医学
呼吸窘迫
胎龄
表面活性剂疗法
置信区间
曲线下面积
肺表面活性物质
内科学
吸入氧分数
多元分析
胃肠病学
外科
机械通风
怀孕
遗传学
生物
物理
热力学
作者
Francesco Raimondi,Pasquale Dolce,Claudio Veropalumbo,Enrico Sierchio,Rebeca Gregorio Hernández,Javier Rodríguez Fanjul,Fabio Meneghin,Roberto Raschetti,Luca Bonadies,Iuri Corsini,Almudena Alonso‐Ojembarrena,Serena Salomè,Lorena Rodeño Fernández,Manuel Sánchez‐Luna,Gianluca Lista,Fabio Mosca,Carlo Dani,Eugenio Baraldi,Lucio Giordano,Peter G Davis,Letizia Capasso
出处
期刊:Neonatology
[S. Karger AG]
日期:2023-10-26
卷期号:: 1-8
摘要
Early targeted surfactant therapy for preterm infants is recommended but the best criteria to personalize treatment are unclear. We validate a previously published multivariate prognostic model based on gestational age (GA), lung ultrasound score (LUS), and oxygen saturation to inspire oxygen fraction ratio (SatO2/FiO2) using an independent data set.Pragmatic, observational study in 10 Italian and Spanish NICUs, including preterm babies (250 and 336 weeks divided into 3 GA intervals) with clinical signs of respiratory distress syndrome and stabilized on CPAP. LUS and SatO2/FiO2 were collected soon after stabilization. Their prognostic accuracy was evaluated on the subsequent surfactant administration by a rigorously masked physician.One hundred seventy-five infants were included in the study. Surfactant was given to 74% infants born at 25-27 weeks, 38.5% at 28-30 weeks, and 26.5% at 31-33 weeks. The calibration curve comparing the validation and the development populations showed significant overlap with an intercept = 0.08, 95% CI (-0.34; 0.5) and a slope = 1.53, 95% CI (1.07-1.98). The validation cohort had a high predictive accuracy. Its ROC curve showed an AUC = 0.95, 95% CI (0.91-0.99) with sensitivity = 0.93, 95% CI (0.83-0.98), specificity = 0.81, 95% CI (0.73-0.88), PPV = 0.76, 95% CI (0.65-0.84), NPV = 0.95, 95% CI (0.88-0.98). LUS ≥9 demonstrated the highest sensitivity (0.91, 95% CI [0.82-0.97]) and specificity = 0.81, 95% CI (0.72-0.88) as individual predictor. LUS and SatO2/FiO2 prognostic performances varied with GA.We validated a prognostic model based on LUS and Sat/FiO2 to facilitate early, customized surfactant administration that may improve respiratory management of preterm neonates.
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