J Pediatr. 2023 Jun 2:113535. doi: 10.1016/j.jpeds.2023.113535. Online ahead of print.
ABSTRACT
OBJECTIVE: To identify prenatal and postnatal risk factors associated with surfactant redosing.
STUDY DESIGN: Retrospective, single-regional center study including all infants born from 24+0 to 31+6 weeks of gestation in the Marche Region, Italy, and admitted to a single level III regional NICU from January 1, 2004, to February 28, 2021. Clinical factors associated with surfactant redosing were identified through logistic regression analysis.
RESULTS: Of 1615 consecutive admissions, 662 infants were treated with exogenous surfactant: 462 (70%) received a single dose and 200 (30%) received more than one dose (25.5% two doses and 4.5% three doses). Risk of redosing was higher for infants born to mothers with hypertension in pregnancy (OR 3.95, p<0.001), for small for gestational age infants (OR 3.93, p<0.001) and when the first surfactant dose was 100mg/kg instead of 200mg/kg (OR 4.56/4.61, p<0.001). Infants with greater gestational age, delayed first surfactant administration, and milder respiratory distress syndrome had reduced risk of redosing. Infants who required multiple surfactant doses had a higher rate of bronchopulmonary dysplasia and mortality, as well as longer duration of respiratory support than patients that received one dose.
CONCLUSION: Hypertension in pregnancy and small-for-gestational age status were found to be statistically and clinically significant predictors of surfactant redosing. Understanding the pathophysiology of these conditions requires further investigation.
PMID:37271494 | DOI:10.1016/j.jpeds.2023.113535
