Legge N A, Shein D, Callander I
Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, Australia.
Liverpool Hospital, Elizabeth St, Liverpool, NSW, Australia.
J Neonatal Perinatal Med. 2019;12(3):255-263. doi: 10.3233/NPM-180074.
This study investigates trends in methods of surfactant administration and early respiratory management in neonatal intensive care units [NICU] in New South Wales [NSW] and the Australian Capital Territory [ACT] in 2015 and evaluate whether differences in practice translate to variances in short term outcomes.
Surveys were sent to NICUs in NSW and ACT to ascertain their practice of surfactant administration and respiratory management. A retrospective data analysis with data from the NICUS database from 01/01/2013-30/06/2015 was performed. Included were all patients that received Surfactant, were inborn, without major malformation, ≥24 weeks gestational age [GA] and birthweight ≥500 g. Major respiratory outcome measures were time ventilated, air leak, oxygen requirement at 36 weeks corrected gestational age [cGA], home oxygen therapy after discharge and retinopathy of prematurity [ROP]. Along with this data demographic and morbidity data was also obtained for comparison [mortality, necrotizing enterocolitis [NEC], persistent ductus arteriosus [PDA], intraventricular hemorrhage [IVH].
1453 patients met inclusion criteria. Patient data comparing major respiratory outcomes showed patients receiving less invasive Surfactant therapy and respiratory management spent longer time on CPAP [559 vs. 407 hrs, p = 0.01] and in the older gestation subgroups less time on mechanical ventilation [18 vs. 50 hrs p = <0.001] and were discharged earlier [48 vs. 54 days, p = 0.03]. There was however, higher rates of oxygen requirement at 36 weeks cGA [33 vs. 26.3% p = 0.01] and a higher proportion of home oxygen in this patient group [11.3 vs. 7.1% p = 0.03]. Major morbidity outcome data showed no significant differences.
Less invasive Surfactant therapy and gentle early respiratory management should be considered as a viable alternative to established methods of surfactant administration and ventilation.
本研究调查了2015年新南威尔士州（NSW）和澳大利亚首都直辖区（ACT）新生儿重症监护病房（NICU）中表面活性剂给药方法和早期呼吸管理的趋势，并评估实践差异是否会转化为短期结局的差异。
向新南威尔士州和澳大利亚首都直辖区的新生儿重症监护病房发送调查问卷，以确定其表面活性剂给药和呼吸管理的实践情况。对2013年1月1日至2015年6月30日新生儿重症监护病房数据库中的数据进行回顾性数据分析。纳入的患者均接受了表面活性剂治疗，为足月儿，无重大畸形，胎龄（GA）≥24周且出生体重≥500g。主要呼吸结局指标包括通气时间、气漏、矫正胎龄36周（cGA）时的氧气需求、出院后家庭氧疗以及早产儿视网膜病变（ROP）。除了这些数据，还获取了人口统计学和发病率数据以作比较（死亡率、坏死性小肠结肠炎（NEC）、动脉导管未闭（PDA）、脑室内出血（IVH））。
1453例患者符合纳入标准。比较主要呼吸结局的患者数据显示，接受侵入性较小的表面活性剂治疗和呼吸管理的患者使用持续气道正压通气（CPAP）的时间更长（559小时对407小时，p = 0.01），在胎龄较大的亚组中机械通气时间更短（18小时对50小时，p = <0.001）且出院更早（48天对54天，p = 0.03）。然而，该患者组在矫正胎龄36周时的氧气需求率更高（33%对26.3%，p = 0.01），家庭氧疗比例也更高（11.3%对7.1%，p = 0.03）。主要发病结局数据显示无显著差异。
侵入性较小的表面活性剂治疗和温和的早期呼吸管理应被视为现有表面活性剂给药和通气方法的可行替代方案。
