Surfactant Therapy for Respiratory Distress Syndrome in High- and Ultra-High-Altitude Settings.

Xudong Duan,Zhen Yu,Zhuoga Mima,Zhangsheng Chen,Zhangsheng Chen,Chun Li,Xuelian Li,Xuelian Li,Dobje Jigme,Yuan Shi,Yuan Shi,Xiaorong Wang,Hong Wu,Zhen Da,Zhen Da,Quanfang Qiu,Bacuozhen Qiang,Xianyang Chen,Min Ren,Min Ren,Li Wu,Li Wu,Yanchao Lv,Tianqi Wu,Lihong Zhang,Li Wang,Li Wang,Haoquan Zhou,Wujin Gongjue,Zhuoma Dawa,Deji Gesang,Jiujun Li ,Long Chen ,Long Chen ,Xu Ai-Li ,Zheng Xue ,Chongde Liu ,Zhaxi Pubu ,Ting Xue

doi:10.3389/fped.2022.777360

Abstract

ObjectiveThe objective of this study is to investigate the therapeutic effect of surfactant replacement therapy (SRT) on respiratory distress syndrome (RDS) in premature infants in the Qinghai-Tibet Plateau.Materials and MethodsThis multi-center retrospective cohort study collected and screened reasonable clinical data of 337 premature infants with RDS from 10 hospitals in the Qinghai-Tibet Plateau from 2015 to 2017. We grouped the cases by rationally analyzing their baseline characteristics, using logistic analysis to evaluate each factor's effect on the prognosis of the infants, and comparing the short-term improvement in blood gas and mortality after SRT treatment at different altitudes, in high-altitude (1,500–3,500 m) and ultra-high-altitude (3,500–5,500 m) groups.ResultsIndependent of altitude, the mortality rate of children with RDS in the SRT group was significantly lower than that of children in the non-SRT group (both P < 0.05). The effect of SRT on preterm infants with RDS in the high-altitude group [odds ratio (OR) = 0.44, 95% confidence interval (CI) = 0.22–0.87, P = 0.02] was better than that in the infants in the ultra-high-altitude group (OR = 0.26, 95% CI = 0.13–0.58, P < 0.01), with death rates of 34.34 and 49.71%, respectively. Similarly, after SRT, the improvement of PaO2/FiO2 and pH of children at high altitude was significantly better than those of children at ultra-high altitude (all P < 0.01).ConclusionsSRT plays a prominent role in curing infants with RDS in both high- and ultra-high-altitude regions, although with better effects at high rather than ultra-high altitude. This study provides a basis for further large-scale studies on SRT for RDS treatment at high altitudes.

Highlights

Respiratory distress syndrome (RDS) due to surfactant deficiency is a major cause of morbidity and mortality due to respiratory failure in newborn infants, especially those born prematurely [1, 2]
This study aimed to investigate the important role of surfactant replacement therapy (SRT) therapy in premature infants with RDS in the Qinghai-Tibet Plateau
We excluded 215 patients as they were not hospitalized after diagnosis or had incomplete clinical data; 35 for having congenital malformations, genetic metabolic abnormalities, intrauterine infections, and chromosomal diseases; 29 whose gestational ages were outside the study range; and 16 infants whose birthplace altitudes were

Summary

Introduction

Respiratory distress syndrome (RDS) due to surfactant deficiency is a major cause of morbidity and mortality due to respiratory failure in newborn infants, especially those born prematurely [1, 2]. Since the 1990s, surfactant replacement therapy (SRT) has been effective in treating RDS [3] and has been confirmed to effectively reduce RDS-related mortality, pneumothorax incidence, and the risk of chronic lung disease [4–8]. In high-altitude regions, due to gravity, with increasing altitude, the atmospheric pressure decreases. While the proportion of oxygen in the atmosphere remains unchanged, the oxygen partial pressure and, the driving pressure for gas exchange in the lungs decrease, and a hypoxic environment is formed [14]. This determines the uniqueness of various pulmonary diseases and their therapy in high-altitude regions

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Results

Conclusion