Dominguez Georgia, Muralidharan Oviya, Lee Him Rachel, Harrison Leila, Vaivada Tyler, Bhutta Zulfiqar A
Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
Neonatology. 2025;122(Suppl 1):152-172. doi: 10.1159/000542482. Epub 2024 Nov 14.
Neonatal respiratory conditions are leading causes of mortality and morbidity during the neonatal period. This review evaluated 11 management interventions for respiratory distress syndrome (RDS), apnoea of prematurity (AOP), meconium aspiration syndrome (MAS), transient tachypnea of the newborn (TTN), as well as bronchopulmonary dysplasia (BPD) as a potential complication from respiratory care in low- and middle-income countries (LMICs).
Two different methodological approaches were completed: (1) updating outdated reviews and pooling all LMIC studies and (2) re-analysis of LMIC studies from up-to-date reviews. Review updates were conducted between October 2022 and February 2023 and followed systematic methodology. A total of 50 studies were included across four review updates and seven review re-analyses.
Findings indicate that bubble CPAP (RR 0.74, 95% CI: 0.58-0.96) and prophylactic CPAP (RR 0.39, 95% CI: 0.26-0.57) for RDS reduced the risk of treatment failure compared to other ventilation types or supportive care, respectively. Postnatal corticosteroids reduced BPD assessed as oxygen requirement at 36 weeks' postmenstrual age (RR 0.56, 95% CI: 0.41-0.77). All other outcomes were found to be non-significant across remaining interventions.
Our findings indicate that prophylactic and bubble CPAP may provide some benefit by reducing treatment failure compared to other pressure sources. The safety and efficacy of other management interventions for RDS, AOP, BPD, MAS, and TTN remains uncertain given limited evaluations in LMICs. Future research should conduct adequately powered trials in underrepresented LMIC regions, investigate long-term outcomes, and evaluate cost-effectiveness.
Neonatal respiratory conditions are leading causes of mortality and morbidity during the neonatal period. This review evaluated 11 management interventions for respiratory distress syndrome (RDS), apnoea of prematurity (AOP), meconium aspiration syndrome (MAS), transient tachypnea of the newborn (TTN), as well as bronchopulmonary dysplasia (BPD) as a potential complication from respiratory care in low- and middle-income countries (LMICs).
Two different methodological approaches were completed: (1) updating outdated reviews and pooling all LMIC studies and (2) re-analysis of LMIC studies from up-to-date reviews. Review updates were conducted between October 2022 and February 2023 and followed systematic methodology. A total of 50 studies were included across four review updates and seven review re-analyses.
Findings indicate that bubble CPAP (RR 0.74, 95% CI: 0.58-0.96) and prophylactic CPAP (RR 0.39, 95% CI: 0.26-0.57) for RDS reduced the risk of treatment failure compared to other ventilation types or supportive care, respectively. Postnatal corticosteroids reduced BPD assessed as oxygen requirement at 36 weeks' postmenstrual age (RR 0.56, 95% CI: 0.41-0.77). All other outcomes were found to be non-significant across remaining interventions.
Our findings indicate that prophylactic and bubble CPAP may provide some benefit by reducing treatment failure compared to other pressure sources. The safety and efficacy of other management interventions for RDS, AOP, BPD, MAS, and TTN remains uncertain given limited evaluations in LMICs. Future research should conduct adequately powered trials in underrepresented LMIC regions, investigate long-term outcomes, and evaluate cost-effectiveness.
新生儿呼吸疾病是新生儿期死亡和发病的主要原因。本综述评估了针对呼吸窘迫综合征（RDS）、早产儿呼吸暂停（AOP）、胎粪吸入综合征（MAS）、新生儿短暂性呼吸急促（TTN）以及支气管肺发育不良（BPD，作为低收入和中等收入国家（LMICs）呼吸护理潜在并发症）的11种管理干预措施。
完成了两种不同的方法：（1）更新过时的综述并汇总所有LMIC研究，以及（2）对最新综述中的LMIC研究进行重新分析。综述更新于2022年10月至2023年2月进行，并遵循系统方法。在四次综述更新和七次综述重新分析中总共纳入了50项研究。
研究结果表明，与其他通气类型或支持性护理相比，用于RDS的气泡持续气道正压通气（bubble CPAP，相对风险（RR）0.74，95%置信区间（CI）：0.58 - 0.96）和预防性持续气道正压通气（prophylactic CPAP，RR 0.39，95% CI：0.26 - 0.57）分别降低了治疗失败的风险。产后使用皮质类固醇降低了以月经后36周时的氧需求评估的BPD（RR 0.56，95% CI：0.41 - 0.77）。在其余干预措施中，所有其他结果均无统计学意义。
我们的研究结果表明，与其他压力源相比，预防性和气泡持续气道正压通气可能通过降低治疗失败率而带来一些益处。鉴于在LMICs中评估有限，其他针对RDS、AOP、BPD、MAS和TTN的管理干预措施的安全性和有效性仍不确定。未来的研究应在代表性不足的LMIC地区进行有足够效力的试验，调查长期结果，并评估成本效益。
新生儿呼吸疾病是新生儿期死亡和发病的主要原因。本综述评估了针对呼吸窘迫综合征（RDS）、早产儿呼吸暂停（AOP）、胎粪吸入综合征（MAS）、新生儿短暂性呼吸急促（TTN）以及支气管肺发育不良（BPD，作为低收入和中等收入国家（LMICs）呼吸护理潜在并发症）的11种管理干预措施。
完成了两种不同的方法：（1）更新过时的综述并汇总所有LMIC研究，以及（2）对最新综述中的LMIC研究进行重新分析。综述更新于2022年10月至2023年2月进行，并遵循系统方法。在四次综述更新和七次综述重新分析中总共纳入了50项研究。
研究结果表明，与其他通气类型或支持性护理相比，用于RDS的气泡持续气道正压通气（bubble CPAP，相对风险（RR）0.74，95%置信区间（CI）：0.58 - 0.96）和预防性持续气道正压通气（prophylactic CPAP，RR 0.39，95% CI：0.26 - 0.57）分别降低了治疗失败的风险。产后使用皮质类固醇降低了以月经后36周时的氧需求评估的BPD（RR 0.56，95% CI：0.41 - 0.77）。在其余干预措施中，所有其他结果均无统计学意义。
我们的研究结果表明，与其他压力源相比，预防性和气泡持续气道正压通气可能通过降低治疗失败率而带来一些益处。鉴于在LMICs中评估有限，其他针对RDS、AOP、BPD、MAS和TTN的管理干预措施的安全性和有效性仍不确定。未来的研究应在代表性不足的LMIC地区进行有足够效力的试验，调查长期结果，并评估成本效益。
