Borszewska-Kornacka Maria Katarzyna, Kostuch Marzena, Korbal Piotr, Krajewski Paweł
Dev Period Med. 2015 Jul-Sep;19(3 Pt 1):271-6.
The efficiency of routine practices in the management of neonatal respiratory distress syndrome (RDS) have never been systematically investigated in Poland.
To evaluate RDS treatment policies and short-term outcomes in neonatal intensive care units (NICUs).
We retrospectively analyzed medical records of premature neonates ≤ 32 weeks' gestation, diagnosed with RDS in level-2 and level-3 referral centers. Collected data: comprised clinical variables, antenatal corticosteroids, respiratory support, surfactant (SFT) policies and short-term outcomes.
Data of 987 infants from 53 NICUs were analyzed. The median gestational age was 29 weeks (range 22-32) and birth weight 1190 g (range 340-2860). Infants requiring SFT had significantly lower exposure to antenatal corticosteroids (75%) vs. those managed without SFT (83%, p = 0.006). SFT was given to 59% infants in level-3 NICUs and 40% in level-2. There was significant variability of SFT use between level 2 and level 3 NICU. (9% to 100%). Poractant alfa was most commonly used (97%) in the median initial dose of 170 mg/kg (IQR 120-200). Single application was most frequent (79.8%). SFT administration methods were endotracheal instillation in babies maintained on mechanical ventilation (68.0%), INSURE (27.6%) and minimally-invasive delivery (MIST) 4.4%. Early rescue treatment remained core SFTstrategy (57.4% cases), while prophylaxis accounted for only 13.3% cases.
There is considerable variation in the frequency of use of surfactant in Polish neonatal centers. Traditional intratracheal instillation with subsequent mechanical ventilation dominates, although newer methods INSURE and MIST are becoming increasingly popular. Early rescue SFT is a predominant strategy, which conforms to current standards. The rate of antenatal corticosteroids remains too low.
在波兰，从未对新生儿呼吸窘迫综合征（RDS）管理中的常规做法效率进行过系统研究。
评估新生儿重症监护病房（NICU）中的RDS治疗策略和短期结局。
我们回顾性分析了在二级和三级转诊中心诊断为RDS的孕周≤32周的早产儿的病历。收集的数据包括临床变量、产前使用的糖皮质激素、呼吸支持、表面活性剂（SFT）策略和短期结局。
分析了来自53个NICU的987例婴儿的数据。中位胎龄为29周（范围22 - 32周），出生体重为1190克（范围340 - 2860克）。需要SFT的婴儿接受产前糖皮质激素治疗的比例（75%）显著低于未使用SFT治疗的婴儿（83%，p = 0.006）。三级NICU中59%的婴儿接受了SFT治疗，二级NICU中这一比例为40%。二级和三级NICU之间SFT的使用存在显著差异（9%至100%）。泊拉坦α最常被使用（97%），中位初始剂量为170毫克/千克（四分位间距120 - 200）。单次应用最为常见（79.8%）。SFT的给药方法在接受机械通气的婴儿中为气管内滴注（68.0%）、INSURE方法（27.6%）和微创给药（MIST）（4.4%）。早期挽救性治疗仍然是核心的SFT策略（57.4%的病例），而预防性治疗仅占13.3%的病例。
波兰新生儿中心表面活性剂的使用频率存在很大差异。传统的气管内滴注随后进行机械通气占主导地位，尽管更新的方法INSURE和MIST越来越受欢迎。早期挽救性SFT是主要策略，符合当前标准。产前糖皮质激素的使用率仍然过低。
