Outcomes of delivery room resuscitation of bradycardic preterm infants: A retrospective cohort study of randomised trials of high vs low initial oxygen concentration and an individual patient data analysis

RESUSCITATION

卷:167

Article

Kapadia, Vishal¹  Oei, Ju Lee^2,3,4  Finer, Neil⁵  Rich, Wade⁵  Rabi, Yacov^6,7  Wright, Ian M.⁸  Rook, Denise⁹  Vermeulen, Marijn J.⁹  Tarnow-Mordi, William O.³  Smyth, John P.^1,2  Lui, Kei^1,2  Brown, Steven¹⁰  Saugstad, Ola D.^11,12  Vento, Maximo¹³ 

[1] UT Southwestern Med Ctr Dallas, Div Neonatal Perinatal Med, Dallas, TX 75390 USA

[2] Royal Hosp Women, Dept Newborn Care, Randwick, NSW, Australia

[3] Univ New South Wales, Sch Womens & Childrens Hlth, Randwick, NSW, Australia

[4] Univ Sydney, NHMRC Clin Trials Ctr, Camperdown, NSW, Australia

[5] Univ Calif San Diego, Dept Neonatol, San Diego, CA 92103 USA

[6] Univ Calgary, Calgary, AB, Canada

[7] Alberta Childrens Hosp Res Inst, Calgary, AB, Canada

[8] Univ Wollongong, Illawarra Hlth & Med Res Inst & Grad Med, Wollongong, NSW, Australia

[9] Sophia Childrens Univ Hosp, Div Neonatol, Dept Pediat, Erasmus Med Ctr, Rotterdam, Netherlands

[10] Parkland Hlth & Hosp Syst, Dallas, TX USA

[11] Univ Oslo, Oslo Univ Hosp, Dept Pediat Res, Oslo, Norway

[12] Northwestern Univ, Ann & Robert H Lurie Childrens Hosp Chicago, Feinberg Sch Med, Evanston, IL 60208 USA

[13] Univ & Polytech Hosp La Fe, Div Neonatol, Valencia, Spain

关键词: Bradycardia;    Neonatal resuscitation;    Death;    Mortality;    Oxygen saturation;    Heart rate;    Newborn;    Systematic review;    Neonatal Resuscitation Program;    International Liaison Committee on Resuscitation;    Oxygen;    Bronchopulmonary dysplasia;    Intraventricular hemorrhage;   

DOI  :  10.1016/j.resuscitation.2021.08.023

来源: Elsevier

【 摘 要 】

Objective: To determine whether hospital mortality (primary outcome) is associated with duration of bradycardia without chest compressions during delivery room (DR) resuscitation in a retrospective cohort study of randomized controlled trials (RCTs) in preterm infants assigned low versus high initial oxygen concentration. Methods: Medline and EMBASE were searched from 01/01/1990 to 12/01/2020. RCTs of low vs high initial oxygen concentration which recorded serial heart rate (HR) and oxygen saturation (SpO(2)) during resuscitation of infants <32 weeks gestational age were eligible. Individual patient level data were requested from the authors. Newborns receiving chest compressions in the DR and those with no recorded HR in the first 2 min after birth were excluded. Prolonged bradycardia (PB) was defined as HR < 100 bpm for >= 2 min. Individual patient data analysis and pooled data analysis were conducted. Results: Data were collected from 720 infants in 8 RCTs. Neonates with PB had higher odds of hospital death before [OR 3.8 (95% CI 1.5, 9.3)] and after [OR 1.7 (1.2, 2.5)] adjusting for potential confounders. Bradycardia occurred in 58% infants, while 38% had PB. Infants with bradycardia were more premature and had lower birth weights. The incidence of bradycardia in infants resuscitated with low (<= 30%) and high (>= 60%) oxygen was similar. Neonates with both, PB and SpO(2) < 80% at 5 min after birth had higher odds of hospital mortality. [OR 18.6 (4.3, 79.7)]. Conclusion: In preterm infants who did not receive chest compressions in the DR, prolonged bradycardia is associated with hospital mortality.

【 授权许可】

Free