高濕度環境對非常低出生體重早產兒之影響－－系統性文獻回顧

The Effect of High Humidity Environments on Very Low Birth Weight Preterm Infants: A Systematic Review

背景早產兒在高濕度環境介入照護的時機及作法在各研究中缺乏一致性，難以評量早產兒合併症預後，使臨床醫護人員缺乏明確的照護準則。
目的本文乃藉由系統性文獻回顧方式探討以高濕度環境介入對於極低體重早產兒之合併症預後成效，作為提供臨床照護準則之實證依據。
方法電子資料庫檢索1930年至2021年9月前發表之所有文獻，以「早產兒」或「非常低體重早產兒」或「極低體重早產兒」和「濕度」為關鍵字，目標族群為體重≤1,500克或出生週數≤34週的早產兒，探討高濕度環境的介入時機、作法及相關合併症與預後之文獻，主要研究結果包括：體重、總水份攝入量、電解質、尿量、無感性水分散失、感染、早產兒常見合併症及死亡率。檢視其研究方法、品質及成效後共納入9篇文獻進行整合分析。
結果本系統性文獻回顧呈現出高濕度環境可改善早產兒的生理指標，包括：減少總水份攝入量、較少發生高血鈉的次數等有顯著改善。統合出高濕度使用之建議：出生週數≤30週或體重≤1,000克，出生第一週提供相對濕度70%−80%之環境，第二週調降至50%−60%。總使用天數建議為兩週，可避免造成皮膚角質層發育的延緩。
結論／實務應用本研究統合出適合的高濕度介入時機及作法，期望可提供臨床照護之參考依據。

Background: The scholarly evidence on the timing and practice of interventional care administered to preterm infants in high-humidity environments is unclear. This makes evaluating the prognosis of preterm infants with comorbidities difficult and means that clinical medical staff lack clear guidelines for care.
Purpose: This systematic review was designed to explore the prognostic effects of interventions for comorbidities performed on very low birthweight preterm infants in high humidity environments to provide an empirical basis for developing related clinical-care guidelines.
Methods: An electronic database was searched for all relevant documents published between 1930 and September 2021. The keywords used were“premature infants”OR“very low weight premature infants”OR“very low weight premature infants”AND“humidity”, and the target groups were premature infants weighing≤1,500 grams or delivered at≤34 weeks of gestation. The timing and practice of interventions in high humidity environments and the occurrence and prognosis of related comorbidities were explored. The main findings cover the issues of body weight, total water intake, electrolytes, urine output, insensitivity water loss, infection, common complications, and mortality in preterm infants. After reviewing the methods, quality, and efficacy of the research in the identified studies, 9 articles were selected for integrated synthesis.
Results: Recommendations for the use of high humidity with infants delivered at≤30 weeks of gestation or at birth weights≤1,000 grams were integrated. An environment with a relative humidity of 70%−80% should be used during the first postpartum week and 50%−60% during the second postpartum week. The recommended total duration of use of a high-humidity environment is two weeks to avoid delaying the development of the stratum corneum. Physiological indicators shown to exhibit significant improvement under this regimen include reduced total water intake, increased urine output, and a lower incidence of hypernatremia.
Conclusions / Implications for Practice: The appropriate timing and practice of high humidity intervention were integrated in this study. It is hoped that this review provides an evidence-based clinical practice guideline for preterm infant care.