Division of Neonatology, Department of Paediatrics, University of Cologne, Faculty of Medicine, Cologne, Germany.
Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, United States.
Semin Fetal Neonatal Med. 2023 Dec;28(6):101496. doi: 10.1016/j.siny.2023.101496. Epub 2023 Nov 22.
Non-invasive modes of respiratory support have been shown to be the preferable way of primary respiratory support of preterm infants with respiratory distress syndrome (RDS). The avoidance of invasive mechanical ventilation can be beneficial for preterm infants in reduction of morbidity and even mortality. However, it is well-established that some infants managed with non-invasive respiratory support from the outset have symptomatic RDS to a degree that warrants surfactant administration. Infants for whom non-invasive respiratory support ultimately fails are prone to adverse outcomes, occurring at a frequency on par with the group intubated primarily. This raises the question how to combine non-invasive respiratory support with surfactant therapy. Several methods of less or minimally invasive surfactant therapy have been developed to address the dilemma between avoidance of mechanical ventilation and administration of surfactant. This paper describes the different methods of less invasive surfactant application, reports the existing evidence from clinical studies, discusses the limitations of each of the methods and the open and future research questions.
已证实，对于患有呼吸窘迫综合征（RDS）的早产儿，采用非侵入性呼吸支持模式作为主要呼吸支持方式更为可取。避免使用有创机械通气，可降低早产儿的发病率，甚至死亡率。然而，众所周知，有些一开始就接受非侵入性呼吸支持的婴儿，其 RDS 症状严重到需要表面活性剂治疗的程度。对于那些最终无法接受非侵入性呼吸支持的婴儿，他们很可能会出现不良后果，其发生频率与主要插管组相当。这就提出了如何将非侵入性呼吸支持与表面活性剂治疗相结合的问题。为了解决避免机械通气和使用表面活性剂之间的困境，已经开发了几种微创或微创表面活性剂治疗方法。本文描述了不同的微创表面活性剂应用方法，报告了临床研究中的现有证据，讨论了每种方法的局限性以及开放和未来的研究问题。
