Kayton Allyson, Timoney Paula, Vargo Lyn, Perez Jose A
Mallinckrodt Pharmaceuticals, Bedminster, New Jersey (Ms Kayton); Neonatal Nurse Practitioner Program, Stony Brook University, Stony Brook, New York (Dr Timoney); Neonatal Nurse Practitioner Program, University of Missouri-Kansas City (Dr Vargo); AND Neonatology-Perinatal Medicine, Orlando Health, Orlando, Florida (Dr Perez).
Adv Neonatal Care. 2018 Apr;18(2):88-97. doi: 10.1097/ANC.0000000000000470.
Excessive supplemental oxygen exposure in the neonatal intensive care unit (NICU) can be associated with oxygen-related toxicities, which can lead to negative clinical consequences. Use of inhaled nitric oxide (iNO) can be a successful strategy for avoiding hyperoxia in the NICU. iNO selectively produces pulmonary vasodilation and has been shown to improve oxygenation parameters across the spectrum of disease severity, from mild to very severe, in neonates with hypoxic respiratory failure associated with persistent pulmonary hypertension of the newborn.
An online survey was conducted among members of the National Association of Neonatal Nurse Practitioners to gain insight into the level of understanding and knowledge among neonatal nurse practitioners (NNPs) about optimizing supplemental oxygen exposure and the use of iNO in the NICU setting.
Of 937 NNP respondents, 51% reported that their healthcare team typically waits until the fraction of inspired oxygen level is 0.9 or more before adding iNO in patients not responding to oxygen ventilation alone. Among respondents with 1 or more iNO-treated patients per month, only 35% reported they know the oxygenation index level at which iNO should be initiated. Less than 20% of NNPs reported perceived benefits associated with early initiation of iNO for preventing progression to use of extracorporeal membrane oxygenation or reducing the length of hospital stay, and about one-third of respondents reported they believe early iNO use minimizes hyperoxia.
More education is needed for NNPs regarding the negative effects of oxidative stress in neonates.
Additional clinical trials investigating the most beneficial strategies for avoiding neonatal hyperoxia are warranted.
新生儿重症监护病房（NICU）中过度暴露于补充氧气可能与氧相关毒性有关，这可能导致负面的临床后果。使用吸入一氧化氮（iNO）可能是在NICU中避免高氧血症的成功策略。iNO可选择性地产生肺血管舒张，并且已被证明可改善患有与新生儿持续性肺动脉高压相关的低氧性呼吸衰竭的新生儿在从轻度到非常严重的整个疾病严重程度范围内的氧合参数。
对全国新生儿护士从业者协会的成员进行了一项在线调查，以深入了解新生儿护士从业者（NNP）对优化补充氧气暴露以及在NICU环境中使用iNO的理解水平和知识。
在937名NNP受访者中，51%报告称他们的医疗团队通常会等到吸入氧分数水平达到0.9或更高时，才会在仅对氧气通气无反应的患者中添加iNO。在每月有1名或更多接受iNO治疗患者的受访者中，只有35%报告他们知道应开始使用iNO时的氧合指数水平。不到20%的NNP报告称他们认为早期使用iNO对于预防进展到使用体外膜肺氧合或缩短住院时间有好处，并且约三分之一的受访者报告他们认为早期使用iNO可将高氧血症降至最低。
需要对NNP进行更多关于新生儿氧化应激负面影响的教育。
有必要进行更多临床试验，以研究避免新生儿高氧血症的最有益策略。
