Abstract：
ImportanceProphylactic cyclo-oxygenase inhibitors (COX-Is) such as indomethacin, ibuprofen and acetaminophen may prevent morbidity and mortality in extremely preterm infants (born ≤28 weeks\' gestation). However, there is controversy around which COX-I, if any, is the most effective and safest, which has resulted in considerable variability in clinical practice. Our objective was to develop rigorous and transparent clinical practice guideline recommendations for the prophylactic use of COX-I drugs for the prevention of mortality and morbidity in extremely preterm infants. The Grading of Recommendations Assessment, Development and Evaluation evidence-to-decision framework for multiple comparisons was used to develop the guideline recommendations. A 12-member panel, including 5 experienced neonatal care providers, 2 methods experts, 1 pharmacist, 2 parents of former extremely preterm infants and 2 adults born extremely preterm, was convened. A rating of the most important clinical outcomes was established a priori. Evidence from a Cochrane network meta-analysis and a cross-sectional mixed-methods study exploring family values and preferences were used as the primary sources of evidence. The panel recommended that prophylaxis with intravenous indomethacin may be considered in extremely preterm infants (conditional recommendation, moderate certainty in estimate of effects). Shared decision making with parents was encouraged to evaluate their values and preferences prior to therapy. The panel recommended against routine use of ibuprofen prophylaxis in this gestational age group (conditional recommendation, low certainty in the estimate of effects). The panel strongly recommended against use of prophylactic acetaminophen (strong recommendation, very low certainty in estimate of effects) until further research evidence is available.
摘要：
重要性预防性环加氧酶抑制剂（COX-Is），如吲哚美辛，布洛芬和对乙酰氨基酚可以预防极早产儿（出生≤28周妊娠）的发病率和死亡率。然而,关于哪种COX-I存在争议，如果有的话,是最有效最安全的,这导致了临床实践中相当大的差异。我们的目标是为预防性使用COX-I药物预防极端早产儿的死亡率和发病率制定严格透明的临床实践指南建议。建议评估的分级，使用用于多重比较的开发和评估证据决策框架来制定指南建议。一个由12名成员组成的小组，包括5名经验丰富的新生儿护理提供者，2方法专家，1名药剂师,2名前极早产儿的父母和2名出生极早产儿的成年人，被召集。最重要的临床结果的评级是先验建立的。来自Cochrane网络荟萃分析和探索家庭价值观和偏好的横断面混合方法研究的证据被用作主要证据来源。小组建议，在极早产儿中可以考虑静脉注射吲哚美辛进行预防（有条件的建议，效果估计的适度确定性)。鼓励父母在治疗前评估他们的价值观和偏好。小组建议在此孕龄组中不常规使用布洛芬预防（有条件推荐，影响估计的确定性低)。专家组强烈建议不要使用预防性对乙酰氨基酚(强烈建议，效果估计的确定性非常低)，直到进一步的研究证据可用。
