Gillot Diane, Milési Christophe, Combes Clémentine, Brodeau Vincent, Gavotto Arthur, Cambonie Gilles
Department of Neonatal Medicine, Pediatric Intensive Care and Pediatric Emergency Transport Service, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, Cedex 5, 34295, Montpellier, France.
PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.
Eur J Pediatr. 2025 Aug 19;184(9):563. doi: 10.1007/s00431-025-06406-z.
This study investigates whether implementation of a less-invasive surfactant administration (LISA) protocol in a level IIIb academic neonatal intensive care unit had an impact on the rate of infants treated with surfactant. This observational cohort study enrolled spontaneously breathing very premature infants, born < 33 weeks' gestational age (GA), with worsening respiratory distress syndrome despite support with continuous positive airway pressure and in need of surfactant replacement therapy. Data were collected over two 3-year periods, preceding (P1, 2013-2015) and following (P2, 2019-2021) implementation of a LISA protocol. Nine hundred and six neonates were studied, 412 (45%) born in P1 and 494 (55%) in P2, with comparable GA, birthweight, and severity score (CRIB-II). Administration technique was mainly conventional at P1 (85%) and LISA at P2 (75%). Surfactant treatment rate decreased from 54% (224/412) at P1 to 47% (233/494) at P2 (p = 0.04), notably in infants born at 28-32 weeks' GA (41 to 33%, OR [95% CI] 0.72 [0.53-0.99]). Among 23-32 weeks' GA infants, need for invasive mechanical ventilation decreased from 56% (231/412) at P1 to 23% (113/494) at P2 (OR 0.23 [0.17-0.31], p < 0.001). Mortality and survival without severe morbidity were comparable. Conclusion: Implementation of a LISA protocol in our level IIIb NICU was associated with less surfactant use and lower exposure to invasive mechanical ventilation.
本研究调查在一家三级甲等学术性新生儿重症监护病房实施微创表面活性剂给药（LISA）方案是否会对接受表面活性剂治疗的婴儿比例产生影响。这项观察性队列研究纳入了孕周小于33周、自主呼吸的极早产儿，这些婴儿尽管接受持续气道正压通气支持，但呼吸窘迫综合征仍在恶化，且需要进行表面活性剂替代治疗。在实施LISA方案之前（P1，2013 - 2015年）和之后（P2，2019 - 2021年）的两个3年期间收集数据。共研究了906例新生儿，412例（45%）在P1期出生，494例（55%）在P2期出生，两组在孕周、出生体重和严重程度评分（CRIB-II）方面具有可比性。给药技术在P1期主要为传统方式（85%），在P2期主要为LISA（75%）。表面活性剂治疗率从P1期的54%（224/412）降至P2期的47%（233/494）（p = 0.04），特别是在孕周为28 - 32周的婴儿中（从41%降至33%，OR[95%CI]0.72[0.53 - 0.99]）。在孕周为23 - 32周的婴儿中，有创机械通气的需求从P1期的56%（231/412）降至P2期的23%（113/494）（OR 0.23[0.17 - 0.31]，p < 0.001）。死亡率和无严重疾病存活情况具有可比性。结论：在我们的三级甲等新生儿重症监护病房实施LISA方案与减少表面活性剂使用和降低有创机械通气暴露相关。
