医学
优势比
入射(几何)
心脏病学
机械通风
内科学
置信区间
儿科
光学
物理
作者
Manon Gijtenbeek,Monique C. Haak,Derk Jan Ten Harkel,Arjan B. te Pas,Johanna M. Middeldorp,Frans Klumper,Nan van Geloven,Dick Oepkes,Enrico Lopriore
出处
期刊:Neonatology
[S. Karger AG]
日期:2017-01-01
卷期号:112 (4): 402-408
被引量:8
摘要
<b><i>Background:</i></b> Persistent pulmonary hypertension of the newborn (PPHN) is associated with severe morbidity and mortality. Twin-twin transfusion syndrome (TTTS) is suggested to increase the risk of PPHN. <b><i>Objectives:</i></b> To describe the incidence of PPHN in TTTS twins and to identify risk factors in TTTS twins for the development of severe PPHN. <b><i>Methods:</i></b> Cases with severe PPHN were extracted from our monochorionic twin database (2002-2016). Severe PPHN was defined as severe hypoxaemia requiring mechanical ventilation and inhaled nitric oxide (iNO) treatment, confirmed by strict echocardiographic criteria. A case-control comparison within TTTS survivors was conducted to identify risk factors for PPHN. <b><i>Results:</i></b> The incidence of PPHN in TTTS twins was 4% (24/598, 95% confidence interval [CI] 2.7-5.9%) and 0.4% (2/493, 95% CI 0.1-1.5%) in uncomplicated monochorionic twins (odds ratio [OR] 10.3, 95% CI 2.4-43.9; <i>p</i> = 0.002). Two risk factors were independently associated with PPHN: severe prematurity (OR 3.3, 95% CI 1.0-11.4) and recipient status (OR 3.9, 95% CI 1.4-11.0). In TTTS recipients, another risk factor for PPHN is anaemia at birth (OR 7.2, 95% CI 1.8-29.6). <b><i>Conclusion:</i></b> Clinicians caring for neonates with TTTS should be aware of the 10-fold increased risk of PPHN compared to uncomplicated monochorionic twins. PPHN occurs more often in case of premature delivery and in recipient twins, particularly in the presence of anaemia at birth. As the development of severe PPHN is difficult to predict, we advise that all TTTS twins should be delivered in a tertiary care centre with iNO treatment options.
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