TRIAL OF LATE SURFACTANT TO PREVENT BRONCHOPULMONARY

这个子项目是利用资源的许多研究子项目之一。 由NIH/NCRR资助的中心拨款提供。对子项目的主要支持 子项目的首席调查员可能是由其他来源提供的， 包括美国国立卫生研究院的其他来源。为子项目列出的总成本可能 表示该子项目使用的中心基础设施的估计数量， 不是由NCRR赠款提供给次级项目或次级项目工作人员的直接资金。 摘要 早产儿的支气管肺发育不良(BPD)已成为美国最常见、最致命、最昂贵的新生儿肺部疾病。BPD的发病机制是多因素的，有遗传因素，涉及与氧中毒和机械通气相关的损伤和炎症，在不发达、未成熟的肺。估计患病率为3万例/年。目前预防和治疗早产儿肺部疾病的治疗方法，包括产前皮质类固醇治疗、出生时替代表面活性物质、出生后给予皮质类固醇、维生素A、利尿剂、咖啡因和支气管扩张剂，对BPD的总体发生没有显著影响。最近的临床试验表明，吸入一氧化氮(INO)对BPD的发生率和严重程度以及短期和长期安全性，包括两年的神经发育结果都有有益的影响。极低出生体重儿(ELBW)，定义为1周大。 目的2.评估晚期肺表面活性物质治疗对呼吸机支持的极低出生体重儿呼吸状态的影响。 我们将收集临床数据，以研究肺表面活性物质治疗对呼吸严重程度评分(RSS)评估的短期呼吸支持需求和36周PMA(无BPD生存)时肺状况的影响。我们还将监测应用表面活性物质的任何已知并发症以及早产儿其他常见疾病的发生和严重程度所表明的毒性证据，包括脑室出血(IVH)和脑室周围白质软化(PVL)、动脉导管未闭(PDA)、坏死性小肠结肠炎(NEC)和早产儿视网膜病变(ROP)。我们预计iNO-表面活性物质联合治疗将是安全的。我们将确定肺表面活性物质功能(目标1)与短期呼吸状态和36周结局的关系。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. ABSTRACT Bronchopulmonary dysplasia (BPD) of prematurity has emerged as the most common, lethal and expensive neonatal pulmonary disorder in the United States. The pathogenesis of BPD is multi-factorial, has a genetic contribution, and involves injury and inflammation associated with oxygen toxicity and mechanical ventilation in an underdeveloped, immature lung. The estimated prevalence is 30,000 cases/year. Current therapeutic approaches to the prevention and treatment of lung disease in premature infants, including antenatal corticosteroid treatment, replacement surfactant at birth, postnatal administration of corticosteroids, vitamin A, diuretics, caffeine, and bronchodilators have not significantly impacted the overall occurrence of BPD. Recent clinical trials of inhaled nitric oxide (iNO) indicate a beneficial impact on the incidence and severity of BPD as well as short- and long-term safety including 2-year neurodevelopmental outcome. Extremely low birth weight infants (ELBW, defined as 1 week of age. Aim 2. Assess effects of late surfactant treatment on the respiratory status of ventilated ELBW infants. We will collect clinical data to investigate effects of surfactant treatment on both short-term respiratory support need, as assessed by the Respiratory Severity Score (RSS), and pulmonary status at 36 weeks PMA (survival without BPD). We also will monitor for evidence of toxicity as indicated by any of the known complications of surfactant administration as well as by the occurrence and severity of other common morbidities of preterm infants, including intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). We expect that combined iNO-surfactant therapy will be safe. We will determine the relationship between surfactant function (Aim 1) and both short-term respiratory status and 36-week outcome.