Greiner Eva, Wittwer Apolline, Albuisson Eliane, Hascoët Jean-Michel
Department of Neonatology, CHRU, Nancy, France.
CHRU-Nancy, Direction de la Recherche et de l'Innovation (DRI), Département MPI, Unité de Méthodologie, Data management et Statistique (UMDS), Nancy, France.
Front Pediatr. 2021 Apr 30;9:663697. doi: 10.3389/fped.2021.663697. eCollection 2021.
Infants presenting respiratory distress syndrome (RDS) not responding to surfactant often receive a second instillation. Few studies evaluated the consequences of this second administration. This study aimed at determining the outcome of infants presenting persistent RDS and receiving an early second dose of surfactant. Infants below 32 weeks' gestation who received a second dose of 100mg/kg of surfactant within the first 72 h of life, were retrospectively involved in this 42 months' study. They were matched to two controls receiving a single dose of 200mg/Kg based upon gender and gestational age. 52/156 infants receiving two doses (Group 2-doses) were significantly more often SGA [22 (42%) vs. 21 (20%) = 0.04] and outborn [29 (56%) vs. 13 (12%) = 0.001]. They had received antenatal corticos teroid therapy less often [26 (50%) vs. 89 (86%) = 0.001] and presented more severe RDS based upon FiO2 level, oxygenation index and radiography. Group 2-doses survival was lower (65.4% vs. 79.6 % < 0.1) but surviving infants did not have different morbidity than controls. Premature newborn receiving a second dose of surfactant had adverse antenatal characteristics, presented more severe RDS and only partially responded to the first dose. Outcomes of surviving infants who received 2 doses of surfactant were comparable to others.
患有呼吸窘迫综合征（RDS）且对表面活性剂无反应的婴儿通常会接受第二次滴注。很少有研究评估这第二次给药的后果。本研究旨在确定患有持续性RDS并接受早期第二剂表面活性剂的婴儿的结局。对出生孕周小于32周、在出生后72小时内接受第二剂100mg/kg表面活性剂的婴儿进行了为期42个月的回顾性研究。根据性别和孕周，将他们与接受单剂量200mg/Kg的两个对照组进行匹配。接受两剂表面活性剂的52/156名婴儿（2剂组）中，小于胎龄儿（SGA）的比例显著更高[22例（42%）对21例（20%），P=0.04]，且为外院出生的比例也更高[29例（56%）对13例（12%），P=0.001]。他们接受产前皮质类固醇治疗的频率较低[26例（50%）对89例（86%），P=0.001]，并且根据吸入氧分数水平、氧合指数和影像学检查显示患有更严重的RDS。2剂组的存活率较低（65.4%对79.6%，P<0.1），但存活婴儿的发病率与对照组没有差异。接受第二剂表面活性剂的早产新生儿具有不良的产前特征，表现出更严重的RDS，且仅对第一剂有部分反应。接受两剂表面活性剂的存活婴儿的结局与其他婴儿相当。
