Lanciotti Lucia, Sartori Anna, Simonato Manuela, Correani Alessio, Cogo Paola, Burattini Ilaria, Giorgetti Chiara, Centorrino Roberta, Loi Barbara, De Luca Daniele, Carnielli Virgilio
Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.
Department of Women's and Children's Health, University of Padova, Padova, Italy.
J Pediatr. 2025 Sep;284:114644. doi: 10.1016/j.jpeds.2025.114644. Epub 2025 May 13.
To evaluate main biophysically active surfactant components and inflammatory mediators, and to identify the factors associated with good response to surfactant, in late preterm infants with respiratory distress syndrome (RDS).
This was a prospective, multicenter, cohort study enrolling late (gestational age 34-36 weeks [late-PT]) and moderately (gestational age 32-33 weeks, [moderately-PT]) preterm infants with RDS. Term infants with no lung disease (term-NLD) were enrolled as controls. The concentration of disaturated-phosphatidylcholine (DSPC), surfactant protein-B (SP-B), total proteins, interleukin (IL)-1β, IL-6, and tumor necrosis factor-α in epithelial lining fluids were measured by high-performance liquid chromatography-mass spectrometry, enzyme-linked immunosorbent assay, Lowry, or Luminex techniques, respectively, and corrected using plasma-to-bronchoalveolar lavage fluid urea ratio. Clinical data, including inspired oxygen fraction (FiO) and preductal oxygen hemoglobin saturation (SpO), were recorded in real-time.
We studied 55 late-PT, 44 moderately-PT and 18 term-NLD infants. DSPC was lower in late-PT (43 [24-124] mg/dL) than in term-NLD (249 [147-688] mg/dL, P < .001) but similar to that of moderately-PT (30 [9-80] mg/dL, P = .083). SP-B, total proteins, IL-1β, IL-6, and tumor necrosis factor-α were similar between late-PT and moderately-PT. SP-B, total proteins, and IL-6 were significantly higher in late-PT than term-NLD. Each hour of delay for surfactant administration, each 5-point increase in FiO threshold, and each 5-point decrease in preductal hemoglobin saturation SpO/FiO ratio before surfactant treatment decreased the likelihood of good response by 12% (P = .002), 28% (P = .019) and 15% (P = .028), respectively.
Late-PT had DSPC and SP-B levels similar to moderately-PT. Early administration, lower FiO threshold, and better oxygenation prior to surfactant treatment were associated with a better response to surfactant therapy.
评估晚期早产儿呼吸窘迫综合征（RDS）中主要的生物物理活性表面活性剂成分和炎症介质，并确定与表面活性剂良好反应相关的因素。
这是一项前瞻性、多中心队列研究，纳入晚期（胎龄34 - 36周[晚期早产儿]）和中度（胎龄32 - 33周，[中度早产儿]）患有RDS的早产儿。无肺部疾病的足月儿（足月儿 - 无肺部疾病）作为对照。分别采用高效液相色谱 - 质谱法、酶联免疫吸附测定法、洛瑞法或Luminex技术测量上皮衬液中双饱和磷脂酰胆碱（DSPC）、表面活性蛋白 - B（SP - B）、总蛋白、白细胞介素（IL）-1β、IL - 6和肿瘤坏死因子 - α的浓度，并使用血浆与支气管肺泡灌洗液尿素比值进行校正。实时记录临床数据，包括吸入氧分数（FiO）和导管前氧血红蛋白饱和度（SpO）。
我们研究了55名晚期早产儿、44名中度早产儿和18名足月儿 - 无肺部疾病的婴儿。晚期早产儿的DSPC（43[24 - 124]mg/dL）低于足月儿 - 无肺部疾病的婴儿（249[147 - 688]mg/dL，P <.001），但与中度早产儿（30[9 - 80]mg/dL，P =.083）相似。晚期早产儿和中度早产儿之间的SP - B、总蛋白、IL - 1β、IL - 6和肿瘤坏死因子 - α相似。晚期早产儿的SP - B、总蛋白和IL - 6显著高于足月儿 - 无肺部疾病的婴儿。表面活性剂给药每延迟1小时、表面活性剂治疗前FiO阈值每增加5个百分点以及导管前血红蛋白饱和度SpO/FiO比值每降低5个百分点，良好反应的可能性分别降低12%（P =.002）、28%（P =.019）和15%（P =.028）。
晚期早产儿的DSPC和SP - B水平与中度早产儿相似。早期给药、较低的FiO阈值以及表面活性剂治疗前更好的氧合与表面活性剂治疗的更好反应相关。
