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

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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

Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center at Dallas, TX, USA.
Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.
Department of Neonatology, University of California San Diego, San Diego, CA, USA.
University of Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Alberta, Canada.
Illawarra Health and Medical Research Institute and Graduate Medicine, The University of Wollongong, Wollongong, NSW, Australia.
Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands.
NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.
Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
Parkland Health and Hospital System, Dallas, TX, USA.
Department of Pediatric Research, University of Oslo, Oslo University Hospital, Norway; Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, USA.
Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain.

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）]。