在产房使用唐氏量表和西尔弗曼量表对妊娠超过 35 周的新生儿进行呼吸障碍评估与 CPAP 呼吸疗法作为转入重症监护室的预测指标的比较。队列研究

O. I. Fedotova, E. Shestak, O. P. Kovtun
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摘要

理论依据。出生后呼吸窘迫(RD)是新生儿入住重症监护室(NICU)的主要原因。本研究的目的--确定并比较在产房对妊娠≥35 0 周、接受 CPAP 治疗的新生儿进行 Downes 和 Silverman RD 评分作为新生儿重症监护病房入院预测指标的预后价值。研究对象包括妊娠≥35.0 周、在产房有 RD 的新生儿。研究于 2023 年 3 月 1 日至 8 月 15 日在叶卡捷琳堡临床围产中心进行。预测结果是从产房到新生儿重症监护室的住院治疗。在总体样本(n = 73)中,根据开始使用 CPAP 治疗时的预测指标确定了亚组:亚组 D1 - Downes 量表评分 n = 24);亚组 D2 - Downes 量表评分≥4 分(n = 49);亚组 S1 - Silverman 量表评分 n = 31);亚组 S2 - Silverman 量表评分≥4 分(n = 42)。在 D2 亚组中,入住新生儿重症监护室的相对风险为 3.9,95% 置信区间 (CI) 为 1.3-11.7,灵敏度为 88.9%,特异度为 45.7%;在 S2 亚组中,入住新生儿重症监护室的相对风险为 2.1,95% 置信区间 (CI) 为 1.021-4.300,灵敏度为 74.1%,特异度为 52.2%。在产房对孕周≥35周的新生儿进行RD评估,在CPAP治疗开始时,唐氏评分≥4分,可预测呼吸治疗效果不佳和转入新生儿重症监护室的情况。使用唐氏量表进行评估时,预测的准确性高于使用西尔弗曼量表进行评估时的准确性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of the Assessment of Respiratory Disorders Using the Downes and Silverman Scales in the Delivery Room in Newborns Over 35 Weeks of Gestation with CPAP Respiratory Therapy as a Predictor of Transfer to the Intensive Care Unit. Cohort Study
Rationale. Respiratory distress (RD) aſter birth is the leading cause of neonatal intensive care unit (NICU) admission. To determine the degree of RD, scales based primarily on clinical symptoms have been developed, but the prognostic value of RD scales remains incompletely studied.Purpose of the study — to determine and compare the prognostic value of the Downes and Silverman RD scoresin the delivery room in neonates ≥35 0 weeks of gestation with CPAP therapy as a predictor of NICU admission.Materials and methods. The study included newborns ≥35 0 weeks of gestation with RDin the delivery room. The study was conducted at the Ekaterinburg Clinical Perinatal Center from March 1 to August 15, 2023. The predicted outcome was hospitalization from the delivery room to the NICU. In the general sample (n = 73), subgroups were identified according to the studied predictor at the start of CPAP therapy: subgroup D1 — Downes scale score n = 24); subgroup D2 — Downes scale score ≥4 points (n = 49); subgroup S1 — Silverman scale score n = 31); subgroup S2 — Silverman score ≥4 points (n = 42).Results. In subgroup D2, the relative risk of NICU admission was 3.9with a 95 % confidenceinterval (CI) of 1.3–11.7, sensitivity of 88.9 % and specificity of 45.7 %; in subgroup S2–2.1with 95 % CI 1.021–4.300, sensitivity 74.1 % and specificity 52.2 %.Conclusion. Assessment of RD in newborns ≥35 0 weeks of gestation in the delivery room on the Downes scale ≥4 points at the start of CPAP therapy allows predicting the ineffectiveness of respiratory therapy and transfer of the child to the NICU. The accuracy of the forecast when assessed using the Downes scale is higher than that using the Silverman scale.
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