Predictors of CPAP failure after less-invasive surfactant administration in preterm infants

• DOI: 10.3389/fped.2024.1444906
• Publication Date: 2024-08-27T04:46:43Z
• Authors: Miguel Alsina-Cas...; Nerea Brito; Carla Balcells-Es...; Ana Herranz-Barbero; Marta Teresa-Palacio; Aleix Soler-García; Carmen Agustí; Guillem Brullas; Jordi Clotet; Cristina Carrasco; Dolors Salvia; Victoria Aldecoa-...
• Keywords: Bronchopulmonary Dysplasia; Surfactant therapy; Mean airway pressure; Meconium aspiration syndrome

Introduction Less-invasive surfactant administration (LISA) is associated with better respiratory outcomes in preterm infants distress syndrome. However, mechanical ventilation (MV) shortly after the LISA procedure has been related to lower survival. This study aimed analyze trends and main predictors of continuous positive airway pressure (CPAP) failure LISA. Material methods Preterm born between 23 0 33 6 weeks gestational age (GA) two level III neonatal units who received were included (2017–2022). Demographic data, lung ultrasound (LUS) scores, saturation/fraction inspired oxygen (SF) ratio, technique, time administration, collected. Results Over period, 289 inborn surfactant, 174 method (60.2%). Patients intubation delivery room ( n = 56) more immature exhibited worse outcomes. via an endotracheal tube intensive care unit 59) had higher LUS scores a SF ratio than those treated The was less death or bronchopulmonary dysplasia (BPD), adjusted odds (aOR) 0.37 [95% confidence interval (CI), 0.18–0.74, p 0.006]. CPAP (defined as need for MV first 72 h life) occurred 38 patients (21.8%), inversely proportional GA (38.7% at 23–26 weeks, 26.3% 27–30 7.9% 30–33 < 0.001). significantly death, aOR 12.0 (95% CI, 3.0–47.8, 0.001), moderate severe BPD, 2.9 1.1–8.0, 0.035), when adjusting GA. best GA, intrauterine growth restriction, temperature admission, score, Nagelkerke's R 2 0.458 predictive model showed area under curve 0.84 0.75–0.93, Conclusions still common extremely infants, leading increase disability. Clinicians must acknowledge risk factors choose wisely right patient technique. admission can be useful making these decisions.