PDF(Pubmed)
Abstract：
Rationale: Increasing survival of extremely preterm infants with a stable rate of severe intraventricular hemorrhage represents a growing health risk for neonates. Objectives: To evaluate the role of early hemodynamic screening (HS) on the risk of death or severe intraventricular hemorrhage. Methods: All eligible patients 22-26+6 weeks\' gestation born and/or admitted <24 hours postnatal age were included. As compared with standard neonatal care for control subjects (January 2010-December 2017), patients admitted in the second epoch (October 2018-April 2022) were exposed to HS using targeted neonatal echocardiography at 12-18 hours. Measurements and Main Results: A primary composite outcome of death or severe intraventricular hemorrhage was decided a priori using a 10% reduction in baseline rate to calculate sample size. A total of 423 control subjects and 191 screening patients were recruited with a mean gestation and birth weight of 24.7 ± 1.5 weeks and 699 ± 191 g, respectively. Infants born at 22-23 weeks represented 41% (n = 78) of the HS epoch versus 32% (n = 137) of the control subjects (P = 0.004). An increase in perinatal optimization (e.g., antepartum steroids) but with a decline in maternal health (e.g., increased obesity) was seen in the HS versus control epoch. A reduction in the primary outcome and each of severe intraventricular hemorrhage, death, death in the first postnatal week, necrotizing enterocolitis, and severe bronchopulmonary dysplasia was seen in the screening era. After adjustment for perinatal confounders and time, screening was independently associated with survival free of severe intraventricular hemorrhage (OR 2.09, 95% CI [1.19, 3.66]). Conclusions: Early HS and physiology-guided care may be an avenue to further improve neonatal outcomes; further evaluation is warranted.
摘要：
原理：严重脑室内出血发生率稳定的极早产儿生存率增加代表新生儿健康风险增加。目的：评估早期血流动力学筛查（HS）在死亡或严重脑室内出血风险中的作用。方法：纳入所有符合条件的妊娠22-26+6周出生和/或出生后<24小时年龄的患者。与对照组的标准新生儿护理（2010年1月至2017年12月）相比，在第2个时期(2018年10月-2022年4月)收治的患者在12-18小时使用靶向新生儿超声心动图暴露于HS.测量和主要结果：死亡或严重脑室内出血的主要复合结局是使用基线率降低10％来计算样本量的先验决定的。共招募423名对照受试者和191名筛查患者，平均妊娠和出生体重为24.7±1.5周和699±191g，分别。22-23周出生的婴儿占HS时期的41％（n=78），而对照组为32％（n=137）（P=0.004）。围产期优化的增加(例如，产前类固醇)，但孕产妇健康下降(例如，与对照组相比，在HS时期观察到肥胖增加）。主要结局和严重脑室内出血的减少，死亡,出生后第一周死亡，坏死性小肠结肠炎,在筛查时代发现了严重的支气管肺发育不良。在调整围产期混杂因素和时间后，筛查与无严重脑室内出血生存率独立相关(OR2.09,95%CI[1.19,3.66]).结论：早期HS和生理指导护理可能是进一步改善新生儿结局的途径；需要进一步评估。
