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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 ( IF 6.5 ) Pub Date : 2021-08-20 , DOI: 10.1016/j.resuscitation.2021.08.023
Vishal Kapadia 1 , Ju Lee Oei 2 , Neil Finer 3 , Wade Rich 3 , Yacov Rabi 4 , Ian M Wright 5 , Denise Rook 6 , Marijn J Vermeulen 6 , William O Tarnow-Mordi 7 , John P Smyth 8 , Kei Lui 8 , Steven Brown 9 , Ola D Saugstad 10 , Maximo Vento 11
Affiliation  

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 (SpO2) 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 SpO2 < 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.



中文翻译:

心动过缓早产儿产房复苏的结果:高与低初始氧浓度随机试验的回顾性队列研究和个体患者数据分析

客观的

旨在确定医院死亡率(主要结果)是否与产房(DR)复苏期间无胸外按压的心动过缓持续时间相关,这是一项针对早产儿的随机对照试验(RCT)回顾性队列研究,初始氧浓度较低与较高。

方法

Medline 和 EMBASE 的检索时间为 1990 年 1 月 1 日至 2020 年 1 月 12 日。低初始氧浓度与高初始氧浓度的随机对照试验(记录胎龄<32周婴儿复苏期间的连续心率(HR)和氧饱和度(SpO 2 ))是合格的。作者要求提供个体患者水平的数据。在 DR 中接受胸外按压的新生儿以及出生后 2 分钟内没有记录 HR 的新生儿被排除在外。长时间心动过缓 (PB) 定义为 HR < 100 bpm ≥2 分钟。进行了个体患者数据分析和汇总数据分析。

结果

数据收集自 8 项随机对照试验中的 720 名婴儿。调整潜在混杂因素后,患有 PB 的新生儿在 [OR 3.8 (95% CI 1.5, 9.3)] 和之后 [OR 1.7 (1.2, 2.5)] 的医院死亡几率较高。58% 的婴儿出现心动过缓,38% 的婴儿患有 PB。患有心动过缓的婴儿早产率更高,出生体重也更低。低氧(≤30%)和高氧(≥60%)复苏的婴儿心动过缓的发生率相似。出生后 5 分钟时 PB 和 SpO 2 < 80%的新生儿 住院死亡率较高。[或18.6(4.3,79.7)]。

结论

对于在 DR 中未接受胸外按压的早产儿,长期心动过缓与医院死亡率相关。

更新日期:2021-09-14
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