Early administration of surfactant in spontaneous breathing with nCPAP:: feasibility and outcome in extremely premature infants (postmenstrual age ≤27 weeks)
Early administration of surfactant in spontaneous breathing with nCPAP:: feasibility and outcome in extremely premature infants (postmenstrual age ≤27 weeks)
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DOI：
10.1111/j.1460-9592.2006.02126.x
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发表时间：
2007-04-01
影响因子：
1.7
通讯作者：
Roth, Bernhard
中科院分区：
文献类型：
--
作者：
Kribs, Angela;Pillekamp, Frank;Roth, Bernhard
背景资料：经鼻持续气道正压通气（nCPAP）支持下的自主呼吸被认为在极早产儿中比机械通气具有一些优势。此外，早期或预防性表面活性剂给药已被证明优于延迟使用上级。一个策略，联合收割机这两个原则进行了测试，在我们的新生儿重症监护病房（NICU）。本可行性研究的目的是描述的程序和比较短期的结果与历史control.Methods：这项研究发生在一个III级新生儿重症监护室。在观察期内，尽管采用了nCPAP，但仍有中度至重度呼吸窘迫综合征临床体征的所有极早产儿在自主呼吸期间通过气管内导管接受了100mg.kg（-1）天然表面活性剂制剂。在历史对照期，这些婴儿插管和通气接受surfactory.Results：二十九个42名婴儿符合标准，并与新的方法进行治疗。在5例病例中，在给予表面活性剂后需要手动袋通气，但所有婴儿均可在几分钟内重新转入nCPAP。10名婴儿在最初3天内进行了插管。以这种方式治疗的婴儿组的死亡率为7%，在观察期内接受治疗的所有婴儿的死亡率为12%。历史对照期的死亡率为35%。死亡率在其他作者报告的范围内。结论：在nCPAP期间使用表面活性剂是可行的。初步结果表明，早期并发症是罕见的。这需要一项前瞻性随机试验。
Background: Spontaneous breathing supported by nasal continuous positive airway pressure (nCPAP) is thought to have some advantages compared with mechanical ventilation in extremely premature infants. In addition, early or prophylactic surfactant administration has been shown to be superior to delayed use. A strategy to combine these two principles was tested in our neonatal intensive care unit (NICU). The aim of this feasibility study was to describe the procedure and compare short-term results with a historical control.Methods: The study took place in a level III NICU. In the observational period all extremely premature infants with clinical signs of moderate to severe respiratory distress syndrome despite nCPAP received 100 mg.kg(-1) of a natural surfactant preparation via an intratracheal catheter during spontaneous breathing. In the historical control period those infants were intubated and ventilated to receive surfactant.Results: Twenty-nine of 42 infants fulfilled the criteria and were treated with the new approach. In five cases ventilation with manual bag was necessary after administration of surfactant but all infants could be retransferred to nCPAP within a few minutes. Ten infants were intubated later during the first 3 days. Mortality was 7% in the group of infants treated in this way and 12% in all infants treated during the observational period. Mortality was 35% in the historical control period. Morbidity was within ranges reported by other authors.Conclusions: Surfactant administration during nCPAP is feasible. First results indicate that early complications are rare. This warrants a prospective randomized trial.