表面活性物质替代疗法在生长受限早产儿中的疗效：有何证据？
The Efficacy of Surfactant Replacement Therapy in the Growth-Restricted Preterm Infant: What is the Evidence?
机构信息
Monash Newborn, Monash Children's Hospital , Melbourne, VIC , Australia ; The Ritchie Centre, Monash Institute of Medical Research , Melbourne, VIC , Australia ; Department of Paediatrics, Monash University , Melbourne, VIC , Australia.
Monash Newborn, Monash Children's Hospital , Melbourne, VIC , Australia.
出版信息
Front Pediatr. 2014 Oct 29;2:118. doi: 10.3389/fped.2014.00118. eCollection 2014.
BACKGROUND
Surfactant replacement therapy (SRT) is an integral part of management of preterm surfactant deficiency respiratory distress syndrome (RDS). Its role in the management of RDS has been extensively studied. However, its efficacy in the management of lung disease in preterm infants born with intrauterine growth restriction (IUGR) has not been systematically studied.
OBJECTIVE
To evaluate the efficacy of exogenous SRT in the management of preterm IUGR lung disease.
METHODS
A systematic search of all available randomized clinical trials (RCT) of SRT in preterm IUGR infants was done according to the standard Cochrane collaboration search strategy. Neonatal respiratory outcomes were compared between the preterm IUGR and appropriately grown for gestational age (AGA) preterm infant populations in eligible studies.
RESULTS
No study was identified which evaluated the efficacy or responsiveness of exogenous SRT in preterm IUGR infants as compared to preterm AGA-infants. The only study identified through the search strategy used small for gestational age (SGA; defined as less than tenth centile for birth weight) as a proxy for IUGR. The RCT evaluated the efficacy or responsiveness of SRT in preterm SGA group as compared to AGA-infants. The rate of intubation, severity of RDS, rate of surfactant administration, pulmonary air leaks, and days on the ventilator did not differ between both groups. However, the requirement for prolonged nasal continuous positive airway pressure (p < 0.001), supplemental oxygen therapy (p < 0.01), and the incidence of bronchopulmonary dysplasia at 28 days and 36 weeks (both p < 0.01) was greater in SGA-infants.
DISCUSSION
There is currently insufficient data available to evaluate the efficacy of SRT in preterm IUGR lung disease. A variety of research strategies will be needed to enhance our understanding of the role and rationale for use of SRT in preterm IUGR lung disease.
背景
表面活性物质替代疗法（SRT）是治疗早产儿肺表面活性物质缺乏性呼吸窘迫综合征（RDS）的重要组成部分。其在 RDS 管理中的作用已得到广泛研究。然而，其在治疗宫内生长受限（IUGR）早产儿肺部疾病中的疗效尚未得到系统研究。
目的
评估外源性 SRT 在治疗早产儿 IUGR 肺部疾病中的疗效。
方法
根据标准的 Cochrane 协作组搜索策略，对所有可用的早产儿 IUGR 婴儿 SRT 随机临床试验（RCT）进行了系统搜索。比较了合格研究中早产儿 IUGR 与适当胎龄（AGA）早产儿的新生儿呼吸结局。
结果
没有发现评估外源性 SRT 在早产儿 IUGR 婴儿中与早产儿 AGA 婴儿相比的疗效或反应性的研究。通过搜索策略确定的唯一一项研究将小于胎龄儿（SGA；定义为出生体重低于第 10 百分位数）作为 IUGR 的替代指标。该 RCT 评估了 SRT 在早产儿 SGA 组与 AGA 婴儿中的疗效或反应性。两组之间的插管率、RDS 严重程度、表面活性剂使用率、肺漏气率和呼吸机使用天数无差异。然而，SGA 婴儿需要长期鼻持续气道正压通气（p < 0.001）、补充氧气治疗（p < 0.01）以及 28 天和 36 周时支气管肺发育不良的发生率（均为 p < 0.01）更高。
讨论
目前尚无足够的数据评估 SRT 在早产儿 IUGR 肺部疾病中的疗效。需要采用各种研究策略来增强我们对 SRT 在早产儿 IUGR 肺部疾病中的作用和使用原理的理解。
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