Alsina-Casanova Miguel, Brito Nerea, Balcells-Esponera Carla, Herranz-Barbero Ana, Teresa-Palacio Marta, Soler-García Aleix, Agustí Carmen, Brullas Guillem, Clotet Jordi, Carrasco Cristina, Salvia Dolors, Aldecoa-Bilbao Victoria
Neonatology Department, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain.
Neonatology Department, Hospital Sant Joan de Déu, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain.
Front Pediatr. 2024 Aug 27;12:1444906. doi: 10.3389/fped.2024.1444906. eCollection 2024.
Less-invasive surfactant administration (LISA) is associated with better respiratory outcomes in preterm infants with respiratory distress syndrome. However, mechanical ventilation (MV) shortly after the LISA procedure has been related to lower survival. This study aimed to analyze the trends and main predictors of continuous positive airway pressure (CPAP) failure after LISA.
Preterm infants born between 23 and 33 weeks gestational age (GA) in two level III neonatal units who received surfactant were included (2017-2022). Demographic data, lung ultrasound (LUS) scores, the saturation/fraction of inspired oxygen (SF) ratio, technique, time to surfactant administration, and the main neonatal outcomes were collected.
Over the study period, 289 inborn preterm infants received surfactant, 174 with the LISA method (60.2%). Patients who received surfactant after intubation in the delivery room ( = 56) were more immature and exhibited worse outcomes. Patients who received surfactant via an endotracheal tube in the neonatal intensive care unit ( = 59) had higher LUS scores and a lower SF ratio than those treated with LISA. The LISA method was associated with less death or bronchopulmonary dysplasia (BPD), with an adjusted odds ratio (aOR) = 0.37 [95% confidence interval (CI), 0.18-0.74, = 0.006]. CPAP failure after LISA (defined as the need for intubation and MV in the first 72 h of life) occurred in 38 patients (21.8%), inversely proportional to GA (38.7% at 23-26 weeks, 26.3% at 27-30 weeks, and 7.9% at 30-33 weeks ( < 0.001). CPAP failure after LISA was significantly related to death, with an aOR = 12.0 (95% CI, 3.0-47.8, < 0.001), and moderate to severe BPD, with an aOR = 2.9 (95% CI, 1.1-8.0, = 0.035), when adjusting for GA. The best predictors of CPAP failure after LISA were GA, intrauterine growth restriction, temperature at admission, the SF ratio, and the LUS score, with a Nagelkerke's = 0.458 ( < 0.001). The predictive model showed an area under the curve = 0.84 (95% CI, 0.75-0.93, < 0.001).
CPAP failure after LISA is still common in extremely preterm infants, leading to an increase in death or disability. Clinicians must acknowledge the main risk factors of CPAP failure to choose wisely the right patient and the best technique. LUS and the SF ratio at admission can be useful when making these decisions.
在患有呼吸窘迫综合征的早产儿中，微创表面活性剂给药（LISA）与更好的呼吸结局相关。然而，LISA程序后不久进行机械通气（MV）与较低的生存率有关。本研究旨在分析LISA后持续气道正压通气（CPAP）失败的趋势和主要预测因素。
纳入在两个三级新生儿病房出生的胎龄为23至33周（GA）且接受表面活性剂治疗的早产儿（2017 - 2022年）。收集人口统计学数据、肺部超声（LUS）评分、血氧饱和度/吸入氧分数（SF）比值、技术、表面活性剂给药时间以及主要的新生儿结局。
在研究期间，289例出生时即早产的婴儿接受了表面活性剂治疗，其中174例采用LISA方法（60.2%）。在产房插管后接受表面活性剂治疗的患者（n = 56）更不成熟且结局更差。在新生儿重症监护病房通过气管内导管接受表面活性剂治疗的患者（n = 59）的LUS评分更高，SF比值低于接受LISA治疗的患者。LISA方法与更低的死亡或支气管肺发育不良（BPD）发生率相关，校正比值比（aOR）= 0.37 [95%置信区间（CI），0.18 - 0.74，P = 0.006]。LISA后CPAP失败（定义为出生后72小时内需插管和MV）发生在38例患者中（21.8%），与GA呈反比（23 - 26周时为38.7%，27 - 30周时为26.3%，30 - 33周时为7.9%，P < 0.001）。校正GA后，LISA后CPAP失败与死亡显著相关，aOR = 12.0（95% CI，3.0 - 47.8，P < 0.001），与中度至重度BPD相关，aOR = 2.9（95% CI，1.1 - 8.0，P = 0.035）。LISA后CPAP失败的最佳预测因素是GA、宫内生长受限、入院时体温、SF比值和LUS评分，Nagelkerke's R² = 0.458（P < 0.001）。预测模型的曲线下面积 = 0.84（95% CI，0.75 - 0.93，P < 0.001）。
LISA后CPAP失败在极早产儿中仍然很常见，导致死亡或残疾增加。临床医生必须认识到CPAP失败的主要风险因素，以便明智地选择合适的患者和最佳技术。入院时的LUS和SF比值在做出这些决定时可能会有所帮助。
