Mary E Pease, Erica Yi, Swosti Joshi, Erica Poletto, Ogechukwu Menkiti, Vilmaris Quiñones Cardona
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Groups were similar in birth weight, gestational age, and severity of HIE. A higher proportion of neonates in the SA group received inhaled nitric oxide (iNO, 39.4% vs. 2%, <i>p</i> < 0.001) and vasopressors (41% vs. 20%, <i>p</i> = 0.012) compared to no SA group. There was no difference in median MRI severity scores for neither T1 (2 [2, 4.25] vs. 3 [2, 6], <i>p</i> = 0.295), T2 (2 [0, 3] vs. 3 [1.5, 5.5], <i>p</i> = 0.088) nor diffusion-weighted images (0 [0, 2] vs. 0 [0, 4.25], <i>p</i> = 0.090) between SA and no SA groups, respectively. In-hospital outcomes were similar between groups except for lower survival to discharge (87% vs. 98%, <i>p</i> = 0.020) in the SA group compared to those without SA. A regression analysis showed death was associated with the concomitant use of iNO (<i>p</i> < 0.001) and inotropes (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong> SA during TH for perinatal HIE did not alter early MRI severity scores. A lower survival to discharge in the SA group may be related to illness severity rather than SA use alone.</p><p><strong>Key points: </strong>· Conflicting studies exist regarding the efficacy of SA use during TH.. · SA use during TH did not alter in-hospital MRI severity scores.. · SA use was associated with a lower survival to discharge, correlated to the severity of illness rather than SA use alone..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"In-Hospital Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy Receiving Sedation-Analgesia during Therapeutic Hypothermia.\",\"authors\":\"Mary E Pease, Erica Yi, Swosti Joshi, Erica Poletto, Ogechukwu Menkiti, Vilmaris Quiñones Cardona\",\"doi\":\"10.1055/a-2461-5295\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong> This study aimed to compare magnetic resonance imaging (MRI) severity scores and in-hospital outcomes among neonates with perinatal hypoxic-ischemic encephalopathy (HIE) with and without exposure to sedation-analgesia (SA) during therapeutic hypothermia (TH).</p><p><strong>Study design: </strong> A single-center, retrospective cohort study of neonates with perinatal HIE undergoing TH between January 2010 and December 2020. Demographics, clinical characteristics, MRI scores, and in-hospital outcomes were compared between patients without SA exposure and those with SA use.</p><p><strong>Results: </strong> Of the 131 neonates, 55 (42%) did not have SA exposure, and 76 (58%) had SA during TH. Groups were similar in birth weight, gestational age, and severity of HIE. A higher proportion of neonates in the SA group received inhaled nitric oxide (iNO, 39.4% vs. 2%, <i>p</i> < 0.001) and vasopressors (41% vs. 20%, <i>p</i> = 0.012) compared to no SA group. There was no difference in median MRI severity scores for neither T1 (2 [2, 4.25] vs. 3 [2, 6], <i>p</i> = 0.295), T2 (2 [0, 3] vs. 3 [1.5, 5.5], <i>p</i> = 0.088) nor diffusion-weighted images (0 [0, 2] vs. 0 [0, 4.25], <i>p</i> = 0.090) between SA and no SA groups, respectively. In-hospital outcomes were similar between groups except for lower survival to discharge (87% vs. 98%, <i>p</i> = 0.020) in the SA group compared to those without SA. 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引用次数: 0
摘要
研究目的本研究旨在比较围产期缺氧缺血性脑病（HIE）新生儿在治疗性低温（TH）期间接受和未接受镇静镇痛（SA）治疗时的磁共振成像（MRI）严重程度评分和院内预后：2010年1月至2020年12月期间接受治疗性低温的围产期HIE新生儿的单中心回顾性队列研究。对未接触过 SA 和使用过 SA 的患者的人口统计学、临床特征、核磁共振成像评分和院内预后进行了比较：在 131 名新生儿中，55 人（42%）未接触过 SA，76 人（58%）在 TH 期间接触过 SA。两组新生儿的出生体重、胎龄和 HIE 严重程度相似。与无 SA 组相比，有 SA 组新生儿吸入一氧化氮（iNO，39.4% 对 2%，P = 0.012）的比例更高。SA组与无SA组的T1（2 [2, 4.25] vs. 3 [2, 6]，p = 0.295）、T2（2 [0, 3] vs. 3 [1.5, 5.5]，p = 0.088）和弥散加权图像（0 [0, 2] vs. 0 [0, 4.25]，p = 0.090）中位核磁共振严重程度评分均无差异。两组患者的院内预后相似，但有 SA 组患者的出院存活率低于无 SA 组患者（87% vs. 98%，p = 0.020）。回归分析表明，死亡与同时使用 iNO 有关（p p 结论）：围产期 HIE 治疗期间使用 SA 不会改变早期 MRI 严重程度评分。SA组出院存活率较低可能与疾病严重程度有关，而非仅与使用SA有关：- 在围产期使用SA的疗效方面存在相互矛盾的研究。- 在TH期间使用SA不会改变院内MRI严重程度评分。- 使用SA与较低的出院存活率有关，这与疾病的严重程度有关，而非仅与使用SA有关。
In-Hospital Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy Receiving Sedation-Analgesia during Therapeutic Hypothermia.
Objective: This study aimed to compare magnetic resonance imaging (MRI) severity scores and in-hospital outcomes among neonates with perinatal hypoxic-ischemic encephalopathy (HIE) with and without exposure to sedation-analgesia (SA) during therapeutic hypothermia (TH).
Study design: A single-center, retrospective cohort study of neonates with perinatal HIE undergoing TH between January 2010 and December 2020. Demographics, clinical characteristics, MRI scores, and in-hospital outcomes were compared between patients without SA exposure and those with SA use.
Results: Of the 131 neonates, 55 (42%) did not have SA exposure, and 76 (58%) had SA during TH. Groups were similar in birth weight, gestational age, and severity of HIE. A higher proportion of neonates in the SA group received inhaled nitric oxide (iNO, 39.4% vs. 2%, p < 0.001) and vasopressors (41% vs. 20%, p = 0.012) compared to no SA group. There was no difference in median MRI severity scores for neither T1 (2 [2, 4.25] vs. 3 [2, 6], p = 0.295), T2 (2 [0, 3] vs. 3 [1.5, 5.5], p = 0.088) nor diffusion-weighted images (0 [0, 2] vs. 0 [0, 4.25], p = 0.090) between SA and no SA groups, respectively. In-hospital outcomes were similar between groups except for lower survival to discharge (87% vs. 98%, p = 0.020) in the SA group compared to those without SA. A regression analysis showed death was associated with the concomitant use of iNO (p < 0.001) and inotropes (p < 0.001).
Conclusion: SA during TH for perinatal HIE did not alter early MRI severity scores. A lower survival to discharge in the SA group may be related to illness severity rather than SA use alone.
Key points: · Conflicting studies exist regarding the efficacy of SA use during TH.. · SA use during TH did not alter in-hospital MRI severity scores.. · SA use was associated with a lower survival to discharge, correlated to the severity of illness rather than SA use alone..
期刊介绍：
The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields.
The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field.
All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication.
The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.
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