在早产新生儿中孤立低血压的积极与限制性方法:系统性审查,元分析和基于GRADE的临床实践指南
Viraraghavan Vadakkencherry Ramaswamy1, Gunjana Kumar2, Abdul Kareem Pullattayil S3
1Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, Telangana, India.
PloS one
|March 18, 2025
概括
在非常早产婴儿 (VPTI) 中孤立低血压的管理尚不清楚. 在前24小时的积极治疗可能会增加风险,而24-72小时之间的治疗可能是有益的,尽管证据的确定性非常低.
科学领域:
- 新生儿科学 新生儿科学
- 围产儿医学 围产儿医学
- 临床儿科 临床儿科
背景情况:
- 隔离性低血压 (IH) 是非常早产婴儿 (VPTI) 常见的,没有 poor perfusion 的迹象.
- 目前缺乏管理VPTI中的IH的指导方针.
研究的目的:
- 为了比较主动与限制性方法对治疗VPTI的IH的影响.
- 评估诸如死亡率,大脑损伤和神经发育障碍等结果.
主要方法:
- 随机对照试验 (RCT) 和非RCT的系统审查和元分析.
- 在Medline,Embase和Web of Science中搜索到2024年4月1日.
- 评估了关键结果,包括死亡率,严重脑损伤 (MBI) 和神经发育障碍 (NDI).
主要成果:
- 对RCT的元分析不能排除临床益处或危害.
- 非RCT建议VPTI<24小时的活跃IH治疗可能会增加MBI几率 (确定性非常低).
- 在VPTI<72小时内,非RCT指示的活跃的IH治疗可能会降低MBI和NEC风险 (确定性非常低),但可能会增加死亡率/NDI和听力损失风险.
结论:
- 在生命的前24小时内避免在VPTI中积极治疗IH.
- 在VPTI中考虑在生命24-72小时之间对IH进行积极治疗.
- 这些建议的证据确定性非常低.
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