Impact of LISA failure on 2-year neurodevelopmental outcomes in preterm infants: a retrospective cohort study.

IF 2.3 4区 医学 Q2 PEDIATRICS
Floor P M Swinkels, Mellanie Swanink, Jeroen Van Vonderen, Jeanne Dieleman, Brigitte Vugs, Carola Van Pul, Peter Andriessen, Hendrik J Niemarkt
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引用次数: 0

Abstract

Background: Less invasive surfactant administration (LISA) reduces the need for mechanical ventilation in preterm infants with respiratory distress syndrome. However, some LISA-treated infants require intubation within 72 hours due to continuous positive airway pressure (CPAP) failure (LISA failure, LISA-F). The long-term neurodevelopmental impact of LISA-F remains unclear.

Objective: To compare 2-year neurodevelopmental outcome in preterm infants with successful LISA (LISA-S) versus LISA-F and primary intubation for surfactant (PI).

Methods: Retrospective cohort study (2015-2023) including infants from 24 to 29 weeks gestational age (GA) with surfactant administration; categorised into three groups: LISA-S (n = 235), LISA-F (n = 117) and PI for surfactant (n = 102). Neurodevelopment was assessed at 2 years corrected age using Bayley Scales of Infant and Toddler Development, Third Edition. Multivariable linear regression adjusted for GA, birth weight and antenatal corticosteroid exposure. A multivariable logistic regression model was constructed to identify independent predictors of cognitive and motor delay.

Results: Adjusted composite motor scores were significantly higher in LISA-S compared with LISA-F infants (adjusted mean difference 6.4; 95% CI 2.0 to 19.0; p = 0.005). No differences were found between LISA-F and PI. Mechanical ventilation within the first 72 hours was the strongest independent predictor of motor delay (aOR (adjusted Odds Ratio) 3.9; 95% CI 1.3 to 11.6; p=0.012).

Conclusions: Preterm infants with LISA-F have significantly worse neurodevelopmental outcomes at 2 years corrected age, comparable to that of PI. Mechanical ventilation, rather than the initial surfactant strategy, emerged as the strongest predictor of developmental impairment, emphasising the importance of preventing CPAP failure after LISA.

LISA失败对早产儿2年神经发育结局的影响:一项回顾性队列研究。
背景:微创表面活性剂给药(LISA)可减少呼吸窘迫综合征早产儿对机械通气的需求。然而,一些接受LISA治疗的婴儿由于持续气道正压通气(CPAP)失败(LISA failure, LISA- f),需要在72小时内插管。LISA-F对神经发育的长期影响尚不清楚。目的:比较成功LISA (LISA- s)与LISA- f和首次插管表面活性剂(PI)的早产儿2年神经发育结局。方法:回顾性队列研究(2015-2023),纳入24 ~ 29周胎龄(GA)给予表面活性剂的婴儿;分为三组:LISA-S (n = 235),LISA-F (n = 117)和表面活性剂PI (n = 102)。使用Bayley婴幼儿发育量表(第三版)在校正年龄2岁时进行神经发育评估。多变量线性回归校正了GA、出生体重和产前皮质类固醇暴露。建立多变量logistic回归模型以确定认知和运动延迟的独立预测因子。结果:与LISA-F婴儿相比,LISA-S婴儿调整后的综合运动评分明显更高(调整后的平均差值为6.4;95% CI为2.0 ~ 19.0;p = 0.005)。LISA-F与PI之间无差异。前72小时内机械通气是运动延迟的最强独立预测因子(aOR(调整优势比)3.9;95% CI 1.3 ~ 11.6;p = 0.012)。结论:与PI相比,LISA-F早产儿在矫正年龄2岁时的神经发育结果明显更差。机械通气,而不是最初的表面活性剂策略,成为发育障碍的最强预测因子,强调了预防LISA后CPAP失效的重要性。
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来源期刊
BMJ Paediatrics Open
BMJ Paediatrics Open Medicine-Pediatrics, Perinatology and Child Health
CiteScore
4.10
自引率
3.80%
发文量
124
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