Hoekstra R E, Ferrara T B, Payne N R
Minneapolis Children's Medical Center, MN 55404.
Eur J Pediatr. 1994;153(9 Suppl 2):S12-6. doi: 10.1007/BF02179667.
Limits of viability of extremely premature infants have recently been addressed both in Europe and the United States. These reports, which demonstrate frequent adverse outcome of infants born before 26 weeks of gestation, have not considered the impact of surfactant therapy. We reviewed records of 445 infants born between 23 and 36 weeks gestation who were admitted to our nursery following the availability of surfactant treatment in 1986 through 1992. Two hundred and eighty-five infants were treated with surfactant (Survanta, Ross Laboratories) as part of controlled, prospective trials or as routine treatment under Food and Drug Administration approval. One hundred and fifty-six infants were unable to be treated with surfactant, as either they received placebo therapy during prospective trials or were born prior to approval of routine surfactant use in the United States. Four additional infants born following the commercial availability of surfactant did not receive surfactant therapy. Survival of untreated infants was 56% compared to 75% in treated infants (P < 0.001). Infants born at all gestational ages between 23 and 26 weeks had an increased likelihood of survival as a result of surfactant treatment. No differences in neurologic outcome between surfactant treated and non-treated infants were demonstrated at subsequent follow-up. We conclude that survival of extremely premature infants is improved following surfactant therapy and that subsequent neurologic outcome is not compromised as a result of this therapy.
最近，欧洲和美国都探讨了极早产儿的生存极限。这些报告显示，妊娠26周前出生的婴儿常有不良结局，但未考虑表面活性剂治疗的影响。我们回顾了1986年至1992年期间在我们新生儿重症监护室收治的445例妊娠23至36周出生的婴儿的记录。其中285例婴儿接受了表面活性剂（Survanta，罗斯实验室）治疗，作为对照性前瞻性试验的一部分，或在食品药品监督管理局批准下作为常规治疗。156例婴儿无法接受表面活性剂治疗，因为他们在前瞻性试验中接受了安慰剂治疗，或在美国常规使用表面活性剂获批之前出生。在表面活性剂上市后出生的另外4例婴儿未接受表面活性剂治疗。未治疗婴儿的存活率为56%，而接受治疗婴儿的存活率为75%（P<0.001）。由于表面活性剂治疗，妊娠23至26周之间各个孕周出生的婴儿存活可能性均增加。在随后的随访中，未发现表面活性剂治疗组和未治疗组婴儿的神经学结局有差异。我们得出结论，表面活性剂治疗可提高极早产儿的存活率，且该治疗不会损害随后的神经学结局。
