Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
Department of Pediatrics and Neonatology, Takatsuki General Hospital, Takatsuki, Osaka, Japan.
Pediatr Neonatol. 2020 Jun;61(3):272-278. doi: 10.1016/j.pedneo.2019.11.007. Epub 2019 Nov 22.
Bronchopulmonary dysplasia (BPD) is a common complication in very preterm infants. Despite advances in perinatal medicine, the number of BPD patients is increasing in Japan. The aim of this study was to conduct a nationwide survey of the strategies used for the prevention or treatment of BPD.
Questionnaires assessing the current strategies used to prevent or treat BPD, including neonatal resuscitation, drug therapy, and respiratory supportive care, were sent to secondary or tertiary perinatal units in 2015; responses were compared with those obtained from similar surveys in 2005 and 2010. The annual trend in incidence of BPD among the very low birth weight infants (VLBWIs) was determined using the Neonatal Research Network of Japan database.
The response rates in 2005, 2010, and 2015 were 86.8% (230/265), 64.5% (185/287), and 82.8% (236/285) of units, respectively. The use of patient-triggered ventilation for initial management significantly increased from 50% of units in 2005 to 91% in 2015. By contrast, decreased use of high-frequency oscillatory ventilation (HFOV) from 72% to 65% and that of nasal continuous positive airway pressure from 79% to 68% were reported. The proportion of units where the upper limit of targeted blood oxygen saturation before a diagnosis of BPD was set to ≥95% decreased substantially from 92% to 56% over the 10-year period. Despite these changes in management of BPD, the incidence of BPD among VLBWIs in Japan was increasing over a decade.
This survey demonstrated that there were various changes in practice regarding the prevention or treatment of BPD in Japan. Continuous surveys are required to understand the current clinical situation, and research is needed to develop and evaluate a novel treatment for BPD in premature infants.
支气管肺发育不良（BPD）是极早产儿常见的并发症。尽管围产期医学取得了进步，但日本的 BPD 患者人数仍在增加。本研究的目的是对预防或治疗 BPD 的策略进行全国性调查。
2015 年向二级或三级围产期单位发送了评估预防或治疗 BPD 目前策略的问卷，包括新生儿复苏、药物治疗和呼吸支持治疗；并将结果与 2005 年和 2010 年的类似调查结果进行了比较。使用日本新生儿研究网络数据库确定极低出生体重儿（VLBWI）中 BPD 的年发生率趋势。
2005 年、2010 年和 2015 年的回复率分别为 265 个单位中的 86.8%（230/265）、287 个单位中的 64.5%（185/287）和 285 个单位中的 82.8%（236/285）。从 2005 年的 50%到 2015 年的 91%，使用患者触发通气进行初始管理的单位显著增加。相比之下，高频振荡通气（HFOV）的使用率从 72%下降到 65%，鼻持续气道正压通气（CPAP）的使用率从 79%下降到 68%。在诊断 BPD 之前将目标血氧饱和度上限设定为≥95%的单位比例在 10 年内从 92%显著下降到 56%。尽管 BPD 的治疗方法发生了这些变化，但日本 VLBWI 中 BPD 的发生率在过去十年中一直在增加。
本调查表明，日本在预防或治疗 BPD 方面的实践存在各种变化。需要进行持续调查以了解当前的临床情况，并需要研究和评估早产儿 BPD 的新治疗方法。
