早产儿和足月新生儿呼吸道疾病护理:来自中低收入国家的证据系统综述》。

Neonatology Pub Date : 2024-11-14 DOI:10.1159/000542482
Georgia Dominguez, Oviya Muralidharan, Rachel Lee Him, Leila Harrison, Tyler Vaivada, Zulfiqar A Bhutta
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引用次数: 0

摘要

导言:新生儿呼吸系统疾病是新生儿期死亡和发病的主要原因。本综述评估了中低收入国家(LMICs)针对呼吸窘迫综合征(RDS)、早产儿呼吸暂停(AOP)、胎粪吸入综合征(MAS)、一过性新生儿呼吸过速(TTN)以及支气管肺发育不良(BPD)的 11 项管理干预措施,这些干预措施是呼吸护理的潜在并发症:完成了两种不同的方法:(1)更新过时的综述并汇总所有 LMIC 研究;(2)重新分析最新综述中的 LMIC 研究。综述更新工作于 2022 年 10 月至 2023 年 2 月期间进行,采用了系统方法。四次综述更新和七次综述重新分析共纳入了 50 项研究:研究结果表明,与其他通气类型或支持性护理相比,气泡CPAP(RR 0.74,95% CI 0.58-0.96)和预防性CPAP(RR 0.39,95% CI 0.26-0.57)治疗RDS可分别降低治疗失败的风险。产后皮质类固醇可降低月龄后 36 周时以需氧量评估的 BPD(RR 0.56,95% CI 0.41 至 0.77)。所有其他干预结果均无显著性差异:我们的研究结果表明,与其他压力源相比,预防性和气泡式 CPAP 可减少治疗失败,从而带来一些益处。鉴于在低收入国家进行的评估有限,其他针对 RDS、AOP、BPD、MAS 和 TTN 的管理干预措施的安全性和有效性仍不确定。未来的研究应在代表性不足的低收入和中等收入国家地区进行充分的试验,调查长期结果并评估成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Care of Preterm and Term Newborns with Respiratory Conditions: A Systematic Synthesis of Evidence from Low- and Middle-Income Countries.

Introduction: Neonatal respiratory conditions are leading causes of mortality and morbidity during the neonatal period. This review evaluated 11 management interventions for respiratory distress syndrome (RDS), apnoea of prematurity (AOP), meconium aspiration syndrome (MAS), transient tachypnea of the newborn (TTN), as well as bronchopulmonary dysplasia (BPD) as a potential complication from respiratory care in low- and middle-income countries (LMICs).

Methods: Two different methodological approaches were completed: (1) updating outdated reviews and pooling all LMIC studies and (2) re-analysis of LMIC studies from up-to-date reviews. Review updates were conducted between October 2022 and February 2023 and followed systematic methodology. A total of 50 studies were included across four review updates and seven review re-analyses.

Results: Findings indicate that bubble CPAP (RR 0.74, 95% CI 0.58 to 0.96) and prophylactic CPAP (RR 0.39, 95% CI 0.26 to 0.57) for RDS reduced the risk of treatment failure compared to other ventilation types or supportive care, respectively. Postnatal corticosteroids reduced BPD assessed as oxygen requirement at 36 weeks' postmenstrual age (RR 0.56, 95% CI 0.41 to 0.77). All other outcomes were found to be non-significant across remaining interventions.

Conclusions: Our findings indicate that prophylactic and bubble CPAP may provide some benefit by reducing treatment failure compared to other pressure sources. The safety and efficacy of other management interventions for RDS, AOP, BPD, MAS, and TTN remains uncertain given limited evaluations in LMICs. Future research should conduct adequately powered trials in underrepresented LMIC regions, investigate long-term outcomes, and evaluate cost-effectiveness.

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