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儿科医生在新生儿科出院后的肾脏随访:一项调查。

Renal follow-up in pediatrician practice after discharge from neonatology units: about a survey.

机构信息

Pediatric Nephrology Unit, Geneva University Hospital, Rue Willy-Donzé 6, 1205, Geneva, Switzerland.

Neonatal Intensive Care Unit, Geneva University Hospital, Rue Willy-Donzé 6, 1205, Geneva, Switzerland.

出版信息

Eur J Pediatr. 2020 Nov;179(11):1721-1727. doi: 10.1007/s00431-020-03652-1. Epub 2020 May 13.

Abstract

There is growing evidences of long-term renal and cardiovascular consequences of prematurity, intra-uterine growth restriction, and neonatal acute kidney injury (AKI). We performed an online survey to describe current pediatric management in this population, sent to 148 ambulatory pediatricians in Geneva. Among the 40% of pediatricians who completed the survey, 43% modify their blood pressure measurement practice in case of neonatal acute kidney injury, 24% and 19% in a context of prematurity or intra-uterine growth restriction, respectively. Twenty-five percent provide information about cardiovascular risk factors or catch up growth. In case of prematurity or intra-uterine growth restriction, renal tests (ultrasound, serum creatinine, micro albuminuria) or referral to nephrologist were realized by less than 5% of the pediatricians. For neonatal acute kidney injury, renal tests, and referral to specialists are performed by 30 and 60% of pediatricians, respectively. When prematurity or intra-uterine growth restriction was associated with abnormal blood pressure or abnormal renal tests, the referral to the specialist reached 80%.Conclusion: Ambulatory renal and cardio-vascular follow-up in case of neonatal medical history can be enhanced, with necessity to raise awareness and to edict guidelines available to pediatricians. What is Known: • There is a compelling evidence of long-term renal and cardiovascular consequences of prematurity and low birth weight. • Specific cardiovascular and renal follow-up guidelines, coming from professional organizations, are currently not available for these patients. What is New: • Pediatricians in ambulatory setting do not adapt their renal and cardiovascular follow-up in case of neonatal medical history. • There is a necessity to raise awareness about these long-term consequences among pediatricians and to edict guidelines available to them.

摘要

越来越多的证据表明,早产儿、宫内生长受限和新生儿急性肾损伤(AKI)会导致长期的肾脏和心血管后果。我们进行了一项在线调查,以描述目前在这一人群中的儿科管理方法,调查对象是日内瓦的 148 名门诊儿科医生。在完成调查的 40%的儿科医生中,43%在新生儿急性肾损伤的情况下会改变他们的血压测量方法,24%和 19%分别在早产儿或宫内生长受限的情况下会改变。25%的儿科医生会提供有关心血管危险因素或追赶生长的信息。在早产儿或宫内生长受限的情况下,不到 5%的儿科医生会进行肾脏检查(超声、血清肌酐、微量白蛋白尿)或转介给肾病专家。对于新生儿急性肾损伤,30%和 60%的儿科医生分别会进行肾脏检查和转介给专家。当早产儿或宫内生长受限与血压异常或肾脏检查异常同时存在时,转介给专家的比例达到 80%。结论:可以加强门诊肾脏和心血管随访,以适应新生儿病史,有必要提高儿科医生的认识,并制定可供儿科医生使用的指南。已知:•早产儿和低出生体重与长期肾脏和心血管后果有确凿的证据。•目前,专业组织没有针对这些患者的特定心血管和肾脏随访指南。新发现:•门诊环境中的儿科医生在遇到新生儿病史时不会调整他们的肾脏和心血管随访。•有必要提高儿科医生对这些长期后果的认识,并为他们制定可用的指南。

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