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预防性皮和新生儿中败血症的风险 极度早产的新生儿
Olivier Baud1,2,3, Philippe Lehert4,5,
1Obstetric, Perinatal, Paediatric and Life Course Epidemiology Team (OPPaLE), Center for Research in Epidemiology and StatisticS (CRESS), Alimentation Et L'Environnement (INRAe), Institut National Pour La Santé Et La Recherche Médicale (INSERM, French Institute for Health and Medical ResearchInstitut National de Recherche Pour L'Agriculture, l'Paris Cité University, Paris, France. olivier.baud@aphp.fr.
在极度早产的婴儿中,预防性皮 (HC) 并不会显著增加晚发性败血症 (LOS) 的风险. 虽然HC改善了没有支气管肺功能失调的生存率,但其对LOS风险的影响在统计学上并不显著.
科学领域:
- 新生儿医学 新生儿医学
- 儿科重症监护 儿科重症监护
- 药理学 药理学是指药理学的学科.
背景情况:
- 支气管肺功能障碍症 (BPD) 是极端早产的严重并发症,治疗选择有限.
- 产后使用类固醇预防BPD是有争议的,尽管预防性皮 (HC) 改善了没有BPD的生存率.
- 在极度早产新生儿的预防性HC中报告了晚发性败血症 (LOS) 的风险增加,但因果关系尚不清楚.
研究的目的:
- 为了评估预防性HC对极度早产新生儿LOS风险的影响,调整为周产因素.
- 调查影响3日后LOS发生率的产后因素.
- 评估预防性HC和LOS风险之间的潜在相互作用.
主要方法:
- 重新分析PREMILOC试验数据.
- 利用波桑,考克斯回归和竞争风险的统计模型.
- 根据包括妊娠年龄,分娩方式和补充皮质类固醇使用在内的共同变量进行调整.
主要成果:
- 在HC暴露和LOS风险之间没有发现显著的关联 (RR1.041,P=0.817).
- 竞争性风险分析证实HC对LOS没有显著影响 (HR 1.105,P=0.560).
- 预防性HC显著降低了竞争性死亡率 (HR 0.427,P<0.001).
结论:
- 与安慰剂相比,预防性HC并没有显著改变极度早产婴儿晚发性败血症的风险.
- LOS与HC的风险比率处于[0.90-1.10]区间内,表明没有显著影响.
- 预防性HC治疗显著降低了这一群体的死亡率.
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