Stiboy Eunice, Chan Mei, Islam Md Saiful, Saravanos Gemma L, Lui Kei, Jaffe Adam, Homaira Nusrat
School of Public Health, The University of Sydney, Camperdown, Australia.
UNSW Medicine and Health, Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Randwick, NSW, Australia.
Pediatr Pulmonol. 2023 Apr;58(4):1210-1220. doi: 10.1002/ppul.26324. Epub 2023 Feb 14.
Uniformity and compliance with clinical practice guidelines (CPGs) for use of palivizumab in preventing severe respiratory syncytial viral infection in Australian high-risk infants remain unclear.
An online survey was conducted across the Australian and New Zealand Neonatal Network (ANZNN) to determine clinical practices around palivizumab. A literature search was also performed to identify and compare national and international guidelines.
A total of 65 of 422 ANZNN members completed the survey. Respondents included 61 senior medical staff of consultants/staff specialists (78%) and four nursing staff (6%). According to the survey, infants most likely to be recommended palivizumab included preterm infants born <29 weeks gestational age (GA) (30%), children with chronic lung diseases (CLDs) born <32 weeks GA (40%), and with hemodynamically significant heart disease (35%). Many of the respondents (53%) stated that CPGs for palivizumab were developed locally. Literature search identified 20 guidelines (10 international and 10 domestic); 16 (80%) recommended palivizumab use in preterm infants, 16 (80%) recommended use in infants with CLD, 17 (85%) in congenital heart disease and 6 (30%) in bronchopulmonary dysplasia (BPD). Eight (40%) guidelines provided specific recommendations for immunocompromised infants. Canada, Western Australia, and American Academy of Paediatrics provided recommendations for Indigenous children. Frequency and dosage of palivizumab was universal across all CPGs. None of the international guidelines obtained were from low- or middle-income countries.
Standardization of CPGs may improve clinical decision making around use of palivizumab in high-risk infants.
在澳大利亚高危婴儿中，使用帕利珠单抗预防严重呼吸道合胞病毒感染的临床实践指南的一致性和依从性尚不清楚。
在澳大利亚和新西兰新生儿网络（ANZNN）开展了一项在线调查，以确定围绕帕利珠单抗的临床实践。还进行了文献检索，以识别和比较国内和国际指南。
422名ANZNN成员中共有65人完成了调查。受访者包括61名顾问/专科医生高级医务人员（78%）和4名护理人员（6%）。根据调查，最有可能被推荐使用帕利珠单抗的婴儿包括孕龄<29周的早产儿（30%）、孕龄<32周的慢性肺病（CLD）患儿（40%）以及有血流动力学显著意义的心脏病患儿（35%）。许多受访者（53%）表示，帕利珠单抗的临床实践指南是在当地制定的。文献检索确定了20项指南（其中10项国际指南和10项国内指南）；16项（80%）推荐在早产儿中使用帕利珠单抗，16项（80%）推荐在CLD婴儿中使用，17项（85%）推荐在先天性心脏病中使用，6项（3%）推荐在支气管肺发育不良（BPD）中使用。8项（40%）指南为免疫功能低下的婴儿提供了具体建议。加拿大、西澳大利亚州和美国儿科学会为原住民儿童提供了建议。所有临床实践指南中帕利珠单抗的使用频率和剂量都是统一的。所获得的国际指南均非来自低收入或中等收入国家。
临床实践指南的标准化可能会改善高危婴儿使用帕利珠单抗的临床决策。
