Beltempo Marc, Isayama Tetsuya, Vento Máximo, Lui Kei, Kusuda Satoshi, Lehtonen Liisa, Sjörs Gunnar, Håkansson Stellan, Adams Mark, Noguchi Akihiko, Reichman Brian, Darlow Brian A, Morisaki Naho, Bassler Dirk, Pratesi Simone, Lee Shoo K, Lodha Abhay, Modi Neena, Helenius Kjell, Shah Prakesh S
Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
Clinical Epidemiology and Biostatistics, McMaster University, Toronto, Ontario, Canada.
Neonatology. 2018;114(1):28-36. doi: 10.1159/000487987. Epub 2018 Apr 13.
There are significant international variations in chronic lung disease rates among very preterm infants yet there is little data on international variations in respiratory strategies.
To evaluate practice variations in the respiratory management of extremely preterm infants born at < 29 weeks' gestational age (GA) among 10 neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of Neonates collaboration.
A web-based survey was sent to the representatives of 390 neonatal intensive care units from Australia/New Zealand, Canada, Finland, Illinois (USA), Israel, Japan, Spain, Sweden, Switzerland, and Tuscany (Italy). Responses were based on practices in 2015.
Overall, 321 of the 390 units responded (82%). The majority of units within networks (40-92%) mechanically ventilate infants born at 23-24 weeks' GA on continuous positive airway pressure (CPAP) with 30-39% oxygen in respiratory distress within 48 h after birth, but the proportion of units that offer mechanical ventilation for infants born at 25-26 weeks' GA at similar settings varied significantly (20-85% of units within networks). The most common respiratory strategy for infants born at 27-28 weeks' GA on CPAP with 30-39% oxygen with respiratory distress within 48 h after birth used by units also varied significantly among networks: mechanical ventilation (0-60%), CPAP (3-82%), intubation and surfactant administration with immediate extubation (0-75%), and less invasive surfactant administration (0-68%).
There are marked variations but also similarities in respiratory management of extremely preterm infants between networks. Further collaboration and exploration is needed to better understand the association of these variations in practice with pulmonary outcomes.
极早产儿慢性肺病发生率在国际上存在显著差异，但关于呼吸策略的国际差异数据较少。
评估参与新生儿国际结局评估网络（iNeo）合作的10个新生儿网络中，孕龄小于29周的极早产儿呼吸管理的实践差异。
向来自澳大利亚/新西兰、加拿大、芬兰、美国伊利诺伊州、以色列、日本、西班牙、瑞典、瑞士和意大利托斯卡纳的390个新生儿重症监护病房的代表发送了基于网络的调查问卷。回答基于2015年的实践情况。
总体而言，390个单位中有321个做出了回应（82%）。各网络中的大多数单位（40%-92%）对孕龄23-24周的出生婴儿在出生后48小时内出现呼吸窘迫时采用持续气道正压通气（CPAP）并给予30%-39%的氧气进行机械通气，但在类似情况下为孕龄25-26周的出生婴儿提供机械通气的单位比例差异很大（各网络中20%-85%的单位）。各网络中，对于孕龄27-28周的出生婴儿在出生后48小时内出现呼吸窘迫时采用CPAP并给予30%-39%氧气的最常见呼吸策略也有显著差异：机械通气（0%-60%）、CPAP（3%-82%）、插管并给予表面活性剂后立即拔管（0%-75%）以及无创表面活性剂给药（0%-68%）。
各网络之间极早产儿的呼吸管理存在显著差异，但也有相似之处。需要进一步合作和探索，以更好地了解这些实践差异与肺部结局之间的关联。
