Gipsman Alexander I, Bhandari Anita, Bhandari Vineet
Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
J Perinatol. 2025 Jan;45(1):5-12. doi: 10.1038/s41372-024-02178-w. Epub 2024 Nov 19.
Clearance of airway secretions and treatment of respiratory tract infections (RTIs) are two common problems caregivers face in the neonatal intensive care unit (NICU). Mucolytics degrade crosslinks in mucus gel, reducing mucus viscosity and facilitating their removal by cough or endotracheal suctioning. While such medications have been studied in older children and adults, their use is not as well described in the NICU. For RTIs, systemic antibiotics are usually prescribed, although their use is often associated with adverse effects. Inhaled antibiotics may provide increased drug concentrations to the infected airways while minimizing systemic toxicity. The use of inhaled antibiotics in the NICU has been described in small case series. As underlying physiologic differences will lend to inaccuracies when extrapolating data obtained from older children, there is an urgent need to determine the safety, efficacy, and optimal dosing of inhaled mucolytics and antibiotics in infants of varying gestational and post-natal ages.
气道分泌物清除和呼吸道感染（RTIs）的治疗是新生儿重症监护病房（NICU）护理人员面临的两个常见问题。黏液溶解剂可降解黏液凝胶中的交联键，降低黏液黏稠度，并通过咳嗽或气管内吸引促进其清除。虽然此类药物已在大龄儿童和成人中进行过研究，但在NICU中的应用描述较少。对于RTIs，通常会开具全身用抗生素，但其使用往往会带来不良反应。吸入性抗生素可使感染气道的药物浓度增加，同时将全身毒性降至最低。NICU中吸入性抗生素的使用在小病例系列中有描述。由于在推断大龄儿童的数据时，潜在的生理差异会导致不准确，因此迫切需要确定不同胎龄和出生后年龄的婴儿吸入性黏液溶解剂和抗生素的安全性、有效性及最佳剂量。
