Department of Neonatology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
Máxima Medical Centre Academy, Máxima Medical Centre, Veldhoven, the Netherlands.
BMC Pediatr. 2020 Sep 3;20(1):421. doi: 10.1186/s12887-020-02325-0.
In preterm infants with Respiratory Distress Syndrome (RDS), Less Invasive Surfactant Administration (LISA) has been established to reduce the need of mechanical ventilation and might improve survival rates without bronchopulmonary dysplasia. The aim of this study was to investigate whether NICU care has changed after introduction of less invasive surfactant administration (LISA), with regard to diagnostic and therapeutic procedures in the first week of life.
Infants with gestational age < 32 weeks who received surfactant by LISA (June 2014 - December 2017, n = 169) were retrospectively compared to infants who received surfactant after intubation (January 2012 - May 2014, n = 155). Local protocols on indication for surfactant, early onset sepsis, blood transfusions and enteral feeding did not change between both study periods. Besides, as secondary outcome complications of prematurity were compared. Data was collected from electronic patient files and compared by univariate analysis through Students T-test, Mann Whitney-U test, Pearson Chi-Square test or Linear by Linear Association.
All baseline characteristics of both groups were comparable. Compared to controls, LISA patients received a higher total surfactant dose (208 vs.160 mg/kg; p < 0.001), required redosing more frequently (32.5% vs. 21.3%; p = 0.023), but needed less mechanical ventilation (35.5% vs. 76.8%; p < 0.001). After LISA, infants underwent fewer X-rays (1.0 vs. 3.0, p < 0.001), blood gas examinations (3.0 vs. 5.0, p < 0.001), less inotropic drugs (9.5% vs. 18.1%; p = 0.024), blood transfusions (24.9% vs. 41.9%, p = 0.003) and had shorter duration of antibiotic therapy for suspected early onset sepsis (3.0 vs. 5.0 days, p < 0.001). Moreover, enteral feeding was advanced faster (120 vs. 100 mL/kg/d, p = 0.048) at day seven. There were no differences in complications of prematurity.
The introduction of LISA is associated with significantly fewer diagnostic and therapeutic procedures in the first week of life, which emphasizes the beneficial effects of LISA.
在患有呼吸窘迫综合征（RDS）的早产儿中，已经建立了微创表面活性剂给药（LISA）以减少对机械通气的需求，并且可能在没有支气管肺发育不良的情况下提高存活率。本研究的目的是调查在引入微创表面活性剂给药（LISA）后，新生儿重症监护病房（NICU）的护理是否发生了变化，特别是在生命的第一周内的诊断和治疗程序方面。
回顾性比较了 2014 年 6 月至 2017 年 12 月期间接受 LISA 治疗的胎龄<32 周的婴儿（n=169）和 2012 年 1 月至 2014 年 5 月期间接受气管内插管治疗的婴儿（n=155）。在这两个研究期间，关于表面活性剂、早发性败血症、输血和肠内喂养的局部方案均未改变。此外，还比较了早产儿并发症。数据从电子病历中收集，并通过单变量分析通过学生 t 检验、曼惠特尼 U 检验、皮尔逊卡方检验或线性线性关联进行比较。
两组的所有基线特征均相似。与对照组相比，LISA 患者接受的总表面活性剂剂量更高（208 毫克/千克与 160 毫克/千克；p<0.001），需要更频繁的重新给药（32.5%与 21.3%；p=0.023），但需要的机械通气更少（35.5%与 76.8%；p<0.001）。在 LISA 之后，婴儿接受的 X 光检查次数更少（1.0 次与 3.0 次，p<0.001），血气检查次数更少（3.0 次与 5.0 次，p<0.001），使用的正性肌力药物更少（9.5%与 18.1%；p=0.024），输血更少（24.9%与 41.9%，p=0.003），疑似早发性败血症的抗生素治疗时间更短（3.0 天与 5.0 天，p<0.001）。此外，第七天肠内喂养的速度更快（120 毫升/千克/天与 100 毫升/千克/天，p=0.048）。早产儿并发症无差异。
微创表面活性剂给药（LISA）的引入与生命的第一周内的诊断和治疗程序明显减少有关，这强调了 LISA 的有益效果。
