比较意大利与欧洲新生儿重症监护病房呼吸护理的策略和技术：欧洲新生儿和围产医学学会联盟（UENPS）和意大利新生儿学会（SIN）的调查结果。

Comparing Italian versus European strategies and technologies for respiratory care in NICU: results of a survey of the Union of European Neonatal and Perinatal Societies (UENPS) and the Italian Society of Neonatology (SIN).

作者信息

Gizzi Camilla, Petrillo Flavia, Ventura Maria Luisa, Gagliardi Luigi, Trevisanuto Daniele, Lista Gianluca, Dellacà Raffaele, Beke Artur, Buonocore Giuseppe, Charitou Antonia, Cucerea Manuela, Filipović-Grčić Boris, Jeckova Nelly Georgieva, Koç Esin, Saldanha Joana, Sanchez-Luna Manuel, Stoniene Dalia, Varendi Heili, Vertecchi Giulia, Orfeo Luigi, Mosca Fabio, Moretti Corrado

机构信息

Division of Neonatology and NICU, Sant'Eugenio Hospital, Rome, ASL RM2, Italy.

Division of Pediatrics and Neonatology, Sandro Pertini Hospital, Rome, ASL RM2, Italy.

出版信息

Ital J Pediatr. 2025 Mar 26;51(1):100. doi: 10.1186/s13052-025-01936-6.

BACKGROUND

Our survey aimed to compare information on respiratory care in Neonatal Intensive Care Units (NICUs) in Italy and in the European and Mediterranean region.

METHODS

Cross-sectional electronic survey. An 89-item questionnaire focusing on the current modes, devices, and strategies employed in neonatal units in the domain of respiratory care was sent to directors/heads of 528 NICUs.

RESULTS

The response rate was 75% (397/528 units). The median number of NICU beds and the admission rate per unit/year of preterm infants < 1500 g was significantly lower in Italy compared with Europe (p < 0.001). In most Italian Delivery Rooms (DR) full resuscitation is given from 22 to 23 weeks gestational age, while 21.0% of the European units initiate from 24 weeks. Initial FiO is set as per American Academy of Pediatrics guidelines in 81.1% of Italian units compared to 30.9% of the European ones (p < 0.001). DR surfactant is less often given through Less-Invasive-Surfactant-Administration (LISA) in Italy (53.4% vs. 76.2% of units, p < 0.03). Volume-targeted, synchronized intermittent positive-pressure ventilation (IPPV) is the preferred invasive mechanical ventilation (MV) mode to treat acute RDS across the surveyed units, however 22.9% % of Italian centers vs. 6.8% of the European ones use HFOV as first choice (p < 0.001). During HFOV, 78% of Italian NICUs set mean airway pressure (MAP) following a lung recruitment procedure compared to 41% of the centers in Europe (p < 0.001). In the NICUs, most of the non-invasive (NIV) modes used are nasal CPAP and nasal IPPV. For infants on NIV, LISA strategy is used in 25.6% of Italian vs. 60.0% of European units (p < 0.001). 70% of surveyed units use a brand caffeine. Inhaled steroids are used in 42.3% of Italian vs. 65.4% of European NICUs (p < 0.001).

CONCLUSIONS

respiratory support strategies among the surveyed Italian and European NICUs are quite dissimilar in some areas, particularly where high-quality evidence is lacking. We believe that hese data will allow stakeholders to make comparisons and to identify opportunities for improvement.

背景

我们的调查旨在比较意大利与欧洲及地中海地区新生儿重症监护病房（NICU）的呼吸护理信息。

方法

横断面电子调查。一份包含89个条目的问卷被发送给528个新生儿重症监护病房的主任/负责人，该问卷聚焦于呼吸护理领域新生儿病房目前采用的模式、设备及策略。

结果

回复率为75%（397/528个单位）。与欧洲相比，意大利新生儿重症监护病房的床位中位数以及每个单位每年收治体重<1500g早产儿的比例显著更低（p<0.001）。在意大利，大多数产房（DR）在孕22至23周开始进行全面复苏，而21.0%的欧洲单位从24周开始。81.1%的意大利单位按照美国儿科学会指南设定初始吸氧浓度（FiO），而欧洲单位这一比例为30.9%（p<0.001）。在意大利，通过微创表面活性剂给药（LISA）在产房给予表面活性剂的情况较少见（单位比例为53.4% vs. 76.2%，p<0.03）。容量目标性同步间歇正压通气（IPPV）是受访单位治疗急性呼吸窘迫综合征（RDS）时首选的有创机械通气（MV）模式，然而22.9%的意大利中心与6.8%的欧洲中心将高频振荡通气（HFOV）作为首选（p<0.001）。在高频振荡通气期间，78%的意大利新生儿重症监护病房在进行肺复张程序后设定平均气道压（MAP），而欧洲中心这一比例为41%（p<0.001）。在新生儿重症监护病房，使用的大多数无创（NIV）模式为鼻持续气道正压通气（CPAP）和鼻间歇正压通气（IPPV）。对于接受无创通气的婴儿，25.6%的意大利单位与60.0%的欧洲单位采用LISA策略（p<0.001）。70%的受访单位使用某一品牌咖啡因。42.3%的意大利新生儿重症监护病房与65.4%的欧洲新生儿重症监护病房使用吸入性类固醇（p<0.001）。