肺超声评分预测极早产儿需要表面活性剂。

Lung Ultrasound Score Predicts Surfactant Need in Extremely Preterm Neonates.

机构信息

Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Centre, South Paris University Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France.

Section of Pediatrics, Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; and.

出版信息

Pediatrics. 2018 Sep;142(3). doi: 10.1542/peds.2018-0463. Epub 2018 Aug 14.

DOI:10.1542/peds.2018-0463

PMID:30108142

Abstract

BACKGROUND AND OBJECTIVES

There are several lung ultrasound scores (LUS) for evaluating lung aeration in critically ill adults with restrictive lung disorders. A modified LUS adapted for neonates correlates well with oxygenation and is able to be used to predict the need for surfactant in preterm neonates with respiratory distress syndrome (RDS). However, no data are available for extremely preterm neonates for whom timely surfactant administration is especially important. We hypothesized that LUS might be reliable in extremely preterm neonates with RDS who are treated with continuous positive airway pressure. We aimed to determine the diagnostic accuracy of LUS in predicting the need for surfactant treatment and re-treatment in this population.

METHODS

We performed a prospective cohort diagnostic accuracy study between 2015 and 2016 in a tertiary-care academic center. Inborn neonates at ≤30 weeks' gestation with RDS treated with continuous positive airway pressure were eligible. Surfactant was given on the basis of oxygen requirement thresholds derived from European guidelines, and a LUS was not used to guide surfactant treatment. We calculated the LUS after admission and analyzed its diagnostic accuracy to predict surfactant treatment and re-treatment.

RESULTS

We enrolled 133 infants; 68 (51%) received 1 dose of surfactant and 19 (14%) received 2 surfactant doses. A LUS is significantly correlated with oxygenation index (ρ = 0.6; < .0001) even after adjustment for gestational age ( < .0001). A LUS can be used to accurately predict the need for the first surfactant dose (area under the curve = 0.94; 95% confidence interval: 0.90-0.98; < .0001) and also the need for surfactant redosing (area under the curve = 0.803; 95% confidence interval: 0.72-0.89; < .0001). The global accuracy for the prediction of surfactant treatment and re-treatment is 89% and 72%, respectively.

CONCLUSIONS

LUS may be used to predict the need for surfactant replacement in extremely preterm neonates with RDS.

摘要

背景和目的

有几种肺部超声评分（LUS）可用于评估患有限制性肺部疾病的重症成人的肺部通气。一种为新生儿量身定制的改良 LUS 与氧合相关良好，并且能够用于预测患有呼吸窘迫综合征（RDS）的早产儿需要表面活性剂。然而，对于需要及时给予表面活性剂治疗的极早产儿尚无相关数据。我们假设 LUS 可能适用于接受持续气道正压通气治疗的患有 RDS 的极早产儿。我们旨在确定 LUS 在预测该人群中表面活性剂治疗和再治疗需求方面的诊断准确性。

方法

我们在 2015 年至 2016 年期间在一家三级学术中心进行了一项前瞻性队列诊断准确性研究。患有 RDS 且接受持续气道正压通气治疗的胎龄≤30 周的新生儿符合入选条件。根据欧洲指南得出的氧需求阈值给予表面活性剂，且不使用 LUS 来指导表面活性剂治疗。我们在入院后计算 LUS，并分析其预测表面活性剂治疗和再治疗的诊断准确性。

结果

我们共纳入 133 名婴儿；68 名（51%）接受了 1 次表面活性剂治疗，19 名（14%）接受了 2 次表面活性剂治疗。即使在校正胎龄后，LUS 与氧合指数仍显著相关（ρ=0.6；<0.0001）（<0.0001）。LUS 可用于准确预测首次表面活性剂治疗的需求（曲线下面积=0.94；95%置信区间：0.90-0.98；<0.0001），也可预测表面活性剂再次给药的需求（曲线下面积=0.803；95%置信区间：0.72-0.89；<0.0001）。预测表面活性剂治疗和再治疗的整体准确性分别为 89%和 72%。