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在非常早产新生儿中用皮松剂预防BPD:元分析和效果大小修饰剂
Daniele De Luca1,2, Sara Ferraioli3, Kristi L Watterberg4
1Division of Pediatrics and Neonatal Critical Care, APHP, Paris Sac;ay University Hospitals, 'A. Beclere' Medical Centre, Paris, France dm.deluca@icloud.com.
在非常早产的新生儿中,系统性皮松治疗并没有预防支气管肺功能障碍,但可能会降低死亡率和死性肠球炎. 需要进一步的研究来探索这些结果的潜在效果修饰剂.
科学领域:
- 新生儿医学 新生儿医学
- 儿科药理学 儿科药理学
- 关键的护理关键的护理
背景情况:
- 支气管肺功能障碍 (BPD) 仍然是极度早产婴儿的一个重大挑战.
- 系统性皮的早期使用正在探索,以减轻不良结果.
- 在这个脆弱人群中,皮的最佳时间和效果需要澄清.
研究的目的:
- 评估早期系统性皮在预防非常早产新生儿BPD和其他不良结果方面的疗效.
- 确定影响皮对新生儿结局影响的潜在效果修饰剂.
- 综合现有关于在早产婴儿中使用皮的试验证据.
主要方法:
- 按照PRISMA指南进行系统审查和元分析.
- 包括7项高质量的试验,涉及2193名非常早产新生儿.
- 进行元回归分析,以探索效果大小修饰因子和生物可信性.
主要成果:
- 皮没有显著降低BPD率 (RR 0.84),观察到异质性 (I2=51.6%).
- 治疗持续时间 (10-12天) 和胆肌炎似乎改变了BPD的效果.
- 在死亡率 (RR 0.75) 和死性肠球炎 (NEC;RR 0.72) 中观察到显著的减少,没有异质性.
- 男性的死亡率下降趋势较高;对NEC没有发现效果修饰剂.
结论:
- 系统性皮可以考虑在个别情况下减少非常早产婴儿的死亡率和NEC.
- 皮似乎没有预防BPD.
- 未来的试验应该调查死亡率和BPD的确定的效果修饰剂.
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