Kato Shin, Minamitani Yohei, Hosokawa Miku, Nakashima Toshinori, Iwatani Sota, Hirata Katsuya, Oda Arata, Hanita Takushi, Miyata Masafumi, Namba Fumihiko, Ochiai Masayuki, Nakao Atsushi, Yoshimoto Seiji, Suzuki Daichi, Ota Erika, Nakanishi Hidehiko
Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
BMJ Open. 2024 Dec 30;14(12):e087740. doi: 10.1136/bmjopen-2024-087740.
Inhaled nitric oxide (iNO) is a known treatment for pulmonary hypertension (PH) associated with bronchopulmonary dysplasia in preterm infants after 7 days of age (postacute phase). However, a consensus regarding the optimal criteria for initiating iNO therapy in this population in the postacute phase is currently lacking. This study, therefore, aimed to identify the criteria for initiating iNO therapy, alongside the associated clinical and echocardiographic findings, in this population.
We performed a scoping review using the population-concept-context framework following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
PubMed, Embase and the Japanese database 'Ichushi' were systematically searched for relevant articles published between January 2003 and August 2023.
This study included randomised controlled trials, prospective and retrospective cohort studies, case-control studies and case series on iNO therapy in the postacute phase for preterm infants born before 34 gestational weeks, written in English or Japanese.
Data screening, extraction and charting were performed independently, with the characteristics and findings of the included studies subsequently summarised.
We included 10 reports that analysed the data from 10 separate studies. The use of iNO therapy was categorised as prophylactic and rescue purposes. While randomised controlled trials (RCTs) and retrospective analyses indicated the safety of iNO during the postacute phase, the latter highlighted poor prognoses associated with severe cases requiring rescue iNO therapy. Additionally, although echocardiography is currently the primary diagnostic tool for identifying PH in preterm infants, standardised diagnostic criteria are lacking. Further, reports of complications and side effects associated with iNO are rare.
Our exploration of the initiation criteria for iNO revealed that definitive guidelines have not been established. Nonetheless, iNO administration during the postacute phase appeared to be safe and devoid of complications.
UMIN000051498.
吸入一氧化氮（iNO）是治疗7日龄后（急性期后）早产儿支气管肺发育不良相关肺动脉高压（PH）的一种已知疗法。然而，目前对于该人群在急性期后启动iNO治疗的最佳标准尚无共识。因此，本研究旨在确定该人群启动iNO治疗的标准以及相关的临床和超声心动图检查结果。
我们使用人群 - 概念 - 背景框架，按照系统评价和Meta分析扩展版的首选报告项目进行了一项范围综述。
对PubMed、Embase和日本数据库“Ichushi”进行系统检索，以查找2003年1月至2023年8月期间发表的相关文章。
本研究纳入了以英文或日文撰写的关于34孕周前出生的早产儿急性期后iNO治疗的随机对照试验、前瞻性和回顾性队列研究、病例对照研究及病例系列。
独立进行数据筛选、提取和制表，随后总结纳入研究的特征和结果。
我们纳入了10份报告，这些报告分析了来自10项独立研究的数据。iNO治疗的使用分为预防性和挽救性目的。虽然随机对照试验（RCT）和回顾性分析表明iNO在急性期后是安全的，但后者强调了需要挽救性iNO治疗的严重病例预后较差。此外，尽管超声心动图目前是识别早产儿PH的主要诊断工具，但缺乏标准化的诊断标准。此外，与iNO相关的并发症和副作用报告很少。
我们对iNO启动标准的探索表明，尚未建立明确的指南。尽管如此，急性期后给予iNO似乎是安全的，且无并发症。
UMIN000051498。
