{"id":24668,"date":"2023-10-19T04:54:00","date_gmt":"2023-10-18T20:54:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24668"},"modified":"2023-10-19T06:09:39","modified_gmt":"2023-10-18T22:09:39","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%97%a9%e4%ba%a7%e5%84%bf%e6%8e%a5%e5%8f%97%e8%a1%a8%e9%9d%a2%e6%b4%bb%e6%80%a7%e7%89%a9%e8%b4%a8%e5%be%ae%e5%88%9b%e6%b2%bb%e7%96%97%e5%90%8e2","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24668","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u65e9\u4ea7\u513f\u63a5\u53d7\u8868\u9762\u6d3b\u6027\u7269\u8d28\u5fae\u521b\u6cbb\u7597\u540e2\u5e74\u9884\u540e"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

September 11, 2023<\/p>\n\n\n\n

Two-Year Outcomes After Minimally Invasive Surfactant Therapy in Preterm Infants: Follow-Up of the OPTIMIST-A Randomized Clinical Trial<\/h1>\n\n\n\n

Peter A.\u00a0Dargaville,\u00a0C. Omar F.\u00a0Kamlin,\u00a0Francesca\u00a0Orsini,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online September 11, 2023. doi:10.1001\/jama.2023.15694<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  For preterm infants with respiratory distress syndrome supported with continuous positive airway pressure (CPAP), does administration of surfactant via a thin catheter improve survival without moderate to severe neurodevelopmental disability (NDD) at 2 years of age compared with sham treatment?<\/p>\n\n\n\n

Findings<\/strong>  In this follow-up of a randomized clinical trial of 486 infants at 25 to 28 weeks\u2019 gestation, the composite outcome of death or NDD at 2 years of age occurred in 36.3% receiving minimally invasive surfactant therapy compared with 36.1% receiving sham treatment.<\/p>\n\n\n\n

Meaning<\/strong>  In preterm infants supported with CPAP, minimally invasive surfactant therapy did not lead to a reduction in the composite outcome of death or neurodevelopmental disability at 2 years of age.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  The long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified.<\/p>\n\n\n\n

Objective<\/strong>  To examine the effect of MIST on death or neurodevelopmental disability (NDD) at 2 years\u2019 corrected age.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Follow-up study of a randomized clinical trial with blinding of clinicians and outcome assessors conducted in 33 tertiary-level neonatal intensive care units in 11 countries. The trial included 486 infants with a gestational age of 25 to 28 weeks supported with continuous positive airway pressure (CPAP). Collection of follow-up data at 2 years\u2019 corrected age was completed on December 9, 2022.<\/p>\n\n\n\n

Interventions<\/strong>  Infants assigned to MIST (n\u2009=\u2009242) received exogenous surfactant (200 mg\/kg poractant alfa) via a thin catheter; those assigned to the control group (n\u2009=\u2009244) received sham treatment.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The key secondary outcome of death or moderate to severe NDD was assessed at 2 years\u2019 corrected age. Other secondary outcomes included components of this composite outcome, as well as hospitalizations for respiratory illness and parent-reported wheezing or breathing difficulty in the first 2 years.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among the 486 infants randomized, 453 had follow-up data available (median gestation, 27.3 weeks; 228 females [50.3%]); data on the key secondary outcome were available in 434 infants. Death or NDD occurred in 78 infants (36.3%) in the MIST group and 79 (36.1%) in the control group (risk difference, 0% [95% CI, \u22127.6% to 7.7%]; relative risk [RR], 1.0 [95% CI, 0.81-1.24]); components of this outcome did not differ significantly between groups. Secondary respiratory outcomes favored the MIST group. Hospitalization with respiratory illness occurred in 49 infants (25.1%) in the MIST group vs 78 (38.2%) in the control group (RR, 0.66 [95% CI, 0.54-0.81]) and parent-reported wheezing or breathing difficulty in 73 (40.6%) vs 104 (53.6%), respectively (RR, 0.76 [95% CI, 0.63-0.90]).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this follow-up study of a randomized clinical trial of preterm infants with respiratory distress syndrome supported with CPAP, MIST compared with sham treatment did not reduce the incidence of death or NDD by 2 years of age. However, infants who received MIST had lower rates of adverse respiratory outcomes during their first 2 years of life.<\/p>\n\n\n\n

Trial Registration<\/strong>  anzctr.org.au Identifier: ACTRN12611000916943<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  September 11, 20 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24668"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24668"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24668\/revisions"}],"predecessor-version":[{"id":24669,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24668\/revisions\/24669"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24668"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24668"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24668"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}