Neonatal Intensive Care Unit, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey.
Arch Iran Med. 2024 Oct 1;27(10):573-579. doi: 10.34172/aim.31725.
Neonatal acute respiratory distress syndrome (NARDS) is an important cause of hypoxemic respiratory failure. This study aimed to investigate the short-term effects of endotracheal surfactant and budesonide combination therapy on NARDS secondary to late-onset neonatal sepsis (LONS).
This was a retrospective, cross-sectional, and observational study. Newborns with NARDS due to LONS who received endotracheal surfactant and budesonide combination therapy between August 2022 and September 2023 were included in this study. Oxygenation status before endotracheal surfactant and budesonide treatment were compared with the values obtained two hours after treatment.
Among 20 neonates, 10 (50%) were diagnosed with severe NARDS, and 10 (50%) were diagnosed with moderate NARDS. The mean corrected gestational age was 33.3±2.9 w when endotracheal surfactant and budesonide were administered to the neonates. The need for the fraction of inspired oxygen (0.75 [0.57-1.00]% vs. 0.55 [0.44-0.80]%; mean difference [MD]: 17.50%, 95% confidence interval [CI]: 14.99 to 22.50) and oxygen saturation index (OSI; 8.03 [4.98-13.94] vs. 4.71 [4.11-8.93]; MD: 2.23, 95% CI: 1.22 to 3.24) decreased (=0.001 and <0.001, respectively) after endotracheal surfactant and budesonide treatment. However, preductal oxygen saturation (SpO ; 93 [91-94]% vs. 95 [94-96]%; MD: -3.50%, 95% CI: -5.00 to -2.00) increased significantly after endotracheal surfactant and budesonide treatment when compared to pre-treatment values (<0.001).
The reduction in oxygen demand and OSI, along with an increase in SpO after treatment compared to pre-treatment values, suggests that endotracheal surfactant and budesonide combination therapy could be an effective option to improve oxygenation in NARDS secondary to LONS.
新生儿急性呼吸窘迫综合征（NARDS）是低氧性呼吸衰竭的重要原因。本研究旨在探讨气管内表面活性剂联合布地奈德治疗晚发型新生儿败血症（LONS）继发 NARDS 的短期疗效。
这是一项回顾性、横断面、观察性研究。纳入 2022 年 8 月至 2023 年 9 月期间接受气管内表面活性剂联合布地奈德治疗的 LONS 继发 NARDS 新生儿。比较气管内表面活性剂联合布地奈德治疗前与治疗后 2 小时的氧合状态。
20 例新生儿中，10 例（50%）诊断为重度 NARDS，10 例（50%）诊断为中度 NARDS。给予气管内表面活性剂联合布地奈德时新生儿的平均校正胎龄为 33.3±2.9 周。吸入氧分数（0.75 [0.57-1.00]% vs. 0.55 [0.44-0.80]%；均数差值 [MD]：17.50%，95%置信区间 [CI]：14.99 至 22.50）和氧饱和度指数（OSI；8.03 [4.98-13.94] vs. 4.71 [4.11-8.93]；MD：2.23，95%CI：1.22 至 3.24）在气管内表面活性剂联合布地奈德治疗后均降低（=0.001 和 <0.001）。然而，与治疗前相比，经气管内表面活性剂联合布地奈德治疗后，经皮氧饱和度（SpO；93 [91-94]% vs. 95 [94-96]%；MD：-3.50%，95%CI：-5.00 至-2.00）显著升高（<0.001）。
与治疗前相比，治疗后氧需求和 OSI 降低，SpO 升高，提示气管内表面活性剂联合布地奈德治疗可能是改善 LONS 继发 NARDS 氧合的有效选择。
