Archives of pediatrics & adolescent medicine · 2008
Prolonged sedation and/or analgesia and 5-year neurodevelopment outcome in very preterm infants: results from the EPIPAGE cohort.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Rozé Jean-Christophe, Denizot Sophie, Carbajal Ricardo, Ancel Pierre-Yves, Kaminski Monique, Arnaud Catherine, Truffert Patrick, Marret Stéphane, Matis Jaqueline, Thiriez Gérard, Cambonie Gilles, André Monique, Larroque Béatrice, Bréart Gérard
Аннотация
OBJECTIVE: To describe the long-term outcome of very preterm infants receiving prolonged sedation and/or analgesia and examine the relationship between prolonged sedation and/or analgesia and this long-term outcome.
DESIGN: A prospective population-based study (Etude EPIdémiologique sur les Petits Ages GEstationnels [EPIPAGE]). To reduce bias, the propensity score method was used.
SETTING: Nine regions of France.
PARTICIPANTS: The study population included very preterm infants of fewer than 33 weeks' gestational age, born in 1997, who received mechanical ventilation and/or surgery. Main Exposure Prolonged exposure to sedative and/or analgesic drugs in the neonatal period, defined as exposure of more than 7 days to sedative and/or opioid drugs.
MAIN OUTCOME MEASURE: Presence of moderate or severe disability at 5 years of age.
RESULTS: The analysis concerns 1572 premature infants who received mechanical ventilation for whom information about exposure to prolonged sedation and/or analgesia in the neonatal period was available. A total of 115 were exposed and 1457 were not exposed. There was no significant difference between the number of patients lost to follow-up from the group of very preterm infants who were exposed to prolonged sedation and/or analgesia and the group who were not. Exposed very preterm infants had severe or moderate disability at 5 years (41/97; 42%) more often than those who were not exposed (324/1248; 26%). After adjustment for gestational age and propensity score, this association was no longer statistically significant (adjusted relative risk, 1.0; 95% confidence interval, 0.8-1.2).
CONCLUSION: Prolonged sedation and/or analgesia is not associated with a poor 5-year neurological outcome after adjustment for the propensity score.
DESIGN: A prospective population-based study (Etude EPIdémiologique sur les Petits Ages GEstationnels [EPIPAGE]). To reduce bias, the propensity score method was used.
SETTING: Nine regions of France.
PARTICIPANTS: The study population included very preterm infants of fewer than 33 weeks' gestational age, born in 1997, who received mechanical ventilation and/or surgery. Main Exposure Prolonged exposure to sedative and/or analgesic drugs in the neonatal period, defined as exposure of more than 7 days to sedative and/or opioid drugs.
MAIN OUTCOME MEASURE: Presence of moderate or severe disability at 5 years of age.
RESULTS: The analysis concerns 1572 premature infants who received mechanical ventilation for whom information about exposure to prolonged sedation and/or analgesia in the neonatal period was available. A total of 115 were exposed and 1457 were not exposed. There was no significant difference between the number of patients lost to follow-up from the group of very preterm infants who were exposed to prolonged sedation and/or analgesia and the group who were not. Exposed very preterm infants had severe or moderate disability at 5 years (41/97; 42%) more often than those who were not exposed (324/1248; 26%). After adjustment for gestational age and propensity score, this association was no longer statistically significant (adjusted relative risk, 1.0; 95% confidence interval, 0.8-1.2).
CONCLUSION: Prolonged sedation and/or analgesia is not associated with a poor 5-year neurological outcome after adjustment for the propensity score.
Предметные рубрики MeSH
Age DistributionAnalgesiaCase-Control StudiesChild, PreschoolConfidence IntervalsProcedural SedationDevelopmental DisabilitiesDisability EvaluationFemaleFollow-Up StudiesFranceGestational AgeHumansIncidenceInfantInfant, NewbornInfant, PrematureIntellectual DisabilityIntensive Care Units, NeonatalMaleMulticenter Studies as TopicProbabilityReference ValuesRespiration, ArtificialRespiratory Distress Syndrome, NewbornRetrospective StudiesRisk AssessmentSex DistributionTime Factors