Lista Gianluca, Bresesti Ilia, Fabbri Laura
Division of Neonatology, "V.Buzzi" Children's Hospital, Asst Fatebenefratelli Sacco, Milan, Italy.
Global Clinical Development-Neonatology, Chiesi Farmaceutici S.p.A, Parma, Italy.
Am J Perinatol. 2018 May;35(6):530-533. doi: 10.1055/s-0038-1637759. Epub 2018 Apr 25.
In the 1990s, the most relevant pillars in the treatment of neonatal respiratory distress syndrome (RDS) have been improvements in ventilation strategies, the introduction of exogenous surfactant replacement therapy, and the use of antenatal steroids. Lately, in addition to the standard INSURE (INtubation-SURfactant administration-Extubation) method to administer surfactant, a new technique has been gaining increasing popularity. It is the so-called less invasive surfactant administration (LISA) method, which has shown promising results in preventing bronchopulmonary dysplasia development and in reducing mortality in preterm neonates. The rationale behind this technique is to avoid positive pressure ventilation and the endotracheal tube, being surfactant delivered through a thin catheter while the neonate is maintained on continuous positive airway pressure. Given the paucity of large-scale randomized trials on LISA method to prove its effects on short- and long-term outcomes, some questions still remain unanswered. Then, uncertainty regarding the feasibility of this maneuver needs to be better clarified before gaining wide acceptance in routine clinical practice. In our report, we aim at hypothesizing the main mechanisms behind the efficacy of LISA, considering it as a single maneuver in a comprehensive approach for RDS management in the delivery room.
20世纪90年代，新生儿呼吸窘迫综合征（RDS）治疗中最关键的支柱包括通气策略的改进、外源性表面活性剂替代疗法的引入以及产前类固醇的使用。最近，除了标准的INSURE（插管-表面活性剂给药-拔管）表面活性剂给药方法外，一种新技术越来越受欢迎。这就是所谓的微创表面活性剂给药（LISA）方法，它在预防支气管肺发育不良和降低早产儿死亡率方面显示出了令人鼓舞的结果。该技术背后的基本原理是避免正压通气和气管插管，在新生儿维持持续气道正压时通过细导管输送表面活性剂。鉴于缺乏关于LISA方法对短期和长期结局影响的大规模随机试验，一些问题仍未得到解答。因此，在常规临床实践中广泛接受之前，需要更好地阐明这种操作的可行性方面的不确定性。在我们的报告中，我们旨在推测LISA疗效背后的主要机制，将其视为产房RDS综合管理方法中的单一操作。
