Abstract：
Persistent pulmonary hypertension of the newborn (PPHN) is a life-threatening disease. Despite being considered the gold standard treatment scheme, inhaled nitric oxide (iNO) is not readily available in settings with limited resources. Therefore, in recent years, research on related drugs is being actively pursued. Herein, we aimed to use random-effects network meta-analysis to evaluate the efficacy and associated mortality of different PPHN therapies.
We electronically searched the PubMed, Embase, and Cochrane Library for data up to January 27, 2023.
Randomized controlled trials involving neonates with PPHN assessing efficacy and mortality of various treatments.
Details of study population, treatments, and outcomes were extracted.
Direct pairwise comparisons and a network meta-analysis was performed under random effects. The ranking probability was further assessed based on the surface under the cumulative ranking curve (SUCRA). We analyzed 23 randomized clinical trials involving 902 newborns with PPHN. Sixteen different treatment strategies were compared with each other and conventional therapy (CON). A median concentration of 10-20 parts per million (ppm) iNO (MNO) coupled with sildenafil orally administered at a dose of 1-3 mg/kg/dose every 6-8 hours (OSID) demonstrated the best efficacy (MNO + OSID vs. CON: odds ratio [OR] = 27.53, 95% CI, 2.36-321.75; SUCRA = 0.818, ranking first; moderate quality). OSID combined with milrinone administered IV also performed well in terms of efficacy (OSID + milrinone vs. CON: OR = 25.13, 95% CI = 1.67-377.78; SUCRA = 0.811, ranking second; low quality) and mortality reduction (CON vs. OSID + milrinone: OR = 25.13, 95% CI = 1.67-377.78; SUCRA = 0.786, ranking last; low quality).
MNO + OSID is the most effective PPHN treatment. If iNO is not available, OSID + milrinone is preferred.
We electronically searched the PubMed, Embase, and Cochrane Library for data up to January 27, 2023.
Randomized controlled trials involving neonates with PPHN assessing efficacy and mortality of various treatments.
Details of study population, treatments, and outcomes were extracted.
Direct pairwise comparisons and a network meta-analysis was performed under random effects. The ranking probability was further assessed based on the surface under the cumulative ranking curve (SUCRA). We analyzed 23 randomized clinical trials involving 902 newborns with PPHN. Sixteen different treatment strategies were compared with each other and conventional therapy (CON). A median concentration of 10-20 parts per million (ppm) iNO (MNO) coupled with sildenafil orally administered at a dose of 1-3 mg/kg/dose every 6-8 hours (OSID) demonstrated the best efficacy (MNO + OSID vs. CON: odds ratio [OR] = 27.53, 95% CI, 2.36-321.75; SUCRA = 0.818, ranking first; moderate quality). OSID combined with milrinone administered IV also performed well in terms of efficacy (OSID + milrinone vs. CON: OR = 25.13, 95% CI = 1.67-377.78; SUCRA = 0.811, ranking second; low quality) and mortality reduction (CON vs. OSID + milrinone: OR = 25.13, 95% CI = 1.67-377.78; SUCRA = 0.786, ranking last; low quality).
MNO + OSID is the most effective PPHN treatment. If iNO is not available, OSID + milrinone is preferred.
摘要：
目的：新生儿持续肺动脉高压（PPHN）是一种危及生命的疾病。尽管被认为是黄金标准治疗方案，在资源有限的环境中，吸入一氧化氮（iNO）不容易获得。因此,近年来,有关药物的研究正在积极进行。在这里，我们旨在使用随机效应网络meta分析来评估不同PPHN治疗的疗效和相关死亡率.
方法：我们以电子方式搜索了PubMed，Embase,和Cochrane图书馆提供截至2023年1月27日的数据。
方法：涉及PPHN新生儿的随机对照试验评估各种治疗方法的疗效和死亡率。
方法：研究人群的详细信息，治疗,并提取结果。
结果：在随机效应下进行直接配对比较和网络荟萃分析。基于累积排序曲线(SUCRA)下的表面进一步评估排序概率。我们分析了23项随机临床试验，涉及902例PPHN新生儿。将16种不同的治疗策略与常规治疗（CON）进行比较。10-20ppm（ppm）iNO（MNO）的中值浓度与每6-8小时1-3mg/kg/剂的西地那非口服给药（OSID）显示出最佳疗效（MNO+OSID与CON：比值比[OR]=27.53，95%CI，2.36-321.75；SUCRA=0.818，排名第一；中等质量）。OSID联合米力农静脉给药在疗效方面也表现良好（OSID+米力农与CON：OR=25.13，95％CI=1.67-377.78；SUCRA=0.811，排名第二；低质量）和死亡率降低（CONvs.OSID+米力农：OR=25.13，95%CI=1.67-377.78；SUCRA=0.786，排名最后；低质量）。
结论：MNO+OSID是最有效的PPHN治疗方法。如果iNO不可用，OSID+米力农是优选的。
方法：我们以电子方式搜索了PubMed，Embase,和Cochrane图书馆提供截至2023年1月27日的数据。
方法：涉及PPHN新生儿的随机对照试验评估各种治疗方法的疗效和死亡率。
方法：研究人群的详细信息，治疗,并提取结果。
结果：在随机效应下进行直接配对比较和网络荟萃分析。基于累积排序曲线(SUCRA)下的表面进一步评估排序概率。我们分析了23项随机临床试验，涉及902例PPHN新生儿。将16种不同的治疗策略与常规治疗（CON）进行比较。10-20ppm（ppm）iNO（MNO）的中值浓度与每6-8小时1-3mg/kg/剂的西地那非口服给药（OSID）显示出最佳疗效（MNO+OSID与CON：比值比[OR]=27.53，95%CI，2.36-321.75；SUCRA=0.818，排名第一；中等质量）。OSID联合米力农静脉给药在疗效方面也表现良好（OSID+米力农与CON：OR=25.13，95％CI=1.67-377.78；SUCRA=0.811，排名第二；低质量）和死亡率降低（CONvs.OSID+米力农：OR=25.13，95%CI=1.67-377.78；SUCRA=0.786，排名最后；低质量）。
结论：MNO+OSID是最有效的PPHN治疗方法。如果iNO不可用，OSID+米力农是优选的。
