Initial Oxygen Use for Preterm Newborn Resuscitation: A Systematic Review With Meta-analysis

被引:82
作者
Welsford, Michelle [1 ,2 ]
Nishiyama, Chika [3 ]
Shortt, Colleen [2 ]
Weiner, Gary [4 ,5 ]
Roehr, Charles Christoph [6 ,7 ]
Isayama, Tetsuya [8 ]
Dawson, Jennifer Anne [9 ,10 ]
Wyckoff, Myra H. [11 ]
Rabi, Yacov [12 ,13 ]
机构
[1] McMaster Univ, Div Emergency Med, Hamilton, ON, Canada
[2] Hamilton Hlth Sci, Ctr Paramed Educ & Res, Hamilton, ON, Canada
[3] Kyoto Univ, Grad Sch Human Hlth, Dept Crit Care Nursing, Kyoto, Japan
[4] Univ Michigan, Dept Pediat & Communicable Dis, Ann Arbor, MI 48109 USA
[5] Charles Stewart Mott Childrens Hosp, Ann Arbor, MI USA
[6] Univ Oxford, Dept Paediat, Med Sci Div, Oxford, England
[7] Oxford Univ Hosp Natl Hlth Serv Fdn Trust, John Radcliffe Hosp, Newborn Serv, Oxford, England
[8] Natl Ctr Child Hlth & Dev, Div Neonatol, Tokyo, Japan
[9] Royal Womens Hosp, Neonatal Serv, Melbourne, Vic, Australia
[10] Univ Melbourne, Melbourne, Vic, Australia
[11] Univ Texas Southwestern Med Ctr Dallas, Div Neonatal Perinatal Med, Dallas, TX 75390 USA
[12] Univ Calgary, Dept Pediat, Calgary, AB, Canada
[13] Alberta Childrens Hosp Res Inst, Calgary, AB, Canada
关键词
2015 INTERNATIONAL CONSENSUS; CARDIOVASCULAR CARE SCIENCE; CARDIOPULMONARY-RESUSCITATION; ROOM-AIR; NEURODEVELOPMENTAL OUTCOMES; DELIVERY ROOM; INFANTS; HEART; BIRTH; SATURATION;
D O I
10.1542/peds.2018-1828
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
CONTEXT: The International Liaison Committee on Resuscitation prioritized to review the initial fraction of inspired oxygen (F-IO2) during the resuscitation of preterm newborns. OBJECTIVES: This systematic review and meta-analysis provides the scientific summary of initial F-IO2 in preterm newborns (< 35 weeks' gestation) who receive respiratory support at birth. DATA SOURCES: Medline, Embase, Evidence-Based Medicine Reviews, and Cumulative Index to Nursing and Allied Health Literature were searched between January 1, 1980 and August 10, 2018. STUDY SELECTION: Studies were selected by pairs of independent reviewers in 2 stages with a Cohen's. of 0.8 and 1.0. DATA EXTRACTION: Pairs of independent reviewers extracted data, appraised the risk of bias (RoB), and assessed Grading of Recommendations Assessment, Development and Evaluation certainty. RESULTS: Ten randomized controlled studies and 4 cohort studies included 5697 patients. There are no statistically significant benefits of or harms from starting with lower compared with higher F-io2 in short-term mortality (n = 968; risk ratio = 0.83 [95% confidence interval 0.50 to 1.37]), long-term mortality, neurodevelopmental impairment, or other key preterm morbidities. A sensitivity analysis in which 1 study with a high RoB was excluded failed to reveal a reduction in mortality with initial low F-io2 (n = 681; risk ratio = 0.63 [95% confidence interval 0.38 to 1.03]). LIMITATIONS: The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was very low for all outcomes due to RoB, inconsistency, and imprecision. CONCLUSIONS: The ideal initial F-io2 for preterm newborns is still unknown, although the majority of newborns >= 32 weeks' gestation will require oxygen supplementation.
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页数:17
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