早期使用枸橼酸咖啡因对极低出生体重儿的影响

Effect of early administration of caffeine citrate in very low-birth weight newborns

目的探讨分析早期使用枸橼酸咖啡因对极低出生体重儿的影响。方法回顾性分析2018年1月-2019年12月期间湖南省妇幼保健院出生并在新生儿科接受治疗的符合入选标准的100例极低出生体重儿,依照治疗方法不同分为两组,观察组(54例)患儿出生2 h内即开始静脉给予枸橼酸咖啡因,对照组(46例)患儿出生后不立即用药,有创呼吸机撤时,开始使用枸橼酸咖啡因。分别对其拔管后72 h内早产儿呼吸暂停(apnea of premature,AOP)发生率、机械通气时长、吸氧时间、恢复出生体重时长、住院时间以及并发症发生率进行分析比较。结果观察组AOP发生率与对照组比较明显降低,机械通气时间、吸氧时间、住院时间与对照组比较均明显缩短,两组比较差异有统计学意义(P<0.05);两组患儿在恢复出生体重时长差异无统计学意义(P=0.423);观察组患儿与对照组比较支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生率略降低,有统计学意义(P=0.029);两组在喂养不耐受、高血糖、新生儿坏死性小肠结肠炎(neonatalnecrotizing enterocolitis, NEC)、3或4级脑室周围-脑室内出血(periventricular-intraventricular hemorrhage,PVH-IVH)、早产儿视网膜病变(retinopathy of prematurity,ROP)的发生率等方面差异无统计学意义(P>0.05)。结论早期使用枸橼酸咖啡因,可有效缩短极低出生体重儿机械通气时长及吸氧时间,从而缩短住院时间,降低BPD发生率。早期应用枸橼酸咖啡因临床效果良好,对极低出生体重儿临床恢复意义大,值得推广。

Objective To explore the effect of early administration of caffeine citrate in very low-birth weight(VLBW) newborns. Methods We retrospectively analyzed 100 VLBW newborns born in Hunan Provincial Maternal and Child Health Care Hospital and received treatment in the neonatal department between January 2018 and December 2019, and all of the cases met the inclusion criteria. According to the different treatment methods, they were divided into the observation group(n=54) and the control group(n=46). The observation group was treated intravenously with caffeine citrate within 2 hours after birth, while the control group was not given the drug immediately after birth,and caffeine citrate was administered when invasive ventilator was removed. The two groups were compared in terms of the incidence rate of apnea of premature( AOP) within 72 hours after extubation,duration of mechanical ventilation,duration of oxygen therapy,time of regaining birth weight,length of hospitalization and the incidence rate of complications. Results The incidence rate of AOP,duration of mechanical ventilation,duration of oxygen inhalation and length of hospitalization were all significantly lower in the observation group than in the control group,showing statistically significant differences( all P<0.05). No statistically significant difference was found in the time of regaining birth weight between the two groups( P = 0.423). The incidence rate of bronchopulmonary dysplasia( BPD) was slightly lower in the observation group than in the control group,with a statistically significant difference( P = 0. 029). No statistically significant differences were observed in the incidence rates of feeding intolerance,hyperglycemia,neonatal necrotizing enterocolitis( NEC),grades III-IV periventricular-intraventricular hemorrhage( PVH-IVH) and retinopathy of prematurity( ROP) between the two groups( all P>0.05). Conclusions Early administration of caffeine citrate can effectively shorten the duration of mechanical ventilation and duration of oxygen therapy for VLBW newborns,and thereby reduce the length of hospitalization and decrease the incidence rate of BPD. Early administration of caffeine citrate has a good clinical effect,it is of great significance to the clinical recovery of VLBW newborns and is worth promoting.