Journal
JOURNAL OF PERINATOLOGY
Volume 38, Issue 8, Pages 1060-1067Publisher
SPRINGERNATURE
DOI: 10.1038/s41372-018-0126-7
Keywords
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Categories
Funding
- Alpert Medical School of Brown University [U10 HD27904]
- Women & Infants Hospital of Rhode Island [U10 HD27904]
- Case Western Reserve University, Rainbow Babies & Children's Hospital [U10 HD21364, M01 RR80]
- Cincinnati Children's Hospital Medical Center [U10 HD27853, M01 RR8084]
- University of Cincinnati Medical Center [U10 HD27853, M01 RR8084]
- Duke University School of Medicine, University Hospital, Alamance Regional Medical Center [U10 HD40492, M01 RR30]
- Durham Regional Hospital [U10 HD40492, M01 RR30]
- Emory University, Grady Memorial Hospital [U10 HD27851, M01 RR39]
- Emory University Hospital Midtown [U10 HD27851, M01 RR39]
- Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children [U10 HD27856, M01 RR750]
- Wishard Health Services [U10 HD27856, M01 RR750]
- RTI International [U10 HD36790]
- Stanford University [U10 HD27880, M01 RR70]
- Lucile Packard Children's Hospital [U10 HD27880, M01 RR70]
- University of Alabama at Birmingham Health System [U10 HD34216, M01 RR32]
- Children's Hospital of Alabama [U10 HD34216, M01 RR32]
- University of California-San Diego Medical Center [U10 HD40461]
- Sharp Mary Birch Hospital for Women [U10 HD40461]
- University of Rochester Medical Center, Golisano Children's Hospital [U10 HD40521, M01 RR44]
- University of Miami Holtz Children's Hospital [U10 HD21397, M01 RR16587]
- University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System [U10 HD40689, M01 RR633]
- Children's Medical Center Dallas [U10 HD40689, M01 RR633]
- University of Texas Health Science Center at Houston Medical School, Children's Memorial Hermann Hospital [U10 HD21373, M01 RR2588]
- Lyndon Baines Johnson General Hospital/Harris County Hospital District [U10 HD21373, M01 RR2588]
- Wayne State University, Hutzel Women's Hospital [U10 HD21385]
- Children's Hospital of Michigan [U10 HD21385]
- Yale University, Yale-New Haven Children's Hospital [U10 HD27871, M01 RR125, UL1 RR24139]
- EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT [UG1HD087229, U10HD034216, U10HD027880, U10HD021364, U10HD027851, U10HD027856, UG1HD027880, U10HD040689, U10HD027871, UG1HD027904, U10HD036790, U10HD040461, U10HD040492, U10HD027853, U10HD027904, UG1HD021385, U10HD021385, UG1HD027853, U10HD021373] Funding Source: NIH RePORTER
- EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH &HUMAN DEVELOPMENT [U10HD021397, U10HD040521] Funding Source: NIH RePORTER
- NATIONAL CENTER FOR RESEARCH RESOURCES [UL1RR024139, M01RR008084, M01RR016587] Funding Source: NIH RePORTER
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Objective To evaluate the association between sedation-analgesia (SA) during initial 72 h and death/disability at 18 months of age in neonatal hypoxic-ischemic encephalopathy (HIE). Design This was a secondary analysis of the NICHD therapeutic hypothermia (TH) randomized controlled trial in moderate or severe HIE. Receipt of SA and anticonvulsant medications at five time points were considered: prior to and at baseline, 24, 48, and 72 h of TH or normothermia. Disability was defined as mental developmental index <85, cerebral palsy, blindness, hearing impairment, or Gross Motor Function Classification System 2-5. Results Of the 208 RCT participants, 38 (18%) infants had no exposure to SA or anticonvulsants at any of the five time points, 20 (10%) received SA agents only, 81 (39%) received anticonvulsants only, and 69 (33%) received both SA and anticonvulsants. SA category drugs were not administered in 57% of infants while 18% received SA at >= 3 time points; 72% infants received anticonvulsants during 72 h of intervention. At 18 months of age, disability among survivors and death/disability was more frequent in the groups receiving anticonvulsants, with (48 and 65%) or without (37 and 58%) SA, compared to groups with no exposure (14 and 34%) or SA (13 and 32%) alone. Severe HIE (aOR 3.60; 1.59-8.13), anticonvulsant receipt (aOR 2.48; 1.05-5.88), and mechanical ventilation (aOR 7.36; 3.15-17.20) were independently associated with 18-month death/disability, whereas TH (aOR 0.28; 0.13-0.60) was protective. SA exposure showed no association with outcome. Conclusions The risk benefits of SA in HIE need further investigation.
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