МИНИМАЛЬНО ИНВАЗИВНОЕ ВВЕДЕНИЕ БЕРАКТАНТА У НЕДОНОШЕННЫХ МЛАДЕНЦЕВ С ГЕСТАЦИОННЫМ ВОЗРАСТОМ МЕНЕЕ 32 НЕДЕЛЬ: РЕЗУЛЬТАТЫ РЕТРОСПЕКТИВНОГО КОГОРТНОГО ИССЛЕДОВАНИЯ

Abstract

The aim of the study was to analyze respiratory therapy and the outcomes of nursing preterm infants with gestational age (GA) of less than 32 weeks, who received Beractant in various ways in order to determine the most optimal methods of surfactant administration. Materials and methods of research: a multicenter retrospective cohort study. It was carried out in nine perinatal centers in different regions of the Russian Federation in the period from 07/01/2019 to 06/30/2020. A total of 258 preterm infants with GA of less than 32 weeks participated in the study. One surfactant was used – Beractant (Survant®) at a dose of 100 mg/kg for the first and repeated administration. Beractant was injected by LISA, INSURE or through an endotracheal tube (ETT). Two groups – 1st (154 children) – administration of Beractant via ETT, 2nd (104 children) – minimally invasive surfactant therapy (MIST) of Beractant – combined the LISA and INSURE methods. Two subgroups were identified in the 2nd group: subgroup 2a (27 children) – administration of Beractant by the LISA method, subgroup 2b (77 children) – administration of Beractant by the INSURE method. Results: the ETT and MIST groups were comparable in terms of the median GA (30 versus 30 weeks, p=0.107, respectively) and body weight at birth (1244 versus 1405 g, p=0.067, respectively). In the ETT group in comparison with the MIST group, the administration of Beractant was performed earlier (10 versus 15 min of life, p=0.003, respectively), the need for respiratory support was longer (196.0 versus 120.0 h, p=0.001, respectively), the need for high-frequency oscillatory ventilation was more common (19.7% versus 7.7%, p<0.001, respectively), as well as the need for invasive mechanical ventilation by 72 hours of life (95.4% versus 31.7%, p<0.001, respectively). The incidence of bronchopulmonary dysplasia (BPD) and the length of stay in the intensive care unit and neonatal intensive care unit (NICU) in the ETT group significantly outperformed the MIST group (35.8% versus 13.6%, p<0.001; 10.0 versus 6,0 days, p<0.001, respectively). There were no differences in the frequency of deaths, intraventricular hemorrhages, pneumothoraxes and other complications. The INSURE and LISA subgroups differed in GA and birth weight (30.0 versus 28.0 weeks, p=0.048; 1490.0 versus 1100.0 g, p=0.001, respectively). Conclusions: minimally invasive administration of Beractant significantly reduces the need for invasive respiratory therapy, and, as a result, the incidence of BPD in premature infants with GA of less than 32 weeks.