Neonatology, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Sleep Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
BMJ Paediatr Open. 2021 Feb 19;5(1):e000979. doi: 10.1136/bmjpo-2020-000979. eCollection 2021.
To determine the practices of neonatologists in managing high-risk neonates believed to be at risk of sleep disordered breathing (SDB).
An electronic web-based questionnaire assessing awareness of and current practices for managing neonates predisposed to SDB with conditions like craniofacial anomalies, neuromuscular disorders or airway problems was emailed to 232 neonatologists and neonatal fellows working in Australia and New Zealand (NZ). Additionally, neonatologists were approached directly during the annual Australia and NZ perinatal conference in 2019.
93 neonatologists (40%) responded to the survey. The majority (85%) of the respondents stated that there were no written protocols/criteria for sleep consultation in their unit. We found considerable variations in the threshold for performing tests including oximetry or referring for polysomnography. Most respondents would perform oximetry before referring for a sleep consultation. However, the duration of oximetry varied from 6 to 24 hours and there was no consensus about what is considered abnormal on an oximetry study.
Management of SDB is gaining importance in neonatal care because of prolonged length of hospital stay and possible long-term effects of SDB. Responses received suggest a lack of clarity regarding thresholds for referral for treatment of SDB. Likely contributory factors are concerns regarding a lack of long-term outcome data from treatment perceived to be onerous for the family, unsettling to some infants and delaying hospital discharge. To overcome inconsistencies in practice, standardised guidelines for assessing and managing SDB in neonates are needed.
确定新生儿科医生在管理被认为存在睡眠呼吸障碍（SDB）风险的高危新生儿时的实践情况。
通过电子邮件向在澳大利亚和新西兰工作的 232 名新生儿科医生和新生儿研究员发送了一份电子网络问卷，评估他们对有颅面畸形、神经肌肉疾病或气道问题等易患 SDB 的新生儿的管理意识和当前管理实践。此外，在 2019 年澳大利亚和新西兰围产期会议期间还直接接触了新生儿科医生。
93 名新生儿科医生（40%）对调查做出了回应。大多数（85%）受访者表示，他们的单位没有关于睡眠咨询的书面协议/标准。我们发现，在进行测试（包括血氧饱和度或多导睡眠图检查）的阈值方面存在相当大的差异。大多数受访者会在进行睡眠咨询之前进行血氧饱和度检查。然而，血氧饱和度检查的持续时间从 6 小时到 24 小时不等，并且对于血氧饱和度研究中什么是异常的，没有共识。
由于住院时间延长和 SDB 可能产生的长期影响，SDB 的管理在新生儿护理中变得越来越重要。收到的回复表明，对于 SDB 治疗的转诊阈值缺乏明确性。可能的促成因素是对治疗的长期结果数据缺乏信心，认为治疗对家庭来说负担过重，对一些婴儿来说不安，并且会延迟医院出院。为了克服实践中的不一致性，需要制定评估和管理新生儿 SDB 的标准化指南。
