院期间需要同步间歇强制通气的婴儿比例分别为98.8％和59.5％。同步间歇性强制通气的平均持续时间分别为35天和15天。校正胎龄为36周时，中度和重度支气管肺发育不良的合并发生率分别为43％和24％。生命最初24小时使用降压药支持降压的比例从39.1％（在进行早期管理变更之前）降至19.7％（在实施变更之后），氧气治疗的累积天数从77±52天减少至56±47天天数，接受家庭氧气治疗的婴儿比例从25.7％降至10.1％;结论：需要手术结扎的动脉导管未闭的发生率从1％增加到10％。死亡率，脑室内出血，脑室白细胞减少，气胸，坏死性小肠结肠炎或早产儿视网膜病变的发生率无差异。通过表面活性剂治疗成功地对极早产儿进行成功的早期治疗，然后在分娩时进行连续气道正压治疗，降低氧饱和度目标和尽早补充氨基酸是可能的，这与减少支气管肺发育不良的发生率和严重程度有关。
展开▼
