Hypothermia for neonatal encephalopathy: Nationwide Survey of Clinical Practice in Japan as of August 2010
Hypothermia for neonatal encephalopathy: Nationwide Survey of Clinical Practice in Japan as of August 2010
复制标题
DOI：
10.1111/j.1651-2227.2011.02562.x
复制
发表时间：
2012-05-01
期刊：
影响因子：
3.8
通讯作者：
Tamura, Masanori
中科院分区：
文献类型：
--
作者：
Iwata, Osuke;Nabetani, Makoto;Tamura, Masanori
背景：治疗性低温现在被推荐作为新生儿脑病的标准治疗。虽然遵守III期试验中使用的标准冷却方案是必不可少的，但经验方法在日本已占上风。目的：阐明标准冷却方法与日本现行做法之间的差距。方法：2010年7月，向注册的新生儿重症监护室的临床负责人邮寄了一份关于新生儿脑病实践的调查问卷。结果：56.2%的单位因人力/医疗资源不足（85.1%）和病例数有限（21.1%）等原因无法提供低温治疗。89个中心使用选择性头部冷却（88.8%）或全身冷却（11.2%）提供治疗性低温。不同的目标温度和冷却时间被使用; 20.2%的单位冷却婴儿不使用专用设备，而14.6%没有持续监测体温。即使在提供低温治疗的中心，对标准方案的遵守情况也极差。为了确保安全性和有效性，需要进一步推广标准冷却协议;必须通过优化工作分配和运输系统来建立高效的冷却中心网络。
Background: Therapeutic hypothermia is now recommended as a standard of care for neonatal encephalopathy. Although adherence to standard cooling protocols used in the phase-III trials is essential, empiric approaches have prevailed in Japan.Aim: To elucidate the gap between the standard cooling methods and the current practice in Japan.Method: In July 2010, a questionnaire regarding the practice of neonatal encephalopathy was mailed to clinical leads of registered neonatal intensive care units.Result: 56.2% of the units were incapable of offering therapeutic hypothermia because of the reasons such as the shortage of human/medical resources (85.1%) and limited number of cases (21.1%). Eighty-nine centres provided therapeutic hypothermia using either selective-head cooling (88.8%) or whole-body cooling (11.2%). Various target temperatures and cooling durations were used; 20.2% of the units cooled infants without using purpose-built equipments, whereas 14.6% did not continuously monitor the body temperature.Discussion: Only 43.8% of the units provided therapeutic hypothermia. Even in centres where hypothermia was offered, adherence to the standard protocols was extremely poor. To secure the safety and efficacy, further promotion of the standard cooling protocols is required; an efficient cooling centre network has to be established by optimizing the work forth distribution and transportation system.