Deshpande Sujata, Suryawanshi Pradeep, Ahya Kunal, Maheshwari Rajesh, Gupta Samir
Associate Professor, Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India.
Professor and Head, Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India.
J Clin Diagn Res. 2017 Aug;11(8):SC09-SC12. doi: 10.7860/JCDR/2017/28523.10520. Epub 2017 Aug 1.
Pathophysiology of pneumonia involves leakage of plasma proteins into the airways and accumulation of cytokines within the lung. Several in vitro and in vivo studies have demonstrated that this proteinaceous material and lung inflammation inhibit surfactant function.
To evaluate whether exogenous surfactant therapy improves oxygenation and gas exchange in late preterm and term neonates with early onset pneumonia and respiratory failure.
This prospective interventional cohort study was conducted at a tertiary care neonatal unit. Twenty four late preterm and term neonates with early onset pneumonia requiring mechanical ventilation for respiratory failure were included and received surfactant therapy. Oxygenation index, arterial/alveolar PO (a/A ratio), mean airway pressure and fraction of inspired oxygen were calculated from arterial blood gases obtained before and after surfactant therapy. Wilcoxon signed rank sum test was used for assessment of change in oxygenation variables 12 hours after surfactant therapy. Data regarding clinical outcomes and complications were collected and analysed.
Just over half (54.2%) of the study neonates were of term gestation. After surfactant therapy, the median Oxygenation Index (OI) decreased from 11.15 to 3.7 at one hour and the change was sustained and significant at 12 hours (p<0.05). The median a/A PO ratio improved from 0.09 to 0.3 within one hour of surfactant replacement and the improvement was significant at 12 hours (p<0.01). Twenty two neonates (92%) survived to discharge. Median duration of hospital stay was 15 days.
Significant and rapid improvement in oxygenation in late preterm and term neonates with early onset pneumonia was seen after surfactant therapy, which is sustained for a longer period. There could be a substantial role for the use of surfactant in early onset pneumonia, although larger controlled trials are needed before definite recommendations can be made.
肺炎的病理生理学涉及血浆蛋白渗漏至气道以及肺内细胞因子的积聚。多项体外和体内研究表明，这种蛋白质物质和肺部炎症会抑制表面活性物质的功能。
评估外源性表面活性物质治疗能否改善早发型肺炎和呼吸衰竭的晚期早产儿及足月儿的氧合和气体交换。
本前瞻性干预性队列研究在一家三级新生儿重症监护病房进行。纳入24例因早发型肺炎导致呼吸衰竭需要机械通气的晚期早产儿及足月儿，并给予表面活性物质治疗。根据表面活性物质治疗前后采集的动脉血气计算氧合指数、动脉血氧分压/肺泡氧分压（a/A比值）、平均气道压和吸入氧分数。采用Wilcoxon符号秩和检验评估表面活性物质治疗12小时后氧合变量的变化。收集并分析有关临床结局和并发症的数据。
略多于一半（54.2%）的研究新生儿为足月儿。表面活性物质治疗后，氧合指数（OI）中位数在1小时时从11.15降至3.7，且在12小时时持续显著下降（p<0.05）。表面活性物质替代治疗1小时内，a/A氧分压比值中位数从0.09提高到0.3，且在12小时时改善显著（p<0.01）。22例新生儿（92%）存活至出院。住院时间中位数为15天。
表面活性物质治疗后，早发型肺炎的晚期早产儿及足月儿的氧合有显著且快速的改善，且这种改善可持续较长时间。表面活性物质在早发型肺炎的治疗中可能发挥重要作用，不过在做出明确推荐之前还需要进行更大规模的对照试验。
