3级支气管肺发育不良婴儿在NICU中的发育支持实践
该横断面研究纳入BPD协作组22个NICU中141例3级BPD婴儿，评估发育治疗频率与发育支持设备可用性同当前呼吸支持水平的关系。结果显示呼吸支持类型与物理治疗、言语治疗及治疗总次数显著相关，气管造口患儿房间内发育支持设备种类更多。多数护士有时间支持发育，但定期阅读或唱歌的婴儿不足半数。
要点
- 3级BPD婴儿的发育治疗频率与当前呼吸支持水平显著相关。
- 气管造口患儿比气管插管或无创通气患儿获得更多发育支持设备。
- 多数护士有时间支持发育，但定期阅读（37%）或唱歌（46%）的婴儿不足半数。
核心结论
- 3级BPD婴儿的发育支持因呼吸支持类型和机构而异，气管造口患儿有更多发育支持活动机会。
研究设计与样本
- 横断面研究，纳入BPD协作组22个NICU中所有符合条件的3级BPD且从未出院回家的婴儿。
- 通过病历回顾和床边护士访谈收集当前呼吸支持、神经发育治疗及房间内发育支持设备可用性数据。
主要发现
- 共纳入141例婴儿，中位矫正胎龄49周（IQR 43-60周），65.2%接受有创通气。
- 呼吸支持与任何物理治疗（P = .008）、言语治疗（P < .001）及过去48小时内完成治疗总次数（P < .001）显著相关。
- 房间内发育支持设备的可用性也与呼吸支持显著相关，气管造口患儿房间内多种发育支持设备数量明显高于气管插管和无创呼吸支持患儿。
- 80%的护士报告有时间支持患儿发育，但定期经历阅读（37%）或唱歌（46%）的婴儿不足半数。
临床怎么用
- 临床可参照呼吸支持水平评估发育治疗需求和设备配置，尤其关注气管插管和无创通气患儿的发育支持机会。
- 数据可用于跨机构基准比较，并指导前瞻性研究以标准化发育支持并改善3级BPD婴儿结局。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To evaluate neurodevelopmental care practices for patients with grade 3 bronchopulmonary dysplasia (BPD), specifically the relationships between frequency of developmental therapies and types of developmentally supportive equipment provided to patients and the patient's current level of respiratory support, while still in the neonatal intensive care unit (NICU). STUDY DESIGN: Cross-sectional study of 22 NICUs in the BPD Collaborative, including all eligible infants in each NICU with grade 3 BPD who had never been discharged home. We collected data about current respiratory support, neurodevelopmental therapies, and availability of developmentally supportive equipment in patients' rooms through the medical records and interviews with bedside nurses. RESULTS: For this study 141 infants were included (median postmenstrual age 49 weeks, IQR 43-60 weeks). The majority (65.2%) were receiving invasive ventilation. Respiratory support was significantly associated with any physical therapy (P = .008) or speech therapy (P < .001) and total number of completed therapy sessions in the prior 48 hours (P < .001). Availability of developmentally supportive equipment in an infant's room was also significantly associated with respiratory support. Patients with tracheostomies had a notably higher count of many different types of developmentally supportive equipment in their rooms than those infants with endotracheal tubes and those receiving noninvasive respiratory support. The majority of nurses reported having time to support their patients' development (80%), but fewer than half the infants regularly experienced reading (37%) or singing (46%). CONCLUSIONS: Developmental supports for infants with grade 3 BPD vary based on respiratory support and across institutions. Infants with tracheostomies have more opportunities for developmentally supportive activities. These data can be used to benchmark care practices across institutions and guide prospective studies to standardize developmental care and improve outcomes in infants with grade 3 BPD.
引用
- DiPrisco B, Brinker K, Coyle M, et al. Developmental Care Practices for Infants with Grade 3 Bronchopulmonary Dysplasia While in the Neonatal Intensive Care Unit. J Pediatr. 2026. PMID: 42190905. doi:10.1016/j.jpeds.2026.115157
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。