产后德克萨米他时间对早产死亡率和支气管肺功能失调的影响:倾向性评分分析
T'ng Chang Kwok1, Lisa Szatkowski1, Don Sharkey2
1Centre for Perinatal Research, Population and Lifespan Science, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
The European respiratory journal
|August 17, 2023
概括
在早产婴儿中晚些时候,即5周后,开始产后德克萨米他 (PND) 与更糟糕的呼吸结果和死亡有关. 早期PND (2-3周) 可能对高风险婴儿更安全. 需要进行进一步的试验.
科学领域:
- 新生儿科学 新生儿科学
- 儿科肺病学 儿科肺病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 产后德克萨米他 (PND) 用于高风险的早产婴儿,以促进输出并预防支气管肺功能障碍 (BPD).
- 启动PND的最佳时间仍然不确定,影响临床决策.
- 这项研究调查了PND时间和婴儿结果之间的关联.
研究的目的:
- 探索产后德克萨米他 (PND) 启动时间与早产婴儿的死亡率和呼吸系统结局之间的关系.
- 为了确定特定的PND治疗窗口是否与改善或恶化的结果有关.
主要方法:
- 来自国家新生儿研究数据库 (2010-2020) 的84,440名早产婴儿 (GA<32周) 的回顾性分析.
- 倾向性评分权重被用于分析2至3周 (PND2/3),4至5周 (PND4/5),5周后 (PND6+) 开始的PND.
- 主要结局:出院前死亡和/或严重BPD的综合结局;次要结局包括输出管的时间和出院时的呼吸支.
主要成果:
- 与PND2/3.3相比,接受PND6+的婴儿死亡/严重BPD (OR 1.68) 和晚期输出口 (3.1周) 的几率较高.
- PND6+与较低的住院死亡率 (OR 0.38) 相关,但在出院时增加了对呼吸系统支持的需求 (OR 1.34).
- PND4/5 没有与严重的 BPD 或排泄呼吸支有显著的关联.
结论:
- 在5周后开始PND与不良的呼吸系统结果有关,尽管残留偏差是可能的.
- 这些发现表明,对于某些结果,较早的PND启动 (2-3周) 有潜在的益处.
- 建议进行临床试验,以使用早期风险分层来确定最佳的PND治疗窗口.
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