Brown D R, Bloom B T, Cohen M, Myers M M, Egan E A, Kattwinkel J, Delmore P, Hall R T, Malloy M H, Holzman I R, Carlo W A, Pramanik A K, McCaffree M A, Weatherstone K B, Willett L D, Topper W H
Newark Beth Israel Medical Center, Department of Pediatrics, NJ 07112, USA.
J Perinatol. 1998 Nov-Dec;18(6 Pt 1):431-5.
To compare the effectiveness of a prophylactic surfactant treatment strategy (PRO) to the effectiveness of a rescue (RESC) surfactant treatment strategy in patients at high risk for developing hyaline membrane disease (HMD).
We analyzed data from a retrospective cohort consisting of all patients admitted to the neonatal intensive care units at the centers participating in the recently completed Infasurf-Survanta Comparative Trial. To be in the cohort, a patient had to be admitted during the trial, be <48 hours of age on admission, have a gestational age of <30 weeks, have a birth weight of 501 to 1250 gm, and be free of congenital anomalies. Twelve centers participated in this study. They contributed 1097 patients of whom 381 were treated with a PRO strategy.
Survival was significantly higher in the PRO-strategy patients (84% vs 72%, p < 0.05) as was survival without oxygen requirement at a postconceptional age of 36 weeks (60% vs 46%, p < 0.05). In addition, the patients with PRO had a lower prevalence of grade III and IV intraventricular hemorrhage (IVH, 9% vs 14%, p < 0.05). All analyses were controlled for birth weight and type of study center.
These data support the conclusion that using a PRO treatment strategy results in improved survival in patients at risk for developing HMD. A PRO treatment strategy may also decrease the likelihood of developing a severe IVH.
比较预防性表面活性剂治疗策略（PRO）与挽救性（RESC）表面活性剂治疗策略对发生透明膜病（HMD）高危患者的有效性。
我们分析了一项回顾性队列研究的数据，该队列包括参与最近完成的英孚素-舒润他比较试验的各中心新生儿重症监护病房收治的所有患者。要纳入该队列，患者必须在试验期间入院，入院时年龄<48小时，胎龄<30周，出生体重501至1250克，且无先天性异常。12个中心参与了本研究。他们共提供了1097例患者，其中381例接受了PRO策略治疗。
PRO策略组患者的存活率显著更高（84%对72%，p<0.05），孕龄36周时无需吸氧的存活率也是如此（60%对46%，p<0.05）。此外，PRO组患者III级和IV级脑室内出血（IVH）的发生率更低（9%对14%，p<0.05）。所有分析均对出生体重和研究中心类型进行了校正。
这些数据支持以下结论，即采用PRO治疗策略可提高HMD高危患者的存活率。PRO治疗策略还可能降低发生严重IVH的可能性。
