背景:PPHN是新生儿呼吸衰竭的常见原因,并且仍然是严重的疾病,并且与高死亡率相关。
目标:为了比较人口统计学变量,临床特征,与接受ECMO并死亡的PHHN新生儿相比,接受ECMO并存活的PHHN新生儿的治疗结局。
方法:我们遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目,Medline,Embase,PubMed,CINAHL,Wiley在线图书馆,Scopus和Nature研究了接受ECMO的新生儿PPHN的发展,发表于2010年1月1日至2023年5月31日,英语限制。
结果:在确定的5689篇论文中,134篇文献纳入系统评价。分析了涉及1814例接受ECMO治疗的PPHN新生儿的研究(1218例存活,594例死亡)。PPHN组死亡的新生儿正常自然阴道分娩比例较低(6.4%vs1.8%;p值>0.05),在1分钟和5分钟时Apgar评分较低[即,低阿普加得分:1.5%对0.5%,与存活者相比,中度异常Apgar评分:10.3%vs1.2%,令人放心的Apgar评分:4%vs2.3%;p值=0.039]。患有PPHN并死亡的新生儿有较高的医疗合并症比例,例如脐膨出(0.7%vs4.7%),全身性低血压(1%vs2.5%),感染单纯疱疹病毒(0.4%vs2.2%)或百日咳博德特氏菌(0.7%vs2%);p=0.042。死亡组中PPHN的新生儿由于先天性膈疝更容易出现(25.5%vs47.3%),新生儿呼吸窘迫综合征(4.2%vs13.5%),胎粪吸入综合征(8%vs12.1%),肺炎(1.6%vs8.4%),脓毒症(1.5%vs8.2%)和肺泡毛细血管发育不良伴肺静脉错位(0.1%vs4.4%);p=0.019。死亡的PPHN新生儿需要更长的机械通气中位时间(15天,IQR10至27vs.10天,IQR7至28;p=0.024)和ECMO使用(9.2天,IQR3.9至13.5vs.6天,IQR3至12.5;p=0.033),住院时间中位数较短(23天,IQR12.5至46vs.58.5天,IQR28.2至60.7;p=0.000)与存活的PPHN新生儿相比。ECMO相关并发症,如乳糜胸(1%vs2.7%),在死亡的PPHN新生儿组中,颅内出血(1.2%vs1.7%)和导管相关性感染(0%vs0.3%)更为常见(p=0.031).
结论:ECMO在心肺支持治疗和常规治疗失败的PPHN新生儿中得到了成功应用,新生儿存活率为67.1%。接受ECMO的PPHN新生儿的死亡率在通过剖腹产分娩方式出生或出生时Apgar评分较低的新生儿中最高。接受ECMO的PPHN新生儿的死亡率在特定医学合并症发生率较高的患者中最高(脐膨出,全身性低血压和单纯疱疹病毒或百日咳博德特氏菌感染)或由于特定病因发生率较高而患有PPHN的病例(先天性膈疝,新生儿呼吸窘迫综合征和胎粪吸入综合征)。死亡的PPHN新生儿可能需要更长的机械通气和ECMO使用时间以及更短的住院时间;并且可能经历更高的ECMO相关并发症(乳糜胸,颅内出血和导管相关感染)与存活的PPHN新生儿相比。
BACKGROUND: PPHN is a common cause of neonatal respiratory failure and is still a serious condition and associated with high mortality.
OBJECTIVE: To compare the demographic variables, clinical characteristics, and treatment outcomes in neonates with PHHN who underwent ECMO and survived compared to neonates with PHHN who underwent ECMO and died.
METHODS: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature for studies on the development of PPHN in neonates who underwent ECMO, published from January 1, 2010 to May 31, 2023, with English language restriction.
RESULTS: Of the 5689 papers that were identified, 134 articles were included in the systematic review. Studies involving 1814 neonates with PPHN who were placed on ECMO were analyzed (1218 survived and 594 died). Neonates in the PPHN group who died had lower proportion of normal spontaneous vaginal delivery (6.4% vs 1.8%; p value > 0.05) and lower Apgar scores at 1 min and 5 min [i.e., low Apgar score: 1.5% vs 0.5%, moderately abnormal Apgar score: 10.3% vs 1.2% and reassuring Apgar score: 4% vs 2.3%; p value = 0.039] compared to those who survived. Neonates who had PPHN and died had higher proportion of medical comorbidities such as omphalocele (0.7% vs 4.7%), systemic hypotension (1% vs 2.5%), infection with Herpes simplex virus (0.4% vs 2.2%) or Bordetella pertussis (0.7% vs 2%); p = 0.042. Neonates with PPHN in the death group were more likely to present due to congenital diaphragmatic hernia (25.5% vs 47.3%), neonatal respiratory distress syndrome (4.2% vs 13.5%), meconium aspiration syndrome (8% vs 12.1%), pneumonia (1.6% vs 8.4%), sepsis (1.5% vs 8.2%) and alveolar capillary dysplasia with misalignment of pulmonary veins (0.1% vs 4.4%); p = 0.019. Neonates with PPHN who died needed a longer median time of mechanical ventilation (15 days, IQR 10 to 27 vs. 10 days, IQR 7 to 28; p = 0.024) and ECMO use (9.2 days, IQR 3.9 to 13.5 vs. 6 days, IQR 3 to 12.5; p = 0.033), and a shorter median duration of hospital stay (23 days, IQR 12.5 to 46 vs. 58.5 days, IQR 28.2 to 60.7; p = 0.000) compared to the neonates with PPHN who survived. ECMO-related complications such as chylothorax (1% vs 2.7%), intracranial bleeding (1.2% vs 1.7%) and catheter-related infections (0% vs 0.3%) were more frequent in the group of neonates with PPHN who died (p = 0.031).
CONCLUSIONS: ECMO in the neonates with PPHN who failed supportive cardiorespiratory care and conventional therapies has been successfully utilized with a neonatal survival rate of 67.1%. Mortality in neonates with PPHN who underwent ECMO was highest in cases born via the caesarean delivery mode or neonates who had lower Apgar scores at birth. Fatality rate in neonates with PPHN who underwent ECMO was the highest in patients with higher rate of specific medical comorbidities (omphalocele, systemic hypotension and infection with Herpes simplex virus or Bordetella pertussis) or cases who had PPHN due to higher rate of specific etiologies (congenital diaphragmatic hernia, neonatal respiratory distress syndrome and meconium aspiration syndrome). Neonates with PPHN who died may need a longer time of mechanical ventilation and ECMO use and a shorter duration of hospital stay; and may experience higher frequency of ECMO-related complications (chylothorax, intracranial bleeding and catheter-related infections) in comparison with the neonates with PPHN who survived.