BMJ paediatrics open · 2025
Less invasive surfactant administration for meconium aspiration syndrome.
СтатьяНазвание и аннотация: Перевод в очереди
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Prasath Arun, Chotzoglou Etze, Ahmad Asmahan, Diaz Efren, Burchfield Patti, Brown L Steven, Nelson David B, Stumpf Katherine, Kakkilaya Venkatakrishna
Аннотация
BACKGROUND: The role of less invasive surfactant administration (LISA) using a thin catheter in the management of meconium aspiration syndrome (MAS) is unclear.
STUDY DESIGN: A retrospective study of infants with MAS admitted between January 2016 and December 2023. Relevant characteristics and outcomes were compared between a group of infants receiving surfactant in conjunction with mechanical ventilation (MV) via an endotracheal tube (ETT-surf) and receiving LISA. Infants intubated at birth were excluded.
RESULTS: Of the 113 infants admitted on continuous positive airway pressure (CPAP), 61 did not receive surfactant, 26 belonged to the ETT-surf group and 26 to the LISA group. Compared with the ETT-surf, a higher proportion of infants in the LISA group were exposed to chorioamnionitis and received a lower median fraction of inspired oxygen at birth and before surfactant therapy. Notably, infants in the LISA group had a lower need for MV (100 vs 23%, p<0.001), inhaled nitric oxide (iNO) (46% vs 12%, p=0.01) and a shorter median duration of hospital stay (14 vs 24 days, p=0.04). A subgroup analysis of infants with hypoxic respiratory failure on admission showed lower need for MV and duration of hospital stay with the LISA group compared with the ETT-surf group.
CONCLUSIONS: LISA was associated with a lower need for MV, iNO and a shorter duration of hospital stay in a select group of infants with MAS. Further prospective studies are necessary to evaluate the role of LISA in MAS.
STUDY DESIGN: A retrospective study of infants with MAS admitted between January 2016 and December 2023. Relevant characteristics and outcomes were compared between a group of infants receiving surfactant in conjunction with mechanical ventilation (MV) via an endotracheal tube (ETT-surf) and receiving LISA. Infants intubated at birth were excluded.
RESULTS: Of the 113 infants admitted on continuous positive airway pressure (CPAP), 61 did not receive surfactant, 26 belonged to the ETT-surf group and 26 to the LISA group. Compared with the ETT-surf, a higher proportion of infants in the LISA group were exposed to chorioamnionitis and received a lower median fraction of inspired oxygen at birth and before surfactant therapy. Notably, infants in the LISA group had a lower need for MV (100 vs 23%, p<0.001), inhaled nitric oxide (iNO) (46% vs 12%, p=0.01) and a shorter median duration of hospital stay (14 vs 24 days, p=0.04). A subgroup analysis of infants with hypoxic respiratory failure on admission showed lower need for MV and duration of hospital stay with the LISA group compared with the ETT-surf group.
CONCLUSIONS: LISA was associated with a lower need for MV, iNO and a shorter duration of hospital stay in a select group of infants with MAS. Further prospective studies are necessary to evaluate the role of LISA in MAS.