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JAMA:咖啡因治早产儿呼吸暂停与改善5岁时无残障存活率无关

  1. 呼吸兴奋剂
  2. 呼吸暂停
  3. 咖啡因疗法
  4. 早产儿

来源:EurekAlert 2012-11-18 10:48

1月18日,《美国医学会杂志》刊登的一则研究"Survival Without Disability to Age 5 Years After Neonatal Caffeine Therapy for Apnea of Prematurity"披露,患有呼吸暂停的极低出生体重婴儿在接受咖啡因治疗后不能显著改善其在5岁时的无残障存活率;咖啡因疗法曾被证明可降低这些婴儿在18个月时的脑瘫及认知延缓的

1月18日,《美国医学会杂志》刊登的一则研究"Survival Without Disability to Age 5 Years After Neonatal Caffeine Therapy for Apnea of Prematurity"披露,患有呼吸暂停的极低出生体重婴儿在接受咖啡因治疗后不能显著改善其在5岁时的无残障存活率;咖啡因疗法曾被证明可降低这些婴儿在18个月时的脑瘫及认知延缓的比例。

咖啡因是治疗极端早产儿呼吸暂停的首选呼吸兴奋剂,这些极端早产儿因为呼吸暂停所致的死亡或残疾风险都会增加。根据文章的背景资料:“然而,极端早产儿的长至2岁时的结果可能并不能精确地预计这些孩子在孩提时代后期的功能。”

加拿大汉密尔顿麦克马斯特大学及费城宾夕法尼亚大学的Barbara Schmidt, M.D., M.Sc.及其同事开展了一项研究,旨在确认新生儿咖啡因疗法是否具有持久的裨益,或在学龄早期会有新的明显的风险。该研究是由一个在加拿大、澳大利亚、欧洲和以色列的35家学术医院中的31家中进行的从2005年至2011年的为期5年的跟踪研究所组成的;在该研究的2,006名参与者中,有1,932人(96.3%)在1999至2004年间曾经被招募到随机分配的以安慰剂作为对照的早产儿呼吸暂停咖啡因疗法试验中。共有1,640个体重在500克至1250克(17.6 至 44.1盎司)的孩子(84.9%)具有足够的5岁时的主要后果数据,它被定义为死亡或活至5岁但有1或多个运动性障碍、认知障碍、行为问题、不佳的总体健康、耳聋及失明的综合后果。

研究人员发现,在833名被分配接受咖啡因治疗的孩子中,有176人(21.1%)死亡或虽存活但患有至少1种损伤,而在分配服用安慰剂的807个孩子中有200人(24.8%)出现死亡或虽存活但患有至少1种损伤。 “在这两组中,运动损伤、严重认知损害伤、行为问题、不佳的总体健康、失明及耳聋等的比率并无显著差异。在这2组中,各自仅有2个孩子在18个月至5岁期间死亡。”在第二则分析中,有证据显示,咖啡因与大体运动功能的改善有关。

研究人员得出结论:“总的来说,这一为期5年的对参与该国际性的咖啡因治疗早产儿呼吸暂停试验者的追踪研究显示,新生儿咖啡因疗法对18个月大时的无残障存活率的裨益会在孩子发育过程中减弱。在5岁时的认知损害率比18个月大时的认知损害率要低得多,提示极端早产之后的生命第二年的认知功能延迟可能不是一个持续性的后果。”(生物谷Bioon.com)

Survival Without Disability to Age 5 Years After Neonatal Caffeine Therapy for Apnea of Prematurity

Barbara Schmidt, MD, MSc; Peter J. Anderson, PhD; Lex W. Doyle, MD, MSc; Deborah Dewey, PhD; Ruth E. Grunau, PhD; Elizabeth V. Asztalos, MD, MSc; Peter G. Davis, MD; Win Tin, MD; Diane Moddemann, MD, MEd; Alfonso Solimano, MD; Arne Ohlsson, MD, MSc; Keith J. Barrington, MB, ChB; Robin S. Roberts, MScfor the Caffeine for Apnea of Prematurity (CAP) Trial Investigators

Context Very preterm infants are prone to apnea and have an increased risk of death or disability. Caffeine therapy for apnea of prematurity reduces the rates of cerebral palsy and cognitive delay at 18 months of age.

Objective To determine whether neonatal caffeine therapy has lasting benefits or newly apparent risks at early school age.

Design, Setting, and Participants Five-year follow-up from 2005 to 2011 in 31 of 35 academic hospitals in Canada, Australia, Europe, and Israel, where 1932 of 2006 participants (96.3%) had been enrolled in the randomized, placebo-controlled Caffeine for Apnea of Prematurity trial between 1999 and 2004. A total of 1640 children (84.9%) with birth weights of 500 to 1250 g had adequate data for the main outcome at 5 years.

Main Outcome Measures Combined outcome of death or survival to 5 years with 1 or more of motor impairment (defined as a Gross Motor Function Classification System level of 3 to 5), cognitive impairment (defined as a Full Scale IQ<70), behavior problems, poor general health, deafness, and blindness.

Results The combined outcome of death or disability was not significantly different for the 833 children assigned to caffeine from that for the 807 children assigned to placebo (21.1% vs 24.8%; odds ratio adjusted for center, 0.82; 95% CI, 0.65-1.03; P = .09). The rates of death, motor impairment, behavior problems, poor general health, deafness, and blindness did not differ significantly between the 2 groups. The incidence of cognitive impairment was lower at 5 years than at 18 months and similar in the 2 groups (4.9% vs 5.1%; odds ratio adjusted for center, 0.97; 95% CI, 0.61-1.55; P = .89).

Conclusion Neonatal caffeine therapy was no longer associated with a significantly improved rate of survival without disability in children with very low birth weights who were assessed at 5 years.

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