Muehlbacher Tobias, Bassler Dirk, Bryant Manuel B
Department of Neonatology, University Hospital Zurich, 8091 Zurich, Switzerland.
Children (Basel). 2021 Apr 13;8(4):298. doi: 10.3390/children8040298.
Very preterm birth often results in the development of bronchopulmonary dysplasia (BPD) with an inverse correlation of gestational age and birthweight. This very preterm population is especially exposed to interventions, which affect the development of BPD.
The goal of our review is to summarize the evidence on these daily procedures and provide evidence-based recommendations for the management of BPD.
We conducted a systematic literature research using MEDLINE/PubMed on antenatal corticosteroids, surfactant-replacement therapy, caffeine, ventilation strategies, postnatal corticosteroids, inhaled nitric oxide, inhaled bronchodilators, macrolides, patent ductus arteriosus, fluid management, vitamin A, treatment of pulmonary hypertension and stem cell therapy.
Evidence provided by meta-analyses, systematic reviews, randomized controlled trials (RCTs) and large observational studies are summarized as a narrative review.
There is strong evidence for the use of antenatal corticosteroids, surfactant-replacement therapy, especially in combination with noninvasive ventilation strategies, caffeine and lung-protective ventilation strategies. A more differentiated approach has to be applied to corticosteroid treatment, the management of patent ductus arteriosus (PDA), fluid-intake and vitamin A supplementation, as well as the treatment of BPD-associated pulmonary hypertension. There is no evidence for the routine use of inhaled bronchodilators and prophylactic inhaled nitric oxide. Stem cell therapy is promising, but should be used in RCTs only.
极早早产常导致支气管肺发育不良（BPD）的发生，且与胎龄和出生体重呈负相关。这一极早早产人群尤其容易受到影响BPD发展的干预措施的影响。
我们综述的目的是总结这些日常操作的证据，并为BPD的管理提供基于证据的建议。
我们使用MEDLINE/PubMed对产前糖皮质激素、表面活性剂替代疗法、咖啡因、通气策略、产后糖皮质激素、吸入一氧化氮、吸入支气管扩张剂、大环内酯类、动脉导管未闭、液体管理、维生素A、肺动脉高压治疗和干细胞疗法进行了系统的文献研究。
通过荟萃分析、系统评价、随机对照试验（RCT）和大型观察性研究提供的证据以叙述性综述的形式进行了总结。
有强有力的证据支持使用产前糖皮质激素、表面活性剂替代疗法，尤其是与无创通气策略、咖啡因和肺保护性通气策略联合使用。对于糖皮质激素治疗、动脉导管未闭（PDA）的管理、液体摄入和维生素A补充以及BPD相关肺动脉高压的治疗，必须采用更具差异化的方法。没有证据支持常规使用吸入支气管扩张剂和预防性吸入一氧化氮。干细胞疗法很有前景，但仅应在随机对照试验中使用。
