在极度早产婴儿住带之前提供呼吸辅助:一项随机临床试验
Karen D Fairchild1, Gina R Petroni2, Nikole E Varhegyi2
1Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville.
JAMA network open
|May 17, 2024
概括
在带紧之前的辅助呼吸并没有减少极度早产婴儿的腹腔内出血 (IVH) 或早期死亡. 需要进一步的研究来探索这种干预措施在新生儿中的安全性和有效性.
科学领域:
- 新生儿科学 新生儿科学
- 围产儿医学 围产儿医学
- 临床试验 临床试验
背景情况:
- 极度早产的婴儿面临高风险的腹腔内出血 (IVH) 和过早死亡.
- 延迟带紧是一种常见的做法,但其与辅助通风的结合需要进一步调查.
研究的目的:
- 为了确定辅助通风之后的带紧是否减少IVH或极度早产婴儿的早期死亡 (23 0/7到28 6/7周的妊娠年龄).
主要方法:
- 一个第三阶段的随机临床试验,涉及12个中心的570名极度早产婴儿.
- 婴儿被随机分为120秒的辅助通风,然后紧绳索,或延迟紧绳索 (30-60秒),然后进行复苏.
- 主要结局包括任何IVH等级或在第7天之前死亡,使用Cochran-Mantel-Haenszel测试进行分析.
主要成果:
- 在干预组 (34.9%) 和对照组 (32.5%) (调整后RR,1.02;95%CI,0.81-1.27) 之间没有观察到IVH或早期死亡的显著差异.
- 在"呼吸不好"队列中,干预组的38.7%发生了IVH或死亡,对照组的43.0%发生了IVH或死亡 (RR,0.91;95% CI,0.68-1.21).
- 两组之间死亡,严重脑损伤或重大疾病没有发现差异.
结论:
- 在极度早产的婴儿中,在带紧之前提供辅助通风并没有减少IVH或过早死亡的发生率.
- 需要进行额外的研究,以评估在此脆弱人群中绳紧之前辅助通风的可行性,安全性和有效性.
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