Kruczek Piotr, Krajewski Paweł, Hożejowski Roman, Szczapa Tomasz
Department of Neonatology, Ujastek Medical Center, Cracow, Poland.
Department of Neonatology, University Center for Mother and Newborn's Health, Warsaw, Poland.
Front Pediatr. 2021 Oct 4;9:734696. doi: 10.3389/fped.2021.734696. eCollection 2021.
To establish the impact of oxygen requirement before surfactant (SF) and time from birth to SF administration on treatment outcomes in neonatal respiratory distress syndrome (RDS). We conducted a analysis of data from a prospective cohort study of 500 premature infants treated with less invasive surfactant administration (LISA). LISA failure was defined as the need for early (<72 h of life) mechanical ventilation (MV). Baseline clinical characteristic parameters, time to SF, and fraction of inspired oxygen (FiO) prior to SF were all included in the multifactorial logistic regression model that explained LISA failure. LISA failed in 114 of 500 infants (22.8%). The median time to SF was 2.1 h (IQR: 0.8-6.7), and the median FiO prior to SF was 0.40 (IQR: 0.35-0.50). Factors significantly associated with LISA failure were FiO prior to SF (OR 1.03, 95% CI 1.01-1.04) and gestational age (OR 0.82, 95 CI 0.75-0.89); both <0.001. Time to SF was not an independent risk factor for therapy failure ( = 0.528) or the need for MV at any time during hospitalization ( = 0.933). The FiO before SF, but not time to SF, influences the need for MV in infants with RDS. While our findings support the relevance of FiO in SF prescription, better adherence to the recommended FiO threshold for SF (0.30) is required in daily practice.
为确定在使用表面活性剂（SF）之前的氧需求以及从出生到给予SF的时间对新生儿呼吸窘迫综合征（RDS）治疗结局的影响。我们对一项前瞻性队列研究的数据进行了分析，该研究纳入了500例接受微创表面活性剂给药（LISA）治疗的早产儿。LISA失败定义为需要早期（出生后<72小时）机械通气（MV）。多因素逻辑回归模型纳入了基线临床特征参数、至SF的时间以及SF之前的吸入氧分数（FiO），该模型用于解释LISA失败情况。500例婴儿中有114例（22.8%）LISA失败。至SF的中位时间为2.1小时（IQR：0.8 - 6.7），SF之前的中位FiO为0.40（IQR：0.35 - 0.50）。与LISA失败显著相关的因素是SF之前的FiO（OR 1.03，95%CI 1.01 - 1.04）和胎龄（OR 0.82，95%CI 0.75 - 0.89）；两者P均<0.001。至SF的时间不是治疗失败（P = 0.528）或住院期间任何时间需要MV（P = 0.933）的独立危险因素。SF之前的FiO而非至SF的时间影响RDS婴儿对MV的需求。虽然我们的研究结果支持FiO在SF处方中的相关性，但在日常实践中需要更好地遵守SF推荐的FiO阈值（0.30）。
