Beauchene Madeline S, Cunningham Alison M, Stanford Amy H, Bischoff Adrianne R, Dagle John M, Rios Danielle R, Klein Jonathan M, Giesinger Regan E, McNamara Patrick J
Stead Family Department of Pediatrics, The University of Iowa, Iowa City, IA, USA.
Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.
J Perinatol. 2023 Oct;43(10):1245-1251. doi: 10.1038/s41372-023-01689-2. Epub 2023 May 9.
To determine the clinical/echocardiography (ECHO) phenotype of patients with hypoxic respiratory failure (HRF) and response to late surfactant, according to patent ductus arteriosus (PDA) status.
This retrospective study included infants ≤26 weeks gestation who received ≥1 surfactant dose after 6 postnatal days and where PDA status was available by ECHO. Response to surfactant was appraised based on change in respiratory severity score over 48 h. The relationship between PDA status and response to surfactant was evaluated via univariate analysis.
We studied late surfactant (n = 71 doses) administration in 35 preterm infants born at a mean weight and GA at birth were 595 g (508, 696) and 23.3 (22.7, 25) weeks, respectively of whom 16 (46%) had a diagnosis of PDA. Positive response to late surfactant treatment was independently associated with absence of PDA [OR 26 (2, 334), p = 0.01] whereas presence of PDA was independently associated with negative response [OR 12 (1.1, 126), p = 0.04].
In neonates ≤26 weeks gestation, with HRF, response to surfactant after postnatal day 6 is influenced by PDA status. Future trials should consider PDA status which may enhance diagnostic precision and refine patient selection for late surfactant treatment.
根据动脉导管未闭（PDA）状态，确定缺氧性呼吸衰竭（HRF）患者的临床/超声心动图（ECHO）表型以及对晚期表面活性剂的反应。
这项回顾性研究纳入了胎龄≤26周的婴儿，这些婴儿在出生后6天接受了≥1剂表面活性剂治疗，且通过ECHO可获得PDA状态。根据48小时内呼吸严重程度评分的变化评估对表面活性剂的反应。通过单因素分析评估PDA状态与对表面活性剂反应之间的关系。
我们研究了35例早产儿晚期表面活性剂（n = 71剂）的给药情况，这些早产儿出生时的平均体重和胎龄分别为595 g（508, 696）和23.3周（22.7, 25），其中16例（46%）诊断为PDA。对晚期表面活性剂治疗的阳性反应与无PDA独立相关[比值比（OR）26（2, 334），p = 0.01]，而PDA的存在与阴性反应独立相关[OR 12（1.1, 126），p = 0.04]。
在胎龄≤26周、患有HRF的新生儿中，出生后6天对表面活性剂的反应受PDA状态影响。未来的试验应考虑PDA状态，这可能会提高诊断准确性并优化晚期表面活性剂治疗的患者选择。
