Prophylactic or Early Selective Surfactant Combined With nCPAP in Very Preterm Infants
Prophylactic or Early Selective Surfactant Combined With nCPAP in Very Preterm Infants
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DOI：
10.1542/peds.2009-2131
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发表时间：
2010-06-01
期刊：
影响因子：
8
通讯作者：
Halliday, Henry
中科院分区：
文献类型：
--
作者：
Sandri, Fabrizio;Plavka, Richard;Halliday, Henry
目的：早期表面活性剂随后拔管至鼻持续气道正压通气（nCPAP）与后期表面活性剂和机械通气（MV）相比，可减少MV、漏气和支气管肺发育不良的需要。这项随机对照试验研究了预防性表面活性剂，然后nCPAP与早期nCPAP应用与早期选择性表面活性剂相比，是否会减少对MV的需要，在前5天的生命。方法：共208名出生在25至28周的妊娠和出生时未插管的新生儿被随机分配到预防性表面活性剂或nCPAP出生后30分钟内。结果：预防性表面活性剂组33例（31.4%）婴儿在出生后5天内需要MV，而nCPAP组为34例（33.0%）（风险比：0.95 [95%置信区间：0.64-1.41]; P = 0.80）。两组出生后28天和经后36周的死亡和生存类型以及早产的主要发病率（次要结局）相似。预防性表面活性剂组和nCPAP组中的78.6%的婴儿在36周的postmenstrual age.CONCLUSIONS：在减少生命的前5天MV的需要和nCPAP上自主呼吸的极早产儿早产的主要发病率方面，预防性表面活性剂并不优于nCPAP和早期选择性表面活性剂的上级。儿科2010; 125：e1402-e1409
OBJECTIVE: Early surfactant followed by extubation to nasal continuous positive airway pressure (nCPAP) compared with later surfactant and mechanical ventilation (MV) reduce the need for MV, air leaks, and bronchopulmonary dysplasia. This randomized, controlled trial investigated whether prophylactic surfactant followed by nCPAP compared with early nCPAP application with early selective surfactant would reduce the need for MV in the first 5 days of life.METHODS: A total of 208 inborn infants who were born at 25 to 28 weeks' gestation and were not intubated at birth were randomly assigned to prophylactic surfactant or nCPAP within 30 minutes of birth. Outcomes were assessed within the first 5 days of life and until death or discharge of the infants from hospital.RESULTS: Thirty-three (31.4%) infants in the prophylactic surfactant group needed MV in the first 5 days of life compared with 34 (33.0%) in the nCPAP group (risk ratio: 0.95 [95% confidence interval: 0.64-1.41]; P = .80). Death and type of survival at 28 days of life and 36 weeks' postmenstrual age and incidence of main morbidities of prematurity (secondary outcomes) were similar in the 2 groups. A total of 78.1% of infants in the prophylactic surfactant group and 78.6% in the nCPAP group survived in room air at 36 weeks' postmenstrual age.CONCLUSIONS: Prophylactic surfactant was not superior to nCPAP and early selective surfactant in decreasing the need for MV in the first 5 days of life and the incidence of main morbidities of prematurity in spontaneously breathing very preterm infants on nCPAP. Pediatrics 2010; 125: e1402-e1409