European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia
European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia
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DOI：
10.1183/13993003.00788-2019
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发表时间：
2020-01-01
影响因子：
24.3
通讯作者：
Pijnenburg, Marielle W.
中科院分区：
文献类型：
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作者：
Duijts, Liesbeth;van Meel, Evelien R.;Pijnenburg, Marielle W.
本文件提供了监测和治疗已确诊支气管肺发育不良（BPD）并已出院或经后年龄>36周的儿童的建议。该指南基于与临床护理相关的预定义人口、干预、比较和结局（皮科）问题、文献的系统综述以及使用建议、评估、开发和评价分级（GRADE）方法进行的证据评估。在考虑了干预措施的理想（获益）和不良（负担、不良反应）后果的平衡、证据的确定性和价值后，工作组根据极低至低质量的证据提出了监测和治疗BPD的有条件建议。我们建议仅在一个亚组中使用电离辐射进行肺成像监测，例如重度BPD或反复住院，并在所有儿童中进行肺功能监测。我们建议就日托出勤情况向家长提供个别建议。关于治疗，我们建议仅在一个亚组中使用支气管扩张剂，例如哮喘样症状或肺功能可逆性;不使用吸入性或全身性皮质类固醇治疗;如果在新生儿期开始使用利尿剂，则随着体重增加，通过相对减少剂量自然停用利尿剂;并使用补充氧治疗，目标饱和度范围为90- 95%。对于新生儿期后至成年期的重度BPD儿童，最好采用多学科方法。在获得新的和迫切需要的证据之前，应考虑这些建议。
This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been discharged from the hospital, or who were >36 weeks of postmenstrual age. The guideline was based on predefined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the task force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding daycare attendance. With regards to treatment, we suggest the use of bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function; no treatment with inhaled or systemic corticosteroids; natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period; and treatment with supplemental oxygen with a saturation target range of 90-95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.