Boesveld Merel, Hemels Marieke A C, Knol Ronny, Logtens-Abels Sandra A M J, Hütten Matthias C, Witlox Ruben S, Hulzebos Christian V, Niemarkt Hendrik J, Vijlbrief Daniel C
Department of Neonatology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands.
Department of Neonatology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands.
Early Hum Dev. 2025 Feb;201:106182. doi: 10.1016/j.earlhumdev.2024.106182. Epub 2024 Dec 17.
Non-invasive respiratory support strategies have evolved to avoid bronchopulmonary dysplasia (BPD) in preterm infants. However, consensus on the best treatment strategy remains lacking. This study aims to investigate current practices and variations in primary respiratory support for extremely preterm neonates across neonatal intensive care units (NICUs) in the Netherlands.
A web-based questionnaire was distributed to neonatologists in the Netherlands. The survey covered aspects like the choice of respiratory support modalities, criteria for their application, and associated clinical practices.
The response rate was 48.5 % (66/136). The majority used continuous positive airway pressure (CPAP) as primary respiratory support; 73.8 % for infants with gestational age (GA) ≤26 wks and 88.9 % for infants with GA 26-28 wks. The most used alternative was non-invasive positive pressure ventilation (NIPPV). Significant variation was particularly found in NIPPV settings. Respiratory support during less invasive surfactant administration (LISA) varied per NICU between CPAP and NIPPV, but overall CPAP was preferred. Caffeine was administered in the delivery room into infants with GA ≤26 weeks (30.2 %) and GA between 26 and 28 weeks (22.2 %). Doxapram was avoided in the first week of life in 81 % of the infants, independent of their GA.
The study highlights diverse practices in primary neonatal respiratory support in the Netherlands, with significant variation in NIPPV settings while there is uniformity in CPAP use, underscoring the need for cohesive guidelines and training to standardize care and improve outcomes for extremely preterm neonates.
无创呼吸支持策略不断发展，以避免早产儿发生支气管肺发育不良（BPD）。然而，对于最佳治疗策略仍缺乏共识。本研究旨在调查荷兰新生儿重症监护病房（NICU）对极早产儿进行初级呼吸支持的当前做法及差异。
向荷兰的新生儿科医生发放了一份基于网络的调查问卷。该调查涵盖了呼吸支持方式的选择、应用标准以及相关临床实践等方面。
回复率为48.5%（66/136）。大多数人使用持续气道正压通气（CPAP）作为初级呼吸支持；胎龄（GA）≤26周的婴儿中73.8%使用，GA为26 - 28周的婴儿中88.9%使用。最常用的替代方法是无创正压通气（NIPPV）。在NIPPV设置方面尤其发现了显著差异。在微创表面活性剂给药（LISA）期间，各NICU在CPAP和NIPPV之间的呼吸支持方式有所不同，但总体上更倾向于CPAP。咖啡因在产房用于GA≤26周（30.2%）和GA在26至28周之间（22.2%）的婴儿。81%的婴儿在出生后第一周避免使用多沙普仑，与他们的GA无关。
该研究突出了荷兰新生儿初级呼吸支持中的多种做法，NIPPV设置存在显著差异，而CPAP的使用较为统一，强调了需要有连贯的指南和培训来规范护理并改善极早产儿的预后。
