Department of Pediatrics, McMaster University, Ontario, Canada.
Am J Perinatol. 2012 Aug;29(7):519-26. doi: 10.1055/s-0032-1310523. Epub 2012 Apr 11.
Despite advances in management of persistent pulmonary hypertension of the newborn (PPHN), the risk of mortality and adverse neurological sequelae remains high. Characterizing variation in practices is a crucial step toward improved patient outcome.
Evaluate intensive care practices in Canada and the Australia-New Zealand region (AUS-NZ).
A prospective cross-sectional online survey of neonatologists was conducted. A 35-item questionnaire was developed, validated, and piloted to collect information on diagnosis, inhaled nitric oxide (iNO) practices, alternative vasodilators or cardiotropes, and echocardiography. Variation among survey respondents as well as intergroup comparison was performed.
Data were collected from 217 respondents. Echocardiography and arterial blood gas were the most common diagnostic tests to assess the severity of PPHN. iNO administration is more frequently scrutinized in Canada (36% versus 10% [AUS-NZ], p < 0.001). Canadian physicians reported higher use of intravenous milrinone (p < 0.001), vasopressin (p = 0.02), and inhaled prostacyclin (p = 0.02), but lower use of sildenafil (p = 0.01) for refractory pulmonary hypertension. A greater proportion of neonatologists in AUS-NZ were trained to perform echocardiography (p < 0.001) to optimize treatment decisions.
Wide variation exists in the management of PPHN. There is a need to provide more guidance regarding principles of management in PPHN, while recognizing the dynamic nature of cardiopulmonary physiology in individual patients.
尽管在治疗新生儿持续性肺动脉高压（PPHN）方面取得了进展，但死亡率和不良神经后遗症的风险仍然很高。描述实践中的差异是改善患者预后的关键步骤。
评估加拿大和澳大利亚-新西兰地区（AUS-NZ）的重症监护实践。
对新生儿科医生进行了一项前瞻性横断面在线调查。制定了一个 35 项的问卷，经过验证和试点，以收集关于诊断、吸入一氧化氮（iNO）实践、替代血管扩张剂或正性肌力药以及超声心动图的信息。对调查对象的差异以及组间比较进行了评估。
共收集了 217 名受访者的数据。超声心动图和动脉血气是评估 PPHN 严重程度最常见的诊断测试。iNO 给药在加拿大更频繁地受到审查（36%比 AUS-NZ 的 10%，p < 0.001）。加拿大医生报告说，静脉注射米力农（p < 0.001）、血管加压素（p = 0.02）和吸入前列环素（p = 0.02）的使用频率更高，但用于治疗难治性肺动脉高压的西地那非（p = 0.01）的使用频率更低。AUS-NZ 中有更多的新生儿科医生接受过超声心动图（p < 0.001）培训，以优化治疗决策。
在 PPHN 的治疗管理中存在广泛的差异。需要提供更多关于 PPHN 管理原则的指导，同时认识到个体患者心肺生理学的动态性质。
