Archives of disease in childhood. Fetal and neonatal edition · 2019
Duration of mechanical ventilation and neurodevelopment in preterm infants.
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Vliegenthart Roos J S, van Kaam Anton H, Aarnoudse-Moens Cornelieke S H, van Wassenaer Aleid G, Onland Wes
Аннотация
OBJECTIVE: To investigate the association between invasive mechanical ventilation (IMV) duration and long-term neurodevelopmental outcomes in preterm infants in an era of restricted IMV.
DESIGN: Retrospective cohort study.
SETTING: Single neonatal intensive care unit in Amsterdam.
PATIENTS: All ventilated patients with a gestational age between 24 and 30 weeks born between 2010 and 2015.
MAIN OUTCOME MEASURES: Neurodevelopmental impairment (NDI) at 24 months corrected age (CA). Data on patient characteristics, respiratory management, neonatal morbidities, mortality and bronchopulmonary dysplasia were collected. The relationship between IMV duration and NDI was determined by multivariate logistic regression analysis.
RESULTS: During the study period, 368 admitted infants received IMV for a median duration of 2 days. Moderate and severe bronchopulmonary dysplasia was diagnosed in 33% of the infant. Multivariate regression analysis with adjustment for gestational age, small for gestational age and socioeconomic status showed a significant association between every day of IMV and NDI at 24 months CA (adjusted OR [aOR] 1.08, 95% CI 1.004 to 1.16, p=0.04). This association only reached borderline significance when also adjusting for severe neonatal morbidity (aOR 1.08, 95% CI 1.00 to 1.17, p=0.05).
CONCLUSION: Even in an era of restricted IMV, every additional day of IMV in preterm infants is strongly associated with an increased risk of NDI at 24 months CA. Limiting IMV should be an important focus in the treatment of preterm infants.
DESIGN: Retrospective cohort study.
SETTING: Single neonatal intensive care unit in Amsterdam.
PATIENTS: All ventilated patients with a gestational age between 24 and 30 weeks born between 2010 and 2015.
MAIN OUTCOME MEASURES: Neurodevelopmental impairment (NDI) at 24 months corrected age (CA). Data on patient characteristics, respiratory management, neonatal morbidities, mortality and bronchopulmonary dysplasia were collected. The relationship between IMV duration and NDI was determined by multivariate logistic regression analysis.
RESULTS: During the study period, 368 admitted infants received IMV for a median duration of 2 days. Moderate and severe bronchopulmonary dysplasia was diagnosed in 33% of the infant. Multivariate regression analysis with adjustment for gestational age, small for gestational age and socioeconomic status showed a significant association between every day of IMV and NDI at 24 months CA (adjusted OR [aOR] 1.08, 95% CI 1.004 to 1.16, p=0.04). This association only reached borderline significance when also adjusting for severe neonatal morbidity (aOR 1.08, 95% CI 1.00 to 1.17, p=0.05).
CONCLUSION: Even in an era of restricted IMV, every additional day of IMV in preterm infants is strongly associated with an increased risk of NDI at 24 months CA. Limiting IMV should be an important focus in the treatment of preterm infants.
Предметные рубрики MeSH
Apgar ScoreBronchopulmonary DysplasiaChild, PreschoolFemaleHumansInfant, NewbornInfant, PrematureInfant, Small for Gestational AgeIntensive Care Units, NeonatalMaleNeurodevelopmental DisordersRespiration, ArtificialRespiratory Function TestsRetrospective StudiesSeverity of Illness IndexSocioeconomic FactorsTime Factors