Association of Administration of Surfactant Using Less Invasive Methods With Outcomes in Extremely Preterm Infants Less Than 27 Weeks of Gestation-Reference-Cited by-同舟云学术

Association of Administration of Surfactant Using Less Invasive Methods With Outcomes in Extremely Preterm Infants Less Than 27 Weeks of Gestation

Published:2022-08-09 Issue:8 Volume:5 Page:e2225810
ISSN:2574-3805
Container-title:JAMA Network Open
language:en
Short-container-title:JAMA Netw Open

Author:

Härtel Christoph¹,Herting Egbert²,Humberg Alexander²,Hanke Kathrin²,Mehler Katrin³,Keller Titus³,Mauer Isabell¹,Frieauff Eric¹,Meyer Sascha⁴,Thome Ulrich H.⁵,Wieg Christian⁶,Schmidtke Susanne⁷,Kribs Angela³,Göpel Wolfgang²,Faust Kirstin⁸,Müller Dirk⁸,Gebauer Corinna⁸,Guthmann Florian⁸,von der Wense Axel⁸,Stangl Oliver⁸,Weller Ursula⁸,Höhn Thomas⁸,Olbertz Dirk⁸,Felderhoff-Müser Ursula⁸,Rossi Rainer⁸,Teig Norbert⁸,Heitmann Friedhelm⁸,Heckmann Matthias⁸,Laux Reinhard⁸,Bohnhorst Bettina⁸,Roth Bernd⁸,Vochem Matthias⁸,Keller-Wackerbauer Annette⁸,Möller Jens⁸,Eichhorn Joachim⁸,Wintgens Jürgen⁸,Böttger Ralf⁸,Reese Jochen⁸,Hubert Mechthild⁸,Dördelmann Michael⁸,Hillebrand Georg⁸,Roll Claudia⁸,Jensen Reinhard⁸,Rüdiger Mario⁸,Werner Claudius⁸,Longardt Ann Carolin⁸,Schäfer Stefan⁸,Schaible Thomas⁸,Franz Axel⁸,Heldmann Michael⁸,Kunzmann Steffen⁸,Schmidt Esther⁸,Orlikowsky Thorsten⁸,Gerleve Hubert⁸,Depping Nico⁸,Haase Roland⁸,Hoppenz Marc⁸,Seeliger Stephan⁸,Küster Helmut⁸,Fuchs Hans⁸,Körner Thorsten⁸,Brune Thomas⁸,Müller Andreas⁸,Urlichs Florian⁸,Berghäuser Martin⁸,Proquitté Hans⁸,Morhart Patrick⁸,Lindner Wolfgang⁸,Schlösser Rolf⁸,Schneider Welfhard⁸,Schroth Michael⁸,Rieger-Fackeldey Esther⁸,Dohle Frank⁸,Sinnecker Gernot⁸,Völkl Thomas⁸,Brevis Nunez Francisco⁸,Welsch Michael⁸,Krüger Marcus⁸,

Affiliation:

1. Department of Paediatrics, University of Würzburg, Würzburg, Germany

2. Department of Paediatrics, University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany

3. Division of Neonatology, Department of Paediatrics, University of Cologne, Cologne, Germany

4. Department of General Pediatrics and Neonatology, University Children’s Hospital of Saarland, Homburg, Germany

5. Division of Neonatology, Department of Women’s and Children’s Health, University Children’s Hospital Leipzig, Leipzig, Germany

6. Neonatology and Pediatric Intensive Care, Children’s Hospital Aschaffenburg-Alzenau, Aschaffenburg, Germany

7. Division of Neonatology, Asklepios Hospital Hamburg-Barmbek, Hamburg, Germany

8. for the German Neonatal Network

Abstract

ImportanceThe inclusion of less invasive surfactant administration (LISA) in the care of preterm infants has been found to be beneficial for respiratory outcomes. Recently, the OPTIMIST trial found higher mortality rates in the subgroup of infants born at 25 to 26 weeks’ gestational age (GA) who received surfactant treatment while spontaneously breathing.ObjectiveTo analyze outcomes among LISA-exposed, highly vulnerable babies born at less than 27 weeks’ GA within the large-scale observational cohort of the German Neonatal Network.Design, Setting, and ParticipantsIn this cohort study of data from 68 tertiary level neonatal intensive care units in Germany of infants born between 22 weeks 0 days to 26 weeks 6 days of gestation between April 1, 2009, and December 31, 2020, short-term outcomes among infants receiving LISA vs infants not receiving LISA were compared.ExposureUse of LISA within the first 72 hours of life.Main Outcomes and MeasuresThe main outcomes were rates of LISA use, use of mechanical ventilation within the first 72 hours (considered failure of LISA), and association of LISA with outcomes, including death from all causes, bronchopulmonary dysplasia (BPD), death and BPD combined, pneumothorax, retinopathy of prematurity, intracerebral hemorrhage, and periventricular leukomalacia. To address potential confounding factors, multivariate logistic regression models were used.ResultsA total of 6542 infants (3030 [46.3%] female and 3512 [53.7%] male; mean [SD] GA, 25.3 (1.1) weeks; mean [SD] birth weight, 715 [180] g) were analyzed; 2534 infants (38.7%) received LISA, which was most frequently given quasi-prophylactically during delivery room management. Among the infants who received LISA, 1357 (53.6%) did not require mechanical ventilation in the first 72 hours compared with 331 infants (8.3%) of 4008 who did not receive LISA. In a multivariate logistic regression model that adjusted for GA, small-for-GA status, sex, multiple birth, inborn status, antenatal steroid use, and maximum fraction of inspired oxygen in the first 12 hours of life, LISA was associated with reduced risks of all-cause death (odds ratio [OR], 0.74; 95% CI, 0.61-0.90; P = .002), BPD (OR, 0.69; 95% CI, 0.62-0.78; P &lt; .001), and BPD or death (OR, 0.64; 95% CI, 0.57-0.72; P &lt; .001) compared with infants without LISA exposure.Conclusions and RelevanceThe results of this long-term multicenter cohort study suggest that LISA may be associated with reduced risks of adverse outcomes in extremely preterm infants.

Publisher

American Medical Association (AMA)

Subject

General Medicine

Link

https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2794980/hrtel_2022_oi_220730_1681740980.53264.pdf

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