Long-Term Effects of Saline Boluses in Very Preterm Infants (VPI)
Notice bibliographique
Résumé
Abstract BACKGROUND: Normal saline bolus is commonly used in clinical practice for treating hypotension in term and preterm neonates during resuscitation in early life despite the paucity of high quality evidence supporting this practice. OBJECTIVES: To determine the effects of normal saline boluses given within seven days of birth in VPI less than 31 weeks at 18 to 36 of months corrected age. DESIGN/METHODS: This is a retrospective population-based cohort analysis of the use of saline boluses from January 2006 to December 2010, of VPI from Halifax County. The outcomes at 18-36 months corrected age were extracted from the Perinatal Follow-Up Program (PFUP) database. This program is dedicated to the care and monitoring of infants who were VPI, very low birth weight or those who had brain injury at birth. It includes the evaluation of long-term developmental outcomes, multidisci-plinary services including rehabilitation, dietetics and social services. Primary Outcome: To assess the incidence of death, cerebral palsy, language, cognitive delay, hearing impairment requiring the amplification, or bilateral blindness at the corrected 18-36 months of VPI who did or did not receive normal saline boluses. Secondary Outcome: To assess patent ductus arteriosus(PDA), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), periventricular leucomalacia, necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP) between VPI who did or did not receive normal saline boluses. Inclusion criteria: VPI from Halifax County admitted to the NICU at the IWK Health Centre, Halifax, Nova Scotia, Canada between January 2006 to December 2010. Exclusion criteria: Infants with major congenital anomalies and who were not offered resuscitation in the delivery room and expected to die. RESULTS: The regression analysis indicated that there was no difference in terms of death or disability between those who received saline bolus 15 (53.6%) versus those who did not receive saline boluses 45 (34.6%), [OR 2.17 (0.94, 5.05) p = 0.07]. Although univariate comparisons between the two groups showed significant differences in rates of PDA, severe IVH, NEC, cystic PVL, BPD and ROP, but after controlling for the influences of birth weight, APGAR score at 1 minute, admission BP and hemoglobin, bolus treatment was not significantly related to any of these outcomes CONCLUSION: In the current study no significant difference was found between the two groups in terms of long term neurodevelopmental outcomes and short term outcomes were significantly different only in univari-ate comparisons. Given the limitations of this retrospective study, a randomized controlled trial to evaluate the effects of normal saline boluses use during early life on neurodevelopment outcomes is warrented.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».