Departments of Surgery and Pediatrics, University of California at Davis, Sacramento, CA, USA.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
J Perinatol. 2019 Jan;39(1):86-94. doi: 10.1038/s41372-018-0258-9. Epub 2018 Oct 23.
We studied decision making regarding inhaled nitric oxide (iNO) in preterm infants with Pulmonary Hypertension (PH).
We asked members of the AAP-Society of Neonatal-Perinatal Medicine and Division-Chiefs to select from three management options- initiate iNO, engage parents in shared decision making or not consider iNO in an extremely preterm with PH followed by rating of factors influencing their decision.
Three hundred and four respondents (9%) completed the survey; 36.5% chose to initiate iNO, 42% to engage parents, and 21.5% did not consider iNO. Provider's prior experience, safety, and patient-centered care were rated higher by those who initiated or offered iNO; lack of effectiveness and cost considerations by participants who did not chose iNO.
Most neonatologists offer or initiate iNO therapy based on their individual experience. The minority who chose not to consider iNO placed higher value on lack of effectiveness and cost. These results demonstrate a tension between evidence and pathophysiology-based-therapy/personal experience.
我们研究了患有肺动脉高压（PH）的早产儿使用吸入一氧化氮（iNO）的决策。
我们要求 AAP-新生儿围产期医学学会成员和科室主任从三种管理方案中选择-启动 iNO，让父母参与共同决策，或不考虑 PH 的极早产儿中的 iNO，并对影响他们决策的因素进行评分。
304 名受访者（9%）完成了调查；36.5%选择启动 iNO，42%选择让父母参与，21.5%不考虑 iNO。那些选择启动或提供 iNO 的医生，将他们的经验、安全性和以患者为中心的护理评价得更高；而那些不选择 iNO 的参与者则认为其缺乏有效性和成本考虑。
大多数新生儿科医生根据个人经验提供或启动 iNO 治疗。少数不考虑 iNO 的人更看重缺乏有效性和成本。这些结果表明证据和基于病理生理学的治疗/个人经验之间存在紧张关系。
