Mahoney Liam, Luyt Karen, Harding David, Odd David
Neonatal Unit, North Bristol NHS Trust, Bristol, United Kingdom.
Academic Department of Paediatrics, Brighton and Sussex Medical School, Brighton, United Kingdom.
Front Pediatr. 2020 Jun 23;8:238. doi: 10.3389/fped.2020.00238. eCollection 2020.
To perform a systematic review and multiple-treatment meta-analysis for the treatment of premature infants with post-hemorrhagic ventricular dilatation (PHVD), to prevent death or long-term neuro-disability. A systematic review was performed using PubMed, EMBASE, and the Cochrane Library. A free-word search was performed to identify likely relevant literature intervention trials of PHVD in preterm infants. Initially, network mapping was performed followed by performing a Bayesian random-effects model using the Markov chain Monte Carlo method. Areas under the cumulative ranking curve (SUCRA) were calculated as a measure of the probability that each intervention was likely to be the 1st, 2nd, 3rd, etc. best therapy. Primary outcome measure was death or moderate or severe neurodevelopmental outcome at or beyond 12 months of corrected age. Ten different trials were identified, enrolling 700 individuals (449 for the primary outcome). Seven intervention categories were identified, and of the 15 possible pair comparisons, 6 have been studied directly. In the multiple-treatment meta-analysis, no comparison reached conventional levels of statistical significance. Drainage Irrigation and Fibrinolytic Therapy (DRIFT) had the highest probability of being the best treatment for the primary outcome (82.1%), followed by CSF removal (10.8%), conservative management (6.7%), and then diuretic therapy (0.4%). PHVD is a significant cause of death and disability in developed countries, yet few therapeutic options have so far been trialed. While new therapies are urgently needed for these infants, at present, NMA shows that DRIFT appears to be the most likely candidate to improve outcomes after sIVH.
为了对出血后脑室扩张（PHVD）早产儿的治疗进行系统评价和多治疗方法的荟萃分析，以预防死亡或长期神经残疾。使用PubMed、EMBASE和Cochrane图书馆进行了系统评价。通过自由词检索来识别可能相关的早产儿PHVD干预试验文献。最初进行网络映射，然后使用马尔可夫链蒙特卡罗方法进行贝叶斯随机效应模型分析。计算累积排名曲线下面积（SUCRA），作为衡量每种干预措施成为最佳治疗方法（第1、2、3等最佳治疗方法）可能性的指标。主要结局指标是矫正年龄12个月及以后的死亡或中度或重度神经发育结局。共识别出10项不同试验，纳入700名个体（449名用于主要结局）。识别出7种干预类别，在15种可能的配对比较中，有6种已直接进行研究。在多治疗方法的荟萃分析中，没有比较达到传统的统计学显著水平。引流冲洗及纤维蛋白溶解疗法（DRIFT）成为主要结局最佳治疗方法的可能性最高（82.1%），其次是脑脊液清除（10.8%）、保守治疗（6.7%），然后是利尿治疗（0.4%）。PHVD是发达国家死亡和残疾的重要原因，但迄今为止很少有治疗方案进行试验。虽然这些婴儿迫切需要新的治疗方法，但目前，网络荟萃分析表明DRIFT似乎是改善脑室周围-脑室内出血后结局最有可能的候选方法。
