Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Eur J Pediatr. 2022 Apr;181(4):1669-1677. doi: 10.1007/s00431-022-04372-4. Epub 2022 Jan 10.
The aim of the study was to identify and explore areas in neonatal care in which significant differences in clinical care exist, among neonatal intensive care (NICU) and pediatric intensive care (PICU) physicians. A questionnaire presenting three common scenarios in neonatal critical care-severe pneumonia, post-cardiac-surgery care, and congenital diaphragmatic hernia (CDH) was electronically sent to all PICU and NICU physicians in Israel. The survey was completed by 110 physicians. Significant differences were noted between NICU and PICU physicians' treatment choices. A non-cuffed endotracheal tube, initial high-frequency ventilation, and lower tidal volumes when applying synchronized-intermittent-mechanical-ventilation were selected more often by NICU physicians. For sedation/analgesia, NICU physicians treated as needed or by continuous infusion of a single agent, while PICU physicians more often chose to continuously infuse ≥ 2 medications. Fentanyl, midazolam, and muscle relaxants were chosen more often by PICU physicians. Morphine administration was similar for both groups. Treating CDH with pulmonary hypertension and systemic hypotension, NICU physicians more often began treatment with high dose dopamine and/or dobutamine, while PICU physicians chose low-dose adrenalin and/or milrinone. For vascular access NICU physicians chose umbilical lines most often, while PICU physicians preferred other central sites.
Our study identified major differences in respiratory and hemodynamic care, sedation and analgesia, and vascular access between NICU and PICU physicians, resulting from field-specific consensus guidelines and practice traditions. We suggest to establish joint committees from both professions, aimed at finding the optimal treatment for this vulnerable population - be it in the NICU or in the PICU.
• Variability in neonatal care between the neonatal and the pediatric intensive care units has been previously described.
• This scenario-based survey study identified major differences in respiratory and hemodynamic care, sedation and analgesia, and vascular access between neonatologists and pediatric intensivists, resulting from lack of evidence-based literature to guide neonatal care, field-specific consensus guidelines, and practice traditions. • These findings indicate a need for joint committees, combining the unique skills and literature from both professions, to conduct clinical trials focusing on these specific areas of care, aimed at finding the optimal treatment for this vulnerable population - be it in the neonatal or the pediatric intensive care unit.
本研究旨在识别并探讨新生儿重症监护病房（NICU）和儿科重症监护病房（PICU）医生在临床护理方面存在显著差异的领域。我们向以色列所有 PICU 和 NICU 医生电子发送了一份包含新生儿危重症三种常见情况（严重肺炎、心脏手术后护理和先天性膈疝（CDH））的问卷。共有 110 名医生完成了这项调查。研究发现，NICU 和 PICU 医生的治疗选择存在显著差异。NICU 医生更倾向于选择无套囊的气管内导管、初始高频通气以及在应用同步间歇机械通气时采用较低的潮气量。在镇静/镇痛方面，NICU 医生按需治疗或通过单一药物持续输注，而 PICU 医生更倾向于连续输注≥2 种药物。PICU 医生更常选择芬太尼、咪达唑仑和肌肉松弛剂。NICU 医生更常选择吗啡进行治疗。对于 CDH 合并肺动脉高压和全身低血压，NICU 医生更常开始使用高剂量多巴胺和/或多巴酚丁胺治疗，而 PICU 医生则选择低剂量肾上腺素和/或米力农。在血管通路方面，NICU 医生最常选择脐静脉，而 PICU 医生则更喜欢其他中央部位。
本研究发现，由于特定领域的共识指南和实践传统，NICU 和 PICU 医生在呼吸和血液动力学治疗、镇静和镇痛以及血管通路方面存在显著差异。我们建议两个专业领域成立联合委员会，旨在为这个脆弱的群体找到最佳治疗方法——无论是在 NICU 还是 PICU。
这项基于情景的调查研究发现，由于缺乏指导新生儿护理的循证文献、特定领域的共识指南和实践传统，新生儿科医生和儿科重症监护医生在呼吸和血液动力学治疗、镇静和镇痛以及血管通路方面存在显著差异。
这些发现表明需要联合委员会，结合两个专业的独特技能和文献，开展针对这些特定护理领域的临床试验，旨在为这个脆弱的群体找到最佳治疗方法——无论是在新生儿重症监护病房还是儿科重症监护病房。
