HYPOCAPNIA BEFORE SURFACTANT THERAPY APPEARS TO INCREASE BRONCHOPULMONARY DYSPLASIA RISK IN INFANTS WITH RESPIRATORY-DISTRESS SYNDROME

被引：112

作者：

GARLAND, JS

BUCK, RK

ALLRED, EN

LEVITON, A

机构：

[1] HARVARD UNIV, SCH MED, JOINT PROGRAM NEONATOL, BOSTON, MA USA

[2] HARVARD UNIV, SCH MED, DEPT NEUROL, BOSTON, MA 02115 USA

[3] CHILDRENS HOSP, BOSTON, MA 02115 USA

来源：

ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE | 1995年 / 149卷 / 06期

关键词：

D O I：

10.1001/archpedi.1995.02170190027005

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Objective: To determine to what extent the risk of bronchopulmonary dysplasia is affected by ventilatory management before the first dose of rescue artificial surfactant. Study Design: Retrospective cohort study. Subjects: One hundred eighty-eight low-birth-weight infants (less than or equal to 1700 g) who received artificial surfactant therapy for respiratory distress syndrome and who were alive at 36 weeks of gestational age. Outcome: Bronchopulmonary dysplasia was defined by a need for supplemental oxygen to maintain an arterial saturation of 92% or more at 36 weeks of gestational age. Results: Thirty-seven percent (70/188) of the cohort met study criteria for bronchopulmonary dysplasia. Early determinants significantly associated with bronchopulmonary dysplasia (given as odds ratio, 95% confidence interval) in the most parsimonious backward stepwise logistic regression model included the following: birth weight of 1000 g or less (5.1, 2.4 to 10.7), cesarean birth because of fetal distress (4.4, 1.7 to 11.4),ventilatory efficiency index of 0.15 or less before surfactant therapy (3.1, 1.4 to 6.8), arterial-alveolar oxygen ratio of 0.15 or less before surfactant therapy (2.2, 1.01 to 4.6), and a low arterial PCO2 (less than or equal to 29 vs greater than or equal to 40 mm Hg, 5.6, 2.0 to 15.6; 30 to 39 vs greater than or equal to 40 mm Hg, 3.3, 1.3 to 8.3). The inverse relationship between hypocarbia and bronchopulmonary dysplasia persisted even in stratified analyses limited to infants with measures of cardiovascular or respiratory illness that suggested less severe manifestations of disease. Conclusions: Ventilatory management before rescue treatment with artificial surfactant therapy that result in hypocarbia may increase the risk of bronchopulmonary dysplasia. These findings suggest that early ventilatory management should not only provide adequate oxygenation but also limit hyperventilation.

引用

页码：617 / 622

页数：6

共 34 条

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