Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2020 Aug 17;35(32):e253. doi: 10.3346/jkms.2020.35.e253.
Pulmonary surfactant (PS) replacement therapy, as a safe and effective treatment for respiratory distress syndrome (RDS) may have further increased with the extended insurance coverage since 2011 in Korea. Thus, this study aimed to investigate the epidemiologic data of PS replacement therapy for RDS in Korea and to analyze the complications associated with RDS.
We included 19,442 infants who were treated with PS and diagnosed with RDS (International Classification of Diseases-10 codes: P22.0) between 2014 and 2018 from the Health Insurance Review and Assessment database. Birth certificate data from Statistics Korea were used to estimate the incidence of RDS.
The average incidence of RDS within the study period was 0.99% among live births. Repeated doses of PS were administered to 1,688 infants (8.7%), ranging from 2 doses in 929 infants (4.8%) to 9 doses in 1 infant (0.01%). The incidence of RDS in term infants markedly increased over 5 years from 0.2% to 0.34%. The incidence was similarly increased among the preterm infants. The RDS mortality rate was 6.3% and showed a decreasing trend according to year. The mortality rate was significantly higher in the lower gestational age group. A decreasing trend was observed in the incidence of the complications, such as patent ductus arteriosus, intraventricular hemorrhage, and bronchopulmonary dysplasia, except for pneumothorax in term infants. The complications were also higher in the lower gestational age group and the lower birth weight group. However, pneumothorax was the most frequent complication in the term infant group and in infants with birth weight ≥ 2,500 g.
Advancements in neonatal care and extended insurance coverage have increased the use of PS replacement therapy for RDS. This, in turn, decreased neonatal mortality and the incidence of the associated complications. The appropriate therapeutic strategy for RDS should be decided according to the gestational age and lung pathology.
自 2011 年韩国扩大医疗保险覆盖范围以来，肺表面活性剂（PS）替代疗法作为一种安全有效的治疗呼吸窘迫综合征（RDS）的方法，其应用可能进一步增加。因此，本研究旨在调查韩国 RDS 患者 PS 替代疗法的流行病学数据，并分析与 RDS 相关的并发症。
我们从健康保险审查和评估数据库中纳入了 2014 年至 2018 年间使用 PS 治疗并被诊断为 RDS（国际疾病分类第 10 版编码：P22.0）的 19442 名婴儿。使用韩国统计局的出生证明数据来估计 RDS 的发生率。
在研究期间，RDS 的平均发生率为活产儿的 0.99%。1688 名婴儿（8.7%）接受了重复剂量的 PS 治疗，其中 929 名婴儿（4.8%）接受了 2 个剂量，1 名婴儿（0.01%）接受了 9 个剂量。5 年来，足月婴儿的 RDS 发生率从 0.2%显著增加到 0.34%。早产儿的发生率也同样增加。RDS 的死亡率为 6.3%，且呈逐年下降趋势。较低的胎龄组死亡率显著更高。除足月婴儿的气胸外，动脉导管未闭、脑室内出血和支气管肺发育不良等并发症的发生率呈下降趋势。较低的胎龄组和较低的出生体重组并发症发生率更高。然而，气胸是足月婴儿组和出生体重≥2500g 的婴儿中最常见的并发症。
新生儿护理的进步和医疗保险覆盖范围的扩大增加了 PS 替代疗法治疗 RDS 的应用。这反过来又降低了新生儿死亡率和相关并发症的发生率。应根据胎龄和肺病理来决定 RDS 的治疗策略。
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