早产儿单纯性低血压的积极治疗与限制性治疗方法：一项系统评价、荟萃分析及基于GRADE的临床实践指南
Active versus restrictive approach to isolated hypotension in preterm neonates: A Systematic Review, Meta-analysis and GRADE based Clinical Practice Guideline.
作者信息
Ramaswamy Viraraghavan Vadakkencherry, Kumar Gunjana, Pullattayil S Abdul Kareem, Aradhya Abhishek S, Suryawanshi Pradeep, Sahni Mohit, Khurana Supreet, More Kiran
机构信息
Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, Telangana, India.
Department of Neonatology, National Institute of Medical Sciences, Jaipur, Rajasthan, India.
出版信息
PLoS One. 2025 Mar 18;20(3):e0309520. doi: 10.1371/journal.pone.0309520. eCollection 2025.
OBJECTIVE
Isolated hypotension (IH) without any clinical or biochemical features of poor perfusion is a common occurrence in very preterm infants (VPTI). There exists no recommendations guiding its management.The objective of this review was to compare the effect of active vs. restrictive approach to treat IH in VPTI.
METHODOLOGY
Medline, Embase and Web of Science were searched until 1st April 2024. RCTs and non-RCTs were included. Mortality, major brain injury (MBI) (intraventricular hemorrhage > grade 2 or cystic periventricular leukomalacia), mortality or neurodevelopmental impairment (NDI) at 18-24 months' corrected age were the critical outcomes evaluated.
RESULTS
44 studies were included: 9 were synthesized in a meta-analysis and 35 studies in the narrative review. Clinical benefit or harm could not be ruled out for the outcomes from the meta-analyses of RCTs. Meta-analysis of 3 non-RCTs suggested that active treatment of IH in VPTI of < 24 hours of life possibly increased the odds of MBI (aOR: 95% CI 1.85 (1.45; 2.36), very low certainty). Meta-analysis of 2 non-RCTs that had included VPTI < 72 hours indicated a possibly decreased risk of MBI (aOR: 95% CI 0.44 (0.24; 0.82), very low certainty) and NEC ≥ stage 2 (aOR: 95% CI 0.61 (0.41; 0.92), very low certainty) with active treatment of IH. Active treatment of IH in the first 24 hours possibly increased the risk of mortality or long-term NDI (aOR: 95% CI 1.84 (1.10; 3.09), very low certainty) and the risk of hearing loss at 2 years (aOR: 95% CI 3.60 (1.30; 9.70), very low certainty). Clinical benefit or harm could not be ruled out for other outcomes. There was insufficient evidence with respect to preterm neonates of ≥ 32 weeks.
CONCLUSIONS
IH may not be treated in VPTI in the first 24 hours. However, IH occurring between 24 hours - 72 hours of life may be treated. The evidence certainty was very low.
目的
孤立性低血压（IH）在极早产儿（VPTI）中很常见，且没有任何灌注不良的临床或生化特征。目前尚无指导其管理的建议。本综述的目的是比较积极治疗与限制性治疗方法对VPTI中IH的治疗效果。
方法
检索截至2024年4月1日的Medline、Embase和科学网。纳入随机对照试验（RCT）和非随机对照试验。评估的关键结局包括死亡率、重度脑损伤（MBI）（脑室内出血>2级或脑室周围白质软化囊性变）、18-24个月矫正年龄时的死亡率或神经发育障碍（NDI）。
结果
纳入44项研究：9项纳入荟萃分析，35项纳入叙述性综述。RCT荟萃分析的结局无法排除临床获益或危害。对3项非RCT的荟萃分析表明，对出生<24小时的VPTI积极治疗IH可能增加MBI的几率（调整后比值比：95%置信区间1.85（1.45；2.36），极低确定性）。对2项纳入<72小时VPTI的非RCT的荟萃分析表明，积极治疗IH可能降低MBI风险（调整后比值比：95%置信区间0.44（0.24；0.82），极低确定性）和≥2期坏死性小肠结肠炎（NEC）风险（调整后比值比：95%置信区间0.61（0.41；0.92），极低确定性）。出生后24小时内积极治疗IH可能增加死亡率或长期NDI风险（调整后比值比：95%置信区间1.84（1.10；3.09），极低确定性）以及2岁时听力损失风险（调整后比值比：95%置信区间3.60（1.30；9.70），极低确定性）。其他结局无法排除临床获益或危害。对于≥32周的早产新生儿，证据不足。
结论
出生后24小时内VPTI中的IH可能无需治疗。然而，出生24小时至72小时之间发生的IH可能可以治疗。证据确定性极低。
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