Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.
Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia.
Lancet. 2017 Apr 22;389(10079):1649-1659. doi: 10.1016/S0140-6736(17)30312-4.
Preterm birth rates are rising, and many preterm infants have breathing difficulty after birth. Treatments for infants with prolonged breathing difficulty include oxygen therapy, exogenous surfactant, various modes of respiratory support, and postnatal corticosteroids. In this Series paper, we review the history of neonatal respiratory care and its effect on long-term outcomes, and we outline the future direction of the research field. The delivery and monitoring of oxygen therapy remains controversial, despite being in use for more than 50 years. Exogenous surfactant replacement has been used for 25 years and has dramatically reduced mortality and morbidity, but more research on when and how it is administered is needed. Methods and techniques of neonatal respiratory support are evolving. Clinicians are moving away from routine intubation and ventilation, and new modes of non-invasive support are being investigated. Postnatal corticosteroids have a limited role in infants with evolving bronchopulmonary dysplasia, but more research is needed to identify the best timing, type, dose, and method of administration. Despite advances in neonatal care in the past 50 years, bronchopulmonary dysplasia, with all its adverse short-term and long-term consequences, is still a serious problem in neonatal care. The challenge remains to support breathing in preterm infants, with special attention to risk factors in the subpopulation of infants that are at highest risk of bronchopulmonary dysplasia, without damaging their lungs or adversely affecting their long-term health.
早产率正在上升，许多早产儿出生后有呼吸困难。对于有长时间呼吸困难的婴儿，治疗方法包括氧疗、外源性表面活性剂、各种呼吸支持模式和产后皮质类固醇。在本系列论文中，我们回顾了新生儿呼吸护理的历史及其对长期结局的影响，并概述了该研究领域的未来方向。尽管氧疗已经使用了 50 多年，但它的输送和监测仍然存在争议。外源性表面活性剂替代已经使用了 25 年，大大降低了死亡率和发病率，但仍需要更多关于何时以及如何使用它的研究。新生儿呼吸支持的方法和技术正在不断发展。临床医生正在远离常规插管和通气，新的非侵入性支持模式正在被研究。对于正在发展为支气管肺发育不良的婴儿，产后皮质类固醇的作用有限，但需要更多的研究来确定最佳的时机、类型、剂量和给药方法。尽管在过去的 50 年里新生儿护理取得了进展，但支气管肺发育不良及其所有短期和长期的不良后果仍然是新生儿护理中的一个严重问题。挑战仍然是支持早产儿的呼吸，特别要注意在支气管肺发育不良风险最高的婴儿亚群中，既要避免损害他们的肺部，又要避免对他们的长期健康产生不利影响。
