Survey of Practices Regarding Utilization of Inhaled Steroids in 223 German Neonatal Units
Survey of Practices Regarding Utilization of Inhaled Steroids in 223 German Neonatal Units
复制标题
对 223 个德国新生儿病房使用吸入类固醇的实践调查
作者：
Christoph Maas;Christian F. Poets;Dirk Bassler
背景：近年来尚未发表主要关注新生儿实践中吸入皮质类固醇处方的调查。因此，吸入皮质类固醇的利用率尚不清楚。目的：阐明目前吸入皮质类固醇在预防和治疗支气管肺发育不良（BPD）中的使用情况。方法：我们制定了一份包含 18 项的调查问卷，并于 2009 年 3 月通过电子邮件分发给所有 343 家设有新生儿病房（各级新生儿护理）的德国儿科医院的首席儿科医生。我们在 4 周和 8 周后发送了电子提醒。结果：223家医院（65%）返回了调查问卷。其中，102 例 (46%) 给早产儿注射吸入皮质类固醇作为 BPD 的预防或治疗。吸入类固醇治疗主要被视为一种“救援疗法”，只有在其他治疗方法失败时才使用。在不使用吸入类固醇的医院中，最常见的原因是“没有足够有力的证据支持治疗的益处”（57%）。大多数医院（81%）选择的活性物质是布地奈德。结论：在应答者中，大约 50% 的人对早产儿使用吸入皮质类固醇作为 BPD 的预防或治疗。缺乏有益的证据是大约一半采取这种方法的单位没有使用吸入类固醇的主要原因。未来的试验应该通过建立吸入皮质类固醇的明确获益风险比来解决这一差异。
Background: No survey has been published in recent years which primarily focuses on the prescription of inhaled corticosteroids in neonatal practice. Thus, the utilization rate of inhaled corticosteroids is unknown. Objectives: To elucidate the current utilization rate of inhaled corticosteroids in the prevention and therapy of bronchopulmonary dysplasia (BPD). Methods: We developed an 18-item questionnaire that was distributed in March 2009, via electronic mail, to the pediatricians-in-chief of all the 343 German pediatric hospitals with a neonatal unit (all levels of neonatal care). We sent electronic reminders after 4 and 8 weeks. Results: 223 hospitals (65%) returned the questionnaire. Of these, 102 (46%) administered inhaled corticosteroids to premature infants either as prophylaxis or treatment for BPD. Predominantly, treatment with inhaled steroids was seen as a ‘rescue therapy’ and used only if other therapeutic approaches had failed. Of the hospitals not administering inhaled steroids, the most frequently stated reason was ‘insufficient robust evidence to support benefit of therapy’ (57%). In the majority of hospitals (81%), the active substance of choice was budesonide. Conclusions: Of the responders, approximately 50% administer inhaled corticosteroids to premature infants either as a prophylaxis or treatment for BPD. Lack of beneficial evidence was the main reason for not administering inhaled steroids in about half of the units which took this approach. Future trials should address this discrepancy by aiming to establish a clear benefit-risk ratio of inhaled corticosteroids.