新生児科における新生児科医のスクリーニングと,新生児集中治療室におけるコルチコステロイド誘発性腎上腺不全の管理に関する実践-多センター研究
Sean Christopher Watson1, Parvesh Mohan Garg1, Cathrine Constantacos2
1Wake Forest University School of Medicine, Department of Neonatology, Winston-Salem, NC, USA.
まとめ
新生児科医は,新生児におけるコルチコステロイド誘発性腎上腺抑制 (AS) のスクリーニングと管理においてさまざまな実践を示しています. この矛盾は,新生児集中治療室 (NICU) での乳児の最適なケアを確保するために,標準化された臨床ガイドラインの必要性を強調しています.
科学分野:
- 新生児医学 新生児医学
- 小児内分泌学について
- クリニカル・プラクティスの変動性
背景:
- コルチコステロイドは,新生児集中治療室 (NICU) で頻繁に使用されています.
- 長期にわたるコルチコステロイドの使用は,潜在的に深刻な状態である腎上腺抑制 (AS) を引き起こす可能性があります.
- 新生児におけるASの現在のスクリーニングと管理の慣行はよく定義されていません.
研究 の 目的:
- 新生児科医が新生児集中治療室でコルチコステロイド誘発性腎上腺抑制 (AS) をスクリーニングし,管理する方法の多様性を調査する.
- ASの診断ツールと治療方法の違いを特定する.
- 退院時にASに関する介護者教育の程度を評価する.
主な方法:
- 児童病院新生児コンソーシアム (Children's Hospitals Neonatal Consortium) 内の160人の新生児科医に全国的な横断調査が配布されました.
- 記述的統計は,スクリーニング方法,診断検査,管理戦略,排出計画に関するデータを分析するために使用されました.
- 82人の新生児科医が調査を完了し,彼らの臨床実践に関する洞察を提供しました.
主要な成果:
- 新生児科医のわずか56.1%が,長期にわたる全身性コルチコステロイド曝露後にASを乳幼児にスクリーニングしています.
- アドレノコルチオトロピックホルモン (ACTH) 刺激検査は,AS診断の回答者の59.8%が利用しています.
- 吸入用コルチコステロイドの使用後のASのスクリーニングはまれ (2.4%),その抑制効果についての不確実性を示す.
結論:
- NICUの乳児における腎上腺抑制の全国的なスクリーニングと管理において,著しい変動がある.
- この矛盾は,標準化された慣行が欠如していることを示しており,証拠に基づいた臨床ガイドラインの必要性を強調しています.
- 明確なガイドラインの開発は,ASのリスクのある乳児のケアとアウトカムを最適化するために不可欠です.
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