Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada.
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
Pediatr Res. 2023 Mar;93(4):990-995. doi: 10.1038/s41390-022-02197-3. Epub 2022 Jul 19.
Examine the real-world clinical impact of adopting less invasive surfactant administration (LISA) as the primary surfactant administration method in extremely preterm infants.
Single-center pre-post cohort study conducted over a 4-year period comparing outcomes of spontaneously breathing inborn infants 24-28 weeks gestational age (GA) receiving surfactant via endotracheal tube (pre-cohort, n = 154) or LISA via thin catheter (post-cohort, n = 70). Primary outcome was need for invasive mechanical ventilation (IMV, ≥2 h) ≤72 h of age. Secondary outcomes were a composite of mortality, bronchopulmonary dysplasia, intraventricular hemorrhage ≥grade 3 or necrotizing enterocolitis, and its individual components. Groups were compared using propensity score methods, including covariates: GA, birth weight, sex, small for GA, SNAP II ≥20, premature rupture of membranes, maternal hypertension/diabetes, and C-section.
GA and birth weight were 27.1 (26, 28.1) weeks and 914 (230) g, and 27.1 (26.1, 28.1) weeks and 920 (236) g for pre- and post-cohorts, respectively. Pre-cohort had higher C-section rates, (67% vs. 51%, p = 0.03). After adjustment for covariates, LISA was associated with reduced IMV exposure [AOR (95% CI) 0.07 (0.04, 0.11)], lower odds of the composite clinical outcome [0.49 (0.33, 0.73)], and most of its individual components.
Real-world experience favors LISA as the primary method in extremely preterm infants with established spontaneous respiration.
Less invasive surfactant administration (LISA) is associated with a reduction in respiratory morbidity, but real-world data of routine use among extremely preterm infants are limited. LISA is associated with reduced frequency of exposure to and duration of IMV in both ≤72 h after birth and during hospital stay. LISA is associated with a reduction in mortality, and most other major morbidities including bronchopulmonary dysplasia, and interventricular hemorrhage. Data from a large North American center providing real-world clinical outcomes following LISA as the primary method of surfactant administration.
研究采用微创表面活性剂给药（LISA）作为极早产儿主要表面活性剂给药方法的真实临床影响。
这是一项为期 4 年的单中心前后队列研究，比较了经气管内管给予表面活性剂的自主呼吸的宫内 24-28 周龄（GA）出生婴儿（前队列，n=154）和经细导管给予 LISA 的婴儿（后队列，n=70）的结局。主要结局为出生后 72 小时内需要有创机械通气（IMV，≥2 小时）。次要结局为死亡、支气管肺发育不良、≥3 级脑室内出血或坏死性小肠结肠炎的复合结局及其各组成部分。采用倾向评分法比较两组，包括协变量：GA、出生体重、性别、GA 小、SNAP II ≥20、胎膜早破、母亲高血压/糖尿病和剖宫产。
GA 和出生体重分别为 27.1（26，28.1）周和 914（230）g，前、后队列分别为 27.1（26.1，28.1）周和 920（236）g。前队列剖宫产率较高（67% vs. 51%，p=0.03）。调整协变量后，LISA 与 IMV 暴露减少相关[比值比（95%CI）0.07（0.04，0.11）]，复合临床结局的可能性降低[0.49（0.33，0.73）]，且其大多数单个组成部分的可能性降低。
真实世界的经验支持 LISA 作为具有自主呼吸的极早产儿的主要方法。
微创表面活性剂给药（LISA）与降低呼吸发病率有关，但极早产儿常规使用的真实世界数据有限。LISA 与出生后≤72 小时和住院期间 IMV 暴露的频率和持续时间减少有关。LISA 与死亡率以及大多数其他主要并发症（包括支气管肺发育不良和脑室内出血）的降低有关。来自北美大型中心的数据提供了 LISA 作为主要表面活性剂给药方法后的真实世界临床结局。
