Department of Paediatrics, Royal Hobart Hospital, Hobart, TAS, Australia.
Neonatology. 2018;113(1):7-14. doi: 10.1159/000480066. Epub 2017 Sep 19.
Most preterm infants born at 29-32 weeks gestation now avoid intubation in early life, and thus lack the usual conduit through which exogenous surfactant is given if needed.
The aim of this work was to examine whether a technique of minimally invasive surfactant therapy used selectively at 29-32 weeks gestation would improve outcomes.
We studied the impact of selective administration of surfactant (poractant alfa 100-200 mg/kg) by thin catheter in infants with respiratory distress syndrome on continuous positive airway pressure (CPAP). The threshold for consideration of treatment was CPAP ≥7 cm H2O and FiO2 ≥0.35 prior to 24 h of life. In-hospital outcomes were compared before and after introducing minimally invasive surfactant therapy (epochs 1 and 2, respectively).
During epoch 2, of 266 infants commencing CPAP, 51 (19%) reached the treatment threshold. Thirty-seven infants received surfactant via thin catheter, and CPAP failure was avoided in 34 of these (92%). For the overall cohort of infants at 29-32 weeks gestation, after the introduction of minimally invasive surfactant therapy, there were reductions in CPAP failure (epoch 1: 14%, epoch 2: 7.2%) and average days of intubation, with equivalent surfactant use and days of respiratory support (intubation + CPAP). Pneumothorax was substantially reduced (from 8.0 to 2.4%). These findings were mirrored within the subgroups reaching the severity threshold in each epoch. The incidence of bronchopulmonary dysplasia was low in both epochs.
Selective use of minimally invasive surfactant therapy at 29-32 weeks gestation permits a primary CPAP strategy to be pursued with a high rate of success, and a low risk of pneumothorax.
现在，大多数在 29-32 周龄出生的早产儿在生命早期避免了插管，因此，如果需要，他们通常缺乏给予外源性表面活性剂的途径。
本研究旨在探讨 29-32 周龄时选择性应用微创表面活性剂治疗技术是否会改善结局。
我们研究了在持续气道正压通气（CPAP）中患有呼吸窘迫综合征的婴儿中，通过细导管给予表面活性剂（猪肺磷脂 100-200mg/kg）对其的影响。治疗的考虑阈值为生命 24 小时前 CPAP≥7cmH2O 和 FiO2≥0.35。分别比较引入微创表面活性剂治疗前后（分别为时期 1 和 2）的住院结局。
在时期 2，开始 CPAP 的 266 名婴儿中，有 51 名（19%）达到治疗阈值。37 名婴儿通过细导管接受了表面活性剂治疗，其中 34 名（92%）避免了 CPAP 失败。对于 29-32 周龄的总体婴儿队列，在引入微创表面活性剂治疗后，CPAP 失败率（时期 1：14%，时期 2：7.2%）和平均插管天数均有所降低，同时表面活性剂使用和呼吸支持（插管+CPAP）天数也相当。气胸显著减少（从 8.0%降至 2.4%）。在每个时期达到严重程度阈值的亚组中，都观察到了这些发现。两个时期的支气管肺发育不良发生率均较低。
29-32 周龄时选择性应用微创表面活性剂治疗可采用高成功率的主要 CPAP 策略，并降低气胸风险。
