Department of Paediatrics, University of Toronto, Toronto, Canada.
Neonatal Department, Christchurch Women's Hospital, Christchurch, New Zealand.
Pediatr Res. 2017 Dec;82(6):901-914. doi: 10.1038/pr.2017.200. Epub 2017 Oct 4.
It is increasingly recognized that the abnormal physiologic consequences of pulmonary hypertension (PH) may contribute to poor cardiopulmonary health in premature babies. Conflicting literature has led to clinical uncertainty, pathological misinterpretation, and variability in treatment approaches among practitioners. There are several disorders with overlapping and interrelated presentations, and other disorders with a similar clinical phenotype but diverse pathophysiological contributors. In this review, we provide a diagnostic approach for acute hypoxemic respiratory failure in the preterm neonate, outline the pathophysiological conditions that may present as acute PH, and discuss the implications of high pulmonary vascular resistance (PVR) on the cardiovascular system. Although PVR and respiratory management are highly interrelated, there may be a population of preterm neonates in whom inhaled nitric oxide may improve illness severity and may relate to outcomes. A management approach based on physiology that considers common clinical conundrums is provided. A more comprehensive understanding of the physiology may help in informed decision-making in clinical situations where conclusive scientific evidence is lacking. Regardless, high-quality research is required, and appropriate definition of the target population is paramount. A thoughtful approach to cardiovascular therapy may also provide an avenue to improve neurodevelopmental outcomes while awaiting more clear answers.
人们越来越认识到，肺动脉高压 (PH) 的异常生理后果可能导致早产儿心肺健康状况不佳。相互矛盾的文献导致了临床不确定性、病理误判以及从业者之间治疗方法的差异。有几种疾病具有重叠和相互关联的表现，还有其他一些疾病具有相似的临床表型但有不同的病理生理原因。在这篇综述中，我们为早产儿急性低氧性呼吸衰竭提供了一种诊断方法，概述了可能表现为急性 PH 的病理生理条件，并讨论了高肺血管阻力 (PVR) 对心血管系统的影响。尽管 PVR 和呼吸管理高度相关，但可能存在一部分早产儿，吸入一氧化氮可能会改善疾病严重程度，并可能与结局相关。我们提供了一种基于生理学的管理方法，考虑了常见的临床难题。更全面地了解生理学可能有助于在缺乏确凿科学证据的临床情况下做出明智的决策。无论如何，都需要高质量的研究，并且适当定义目标人群至关重要。对心血管治疗的深思熟虑的方法也可能为改善神经发育结局提供途径，同时等待更明确的答案。
