减少光照不会对早产儿产生影响

在新生儿重症加护病房使用自然周期光照可能会更好

  10月份出版的《儿科杂志》中的一项研究结果发现:减少光照并不会影响极低出生体重的婴儿的医疗效果。这一结果可能会使那些支持依据「子宫环境」理论进行育婴室设计的人感到失望。

  Ronald L. Ariagno医师和 Majid Mirmiran医师在一篇附论中写到:「在新生儿科学不同的领域中,很少有哪里些领域像新生儿重症加护育婴所的设计那样依然存在争议,特别是光照的优点这一方面。」Ariagno医师任职于史丹福大学医学院的小儿科,Mirmiran医师任职于荷兰脑研究研究所。

  他们写到:「通过取消无序的光照和声响,使用天然的、徐缓的、昼夜变化的明暗周期,使新生儿重症加护病房的设计更适合于新生儿的发育是非常合理的。」

  在这项前瞻性的多中心实验中,达拉斯的德克萨斯大学西南医学中心的研究者们登记了409名孕龄小于30周、出生体重小于1,251克的婴儿,并报导了其中395名存活下来的婴幼儿的结果资料。这些资料是来源于《光照-早产儿视网膜病变合作组研究》(减少光照对预防早产儿视网膜病变没有疗效)的二手资料。

  新生儿被随机分配到对照组或佩带护目镜组,佩带护目镜可以减少97%的可见光。新生儿在出生后24小时内佩带护目镜,并且一直使用至月经年龄后31周(最少为4周)。

  Ariagno和Mirmiran建议在该项研究中使用护目镜,因为护目镜能更有效地保持婴幼儿的光照减少,同时避免了育婴室工作人员的光照缺失。

  佩带护目镜组在体重增加、氧疗持续时间、呼吸器的使用、住院时间和颅内出血的发生率方面与对照组类似。

  Kathleen A. Kennedy医师是UP休斯顿医学院的一名小儿科医师。他和他的合著者写到:「在低出生体重婴儿出生后的前几周内,进行连续的减少光照的随机实验,结果发现减少光照对治疗效果没有影响。如果减少光照所带来的有益影响存在,那就必须对减少光照的潜在危害性进行衡量。」

  尽管极低出生体重的婴幼儿面临著因早产儿视网膜病变引起失明的危险,《儿科杂志》中的这项研究显示出:减少光照对早产儿视网膜病变、失明或其它视觉并发症的发生率没有影响。

  

Reduced Light Does Not Change Outcome in Premature Infants

Natural-Cycled Lighting May Be Better in NICU

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Charlotte E. Grayson, MD

Nov. 12, 2001 -- Proponents of the "womb environment" theory of nursery design will be disappointed in the outcome of a study in the October issue of the Journal of Pediatrics: reduced lighting did not improve medical outcomes in very low birth weight infants.

"Few areas in neonatology have remained as controversial as the design of neonatal intensive care nurseries, and particularly, the recommendation for lighting," Ronald L. Ariagno, MD, and Majid Mirmiran, MD, PhD, write in an accompanying editorial. Ariagno is with the department of pediatrics at Stanford University School of Medicine and Mirmiran is with the Netherlands Institute for Brain Research.

"It is reasonable to make NICUs more developmentally appropriate through elimination of chaotic lighting and sound and by using a natural, gradual, dawn-and-dusk transition of the light-dark cycle," they write.

In this prospective multicenter trial, researchers from the University of Texas Southwestern Medical Center in Dallas enrolled 409 infants <1,251grams birth weight and <31 weeks gestational age and reported outcome data for 359 surviving infants. These data were secondary findings from the LIGHT-ROP Cooperative Group Study (Lack of efficacy of light reduction in preventing retinopathy of prematurity).

Neonates were randomly assigned to a control group or to wear goggles that reduced visible light by 97%, which were placed within 24 hours of birth and remained in use until 31 weeks postmenstrual age or for a minimum of four weeks.

Ariagno and Mirmiran commend the study for using goggles, which were more effective in maintaining light reduction for the infant while avoiding light deprivation in caregivers and nursery personnel.

The treatment groups were similar in weight gain, duration of oxygen therapy, need for mechanical ventilation, hospital stay and incidence of intracranial hemorrhage, both before and after adjustments for birth weight, gestational age, race, sex, and delivery location.

"This randomized trial of continuous light reduction in the first few weeks of life for very low birth weight infants showed no effect on medical outcomes," writes Kathleen A. Kennedy, MD, MPH, and coauthors. "If beneficial effects of light reduction exist, these would need to be weighed against the potential hazards of light reduction." Kennedy is a pediatrician at UP Houston Medical School.

Although very low birth weight infants are at higher risk for blindness caused by retinopathy of prematurity (ROP), earlier studies summarized in the editorial have shown no change from light reduction in the incidence of ROP, blindness, or other visual complications.


© 2001 WebMD Corporation. All rights reserved.

    
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