National Center for Child Health and Development, Tokyo, Japan;
Middlemore Hospital, Otahuhu, Auckland, New Zealand.
Pediatrics. 2020 Oct;146(4). doi: 10.1542/peds.2020-0586. Epub 2020 Sep 9.
Current International Liaison Committee on Resuscitation recommendations on epinephrine administration during neonatal resuscitation were derived in 2010 from indirect evidence in animal or pediatric studies.
Systematic review of human infant and relevant animal studies comparing other doses, routes, and intervals of epinephrine administration in neonatal resuscitation with (currently recommended) administration of 0.01 to 0.03 mg/kg doses given intravenously (IV) every 3 to 5 minutes.
Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and trial registry databases.
Predefined criteria were used for selection.
Risk of bias was assessed by using published tools appropriate for the study type. Certainty of evidence was assessed by using Grading of Recommendations Assessment, Development and Evaluation.
Only 2 of 4 eligible cohort studies among 593 unique retrieved records yielded data allowing comparisons. There were no differences between IV and endotracheal epinephrine for the primary outcome of death at hospital discharge (risk ratio = 1.03 [95% confidence interval 0.62 to 1.71]) or for failure to achieve return of spontaneous circulation, time to return of spontaneous circulation (1 study; 50 infants), or proportion receiving additional epinephrine (2 studies; 97 infants). There were no differences in outcomes between 2 endotracheal doses (1 study). No human infant studies were found in which authors addressed IV dose or dosing interval.
The search yielded sparse human evidence of very low certainty (downgraded for serious risk of bias and imprecision).
Administration of epinephrine by endotracheal versus IV routes resulted in similar survival and other outcomes. However, in animal studies, researchers continue to suggest benefit of IV administration using currently recommended doses.
目前的国际复苏联络委员会关于新生儿复苏期间肾上腺素给药的建议是 2010 年从动物或儿科研究的间接证据中得出的。
系统评价比较其他剂量、途径和间隔时间的肾上腺素在新生儿复苏中的应用，与（目前推荐的）每 3 至 5 分钟静脉内（IV）给予 0.01 至 0.03mg/kg 剂量的复苏，与目前推荐的方案相比。
Medline、Embase、护理学及相关健康文献累积索引、Cochrane 系统评价数据库和试验注册数据库。
使用预定义标准进行选择。
使用适用于研究类型的已发表工具评估偏倚风险。使用推荐评估、制定和评估分级法评估证据的确定性。
在 593 条独特检索记录中，只有 2 项符合条件的队列研究提供了允许比较的数据。在主要结局（出院时死亡）方面，IV 与气管内肾上腺素之间没有差异（风险比=1.03[95%置信区间 0.62 至 1.71]）或未能实现自主循环恢复、自主循环恢复时间（1 项研究；50 名婴儿）或接受额外肾上腺素的比例（2 项研究；97 名婴儿）。2 项气管内剂量研究之间的结果没有差异。未发现作者解决 IV 剂量或给药间隔的人类婴儿研究。
搜索结果仅提供了非常低确定性（因严重偏倚和不精确而降级）的少量人类证据。
气管内与 IV 途径给药肾上腺素导致相似的存活率和其他结局。然而，在动物研究中，研究人员继续使用目前推荐的剂量建议 IV 给药的益处。
