Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, AP-HP, Paris, France.
Division of Obstetrics and Gynecology, Medical Center "A.Béclère", South Paris University Hospitals, AP-HP, Paris, France.
Respir Res. 2019 Apr 16;20(1):75. doi: 10.1186/s12931-019-1040-z.
It is not known if the endogenous surfactant pool available early in life is associated with the RDS clinical course in preterm neonates treated with CPAP. We aim to clarify the clinical factors affecting surfactant pool in preterm neonates and study its association with CPAP failure.
Prospective, pragmatic, blind, cohort study. Gastric aspirates were obtained (within the first 6 h of life and before the first feeding) from 125 preterm neonates with RDS. Surfactant pool was measured by postnatal automated lamellar body count based on impedancemetry, without any pre-analytical treatment. A formal respiratory care protocol based on European guidelines was applied. Clinical data and perinatal risk factors influencing RDS severity or lamellar body count were real-time recorded. Investigators performing lamellar body count were blind to the clinical data and LBC was not used in clinical practice.
Multivariate analysis showed gestational age to be the only factor significantly associated with lamellar body count (standardized β:0.233;p = 0.023). Lamellar body count was significantly higher in neonates with CPAP success (43.500 [23.750-93.750]bodies/μL), than in those failing CPAP (20.500 [12.250-49.750] bodies/μL;p = 0.0003).LBC had a moderate reliability to detect CPAP failure (AUC: 0.703 (0.615-0.781);p < 0.0001; best cut-off: ≤30,000 bodies/μL). Upon adjustment for possible confounders, neither lamellar body count, nor its interaction factor with gestational age resulted associated with CPAP failure.
Early postnatal lamellar body count on gastric aspirates in CPAP-treated preterm neonates with RDS is significantly influenced only by gestational age. Lamellar bodies are not associated with CPAP failure. Thus, the endogenous surfactant pool available early in life only has a moderate reliability to predict CPAP failure.
目前尚不清楚在接受 CPAP 治疗的早产儿中，生命早期内源性表面活性剂池是否与 RDS 的临床病程有关。我们旨在阐明影响早产儿表面活性剂池的临床因素，并研究其与 CPAP 失败的关系。
前瞻性、实用、盲法、队列研究。对 125 例 RDS 早产儿在生命最初 6 小时内（首次喂养前）采集胃抽吸物。通过基于阻抗法的产后自动板层小体计数来测量表面活性剂池，无需任何预处理。根据欧洲指南应用了正式的呼吸治疗方案。实时记录影响 RDS 严重程度或板层小体计数的临床数据和围产期危险因素。进行板层小体计数的研究人员对临床数据不知情，并且 LBC 并未在临床实践中使用。
多变量分析显示，胎龄是唯一与板层小体计数显著相关的因素（标准化β：0.233；p=0.023）。CPAP 成功的新生儿板层小体计数明显较高（43500[23750-93750] 个/μL），而 CPAP 失败的新生儿板层小体计数较低（20500[12250-49750] 个/μL；p=0.0003）。LBC 具有中等可靠性来检测 CPAP 失败（AUC：0.703[0.615-0.781]；p<0.0001；最佳截断值：≤30000 个/μL）。在校正可能的混杂因素后，板层小体计数及其与胎龄的交互因子均与 CPAP 失败无关。
CPAP 治疗的 RDS 早产儿胃抽吸物中早期产后板层小体计数仅受胎龄显著影响。板层小体与 CPAP 失败无关。因此，生命早期内源性表面活性剂池仅具有中等可靠性来预测 CPAP 失败。
