在自主呼吸的早产儿中，采用侵入性较小的表面活性剂给药方式与改善肺部预后相关。

Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants.

作者信息

Göpel Wolfgang, Kribs Angela, Härtel Christoph, Avenarius Stefan, Teig Norbert, Groneck Peter, Olbertz Dirk, Roll Claudia, Vochem Matthias, Weller Ursula, von der Wense Axel, Wieg Christian, Wintgens Jürgen, Preuss Michael, Ziegler Andreas, Roth Bernhard, Herting Egbert

机构信息

Department of Pediatrics, University of Lübeck, Lübeck, Germany.

出版信息

Acta Paediatr. 2015 Mar;104(3):241-6. doi: 10.1111/apa.12883.

DOI:10.1111/apa.12883

PMID:25474712

Abstract

AIM

Providing less invasive surfactant administration (LISA) to spontaneously breathing preterm infants has been reported to reduce mechanical ventilation and bronchopulmonary dysplasia (BPD) in randomised controlled trials. This large cohort study compared these outcome measures between LISA-treated infants and controls.

METHODS

Infants receiving LISA, who were born before 32 gestational weeks and enrolled in the German Neonatal Network, were matched to control infants by gestational age, umbilical cord pH, Apgar-score at 5 min, small for gestational age status, antenatal treatment with steroids, gender and highest supplemental oxygen during the first 12 h of life. Outcome data were compared with chi-square and Mann-Whitney U-tests and adjusted for multiple comparisons.

RESULTS

Between 2009 and 2012, 1103 infants were treated with LISA at 37 centres. LISA infants had lower rates of mechanical ventilation (41% versus 62%, p < 0.001), postnatal dexamethasone treatment (2.5% versus 7%, p < 0.001), BPD (12% versus 18%, p = 0.001) and BPD or death (14% versus 21%, p < 0.001) than the controls.

CONCLUSION

Surfactant treatment of spontaneously breathing infants was associated with lower rates of mechanical ventilation and BPD. Additional large-scale randomised controlled trials are needed to assess the possible long-term benefits of LISA.

摘要

目的

在随机对照试验中，据报道，对自主呼吸的早产儿采用微创表面活性剂给药（LISA）可减少机械通气和支气管肺发育不良（BPD）。这项大型队列研究比较了接受LISA治疗的婴儿与对照组之间的这些结局指标。

方法

将孕周小于32周且纳入德国新生儿网络的接受LISA治疗的婴儿，按照孕周、脐带血pH值、5分钟时的阿氏评分、小于胎龄状态、产前类固醇治疗、性别以及出生后12小时内最高吸氧浓度与对照婴儿进行匹配。结局数据采用卡方检验和曼-惠特尼U检验进行比较，并针对多重比较进行调整。

结果

2009年至2012年期间，37个中心的1103名婴儿接受了LISA治疗。与对照组相比，接受LISA治疗的婴儿机械通气率较低（41%对62%，p<0.001）、出生后地塞米松治疗率较低（2.5%对7%，p<0.001）、BPD发生率较低（12%对18%，p = 0.001）以及BPD或死亡率较低（14%对21%，p<0.001）。