Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.
Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.
J Pediatr. 2021 Feb;229:141-146. doi: 10.1016/j.jpeds.2020.10.025. Epub 2020 Oct 14.
To assess the procedural and clinical outcomes associated with the introduction of minimally invasive surfactant therapy (MIST) into standard care at 2 tertiary Australian neonatal intensive care units.
A prospective audit was designed before the introduction of MIST in 2018, with data collected over a period of 18 months. Procedural data were completed by the clinical team performing MIST, including clinical observations, medication use, and adverse events. The audit team collected demographic data and subsequent clinical outcomes from medical records.
There were 135 MIST procedures recorded in 122 infants. For the included infants, the median gestation was 30 weeks (IQR, 27 to 32 weeks) and birth weight was 1439 g (IQR, 982-1958 g). During the MIST procedure, desaturation to a peripheral oxygen saturation of <80% was common, occurring in 75.2% of procedures. Other adverse events included need for positive pressure ventilation (10.6%) and bradycardia <100 beats per minute (13.3%). The use of atropine premedication was associated with a significantly lower incidence of bradycardia: 8.6% vs 52.9% (P < .01). Senior clinicians demonstrated higher rates of procedural success. The majority of infants (63.9%) treated with MIST did not require subsequent intubation and mechanical ventilation.
MIST can be successfully introduced in neonatal units with limited experience of this technique. The use of atropine premedication decreases the incidence of bradycardia during the procedure. Success rates can be optimized by limiting MIST to clinicians with greater competence in endotracheal intubation.
评估微创表面活性剂治疗（MIST）引入澳大利亚 2 家三级新生儿重症监护病房标准护理后与程序和临床结局相关联的情况。
在 2018 年 MIST 引入之前设计了前瞻性审核，在此期间收集了 18 个月的数据。MIST 临床团队完成程序数据，包括临床观察、药物使用和不良事件。审核团队从病历中收集人口统计学数据和后续临床结局。
在 122 名婴儿中记录了 135 次 MIST 操作。纳入的婴儿中，中位胎龄为 30 周（IQR，27 至 32 周），出生体重为 1439g（IQR，982-1958g）。在 MIST 过程中，饱和度降至外周血氧饱和度<80%很常见，发生在 75.2%的操作中。其他不良事件包括需要正压通气（10.6%）和心动过缓<100 次/分钟（13.3%）。术前使用阿托品与心动过缓发生率显著降低相关：8.6%对 52.9%（P<.01）。资深临床医生表现出更高的操作成功率。大多数接受 MIST 治疗的婴儿（63.9%）不需要随后进行插管和机械通气。
在经验有限的新生儿病房中可以成功引入 MIST。术前使用阿托品可降低操作过程中心动过缓的发生率。通过将 MIST 限制在具有更高气管内插管能力的临床医生手中，可以优化成功率。
