一项关于新生儿呼吸窘迫综合征管理的全国性调查：来自中国 394 家医院的慕尼黑调查的见解。

A nationwide survey on the management of neonatal respiratory distress syndrome: insights from the MUNICH survey in 394 Chinese hospitals.

机构信息

Department of Neonatology, Women and Children's Hospital of Chongqing Medical University, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, China.

Department of Neonatology, Children's Hospital of Shanxi, No.310 Changzhi Road, Xiaodian District, Taiyuan, Shanxi, China.

出版信息

Ital J Pediatr. 2024 Sep 7;50(1):168. doi: 10.1186/s13052-024-01741-7.

DOI:10.1186/s13052-024-01741-7

PMID:39244592

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11380405/

Abstract

BACKGROUND

At present, preterm infants with respiratory distress syndrome (RDS) in China present higher mortality and morbidity rates than those in high-income countries. The aim of this nationwide survey was to assess the clinical management of RDS in China.

METHODS

A nationwide cross-sectional survey to assess adherence to RDS management recommendations was performed. One neonatologist per hospital was randomly selected. The primary outcome was the key care of RDS management.

RESULTS

Among the 394 participating hospitals, 88·3% were birthing centres. The number of doctors and nurses per bed were 0·27 and 0·72, respectively. Antenatal corticosteroids (any dose) were administered to 90% of the women at risk of preterm birth at < 34 weeks of gestation (90·0% inborn vs. 50·0% outborn, p < 0·001). The median fraction of inspired oxygen (FiO) for initial resuscitation was 0·30 for babies born at ≤ 32 weeks of gestation and 0·25 for those born at > 32 weeks. T-piece resuscitators were available in 77·8% of delivery rooms (DRs) (tertiary hospitals: 82·5% vs. secondary hospitals: 63·0%, p < 0·001). Surfactant was used in 51·6% of the DRs. Less invasive surfactant administration (LISA) was used in 49·7% of the hospitals (tertiary hospitals: 55·3% vs. secondary hospitals: 31·5%, p < 0·001). Primary non-invasive ventilation was initiated in approximately 80·0% of the patients. High-frequency oscillation ventilation was primarily reserved for rescue after conventional mechanical ventilation (MV) failure. Caffeine was routinely used during MV in 59·1% of the hospitals. Bedside lung ultrasonography was performed in 54·3% of the health facilities (tertiary hospitals: 61·6% vs. secondary hospitals: 30·4%, p < 0·001). Qualified breast milk banks and Family Integrated Care (FICare) were present in 30·2% and 63·7% of the hospitals, respectively.

CONCLUSIONS

Significant disparities in resource availability and guidelines adherence were evident across hospitals. Future strategies should address DR facilities and medication access, technical training, staff allocation, and ancillary facility development for a better management of RDS patients in China.

摘要

背景

目前，中国患有呼吸窘迫综合征（RDS）的早产儿死亡率和发病率高于高收入国家。本项全国性调查旨在评估中国 RDS 的临床管理情况。

方法

开展了一项全国性的横断面调查，以评估 RDS 管理建议的实施情况。每家医院随机选择一名新生儿科医生。主要结局为 RDS 管理的关键护理。

结果

在参与的 394 家医院中，88.3%为分娩中心。每床医生和护士人数分别为 0.27 和 0.72。90.0%的有早产风险的孕妇（<34 孕周）接受了产前皮质激素（任何剂量）治疗（院内分娩：90.0%；院外分娩：50.0%，p<0.001）。胎龄≤32 周出生的婴儿初始复苏时吸入氧分数中位数为 0.30，胎龄>32 周出生的婴儿为 0.25。复苏 T 型管在 77.8%的产房（三级医院：82.5%；二级医院：63.0%，p<0.001）中可用。51.6%的产房使用了肺表面活性物质。49.7%的医院采用了经鼻间歇正压通气（初级无创通气）（三级医院：55.3%；二级医院：31.5%，p<0.001）。大约 80.0%的患者开始使用高频振荡通气。高频振荡通气主要作为常规机械通气（MV）失败后的抢救措施。59.1%的医院在 MV 期间常规使用咖啡因。54.3%的医疗机构（三级医院：61.6%；二级医院：30.4%，p<0.001）开展了床边肺部超声检查。合格的母乳库和家庭综合护理（FICare）分别存在于 30.2%和 63.7%的医院。