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Oscillatory mechanics at birth for identifying infants requiring surfactant: a prospective, observational trial

Current criteria for surfactant administration assume that hypoxia is a direct marker of lung-volume de-recruitment. We first introduced an early, non-invasive assessment of lung mechanics by the Forced Oscillation Technique (FOT) and evaluated its role in predicting the need for surfactant therapy....

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Published in:Respiratory research 2021-12, Vol.22 (1), p.314-11, Article 314
Main Authors: Lavizzari, Anna, Veneroni, Chiara, Beretta, Francesco, Ottaviani, Valeria, Fumagalli, Claudia, Tossici, Marta, Colnaghi, Mariarosa, Mosca, Fabio, Dellacà, Raffaele L
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container_title Respiratory research
container_volume 22
creator Lavizzari, Anna
Veneroni, Chiara
Beretta, Francesco
Ottaviani, Valeria
Fumagalli, Claudia
Tossici, Marta
Colnaghi, Mariarosa
Mosca, Fabio
Dellacà, Raffaele L
description Current criteria for surfactant administration assume that hypoxia is a direct marker of lung-volume de-recruitment. We first introduced an early, non-invasive assessment of lung mechanics by the Forced Oscillation Technique (FOT) and evaluated its role in predicting the need for surfactant therapy. To evaluate whether lung reactance (Xrs) assessment by FOT within 2 h of birth identifies infants who would need surfactant within 24 h; to eventually determine Xrs performance and a cut-off value for early detection of infants requiring surfactant. We conducted a prospective, observational, non-randomized study in our tertiary NICU in Milan. Eligible infants were born between 27 and 34  weeks' gestation, presenting respiratory distress after birth. endotracheal intubation at birth, major malformations participation in other interventional trials, parental consent denied. We assessed Xrs during nasal CPAP at 5 cmH O at 10 Hz within 2 h of life, recording flow and pressure tracing through a Fabian Ventilator for off-line analysis. Clinicians were blinded to FOT results. We enrolled 61 infants, with a median [IQR] gestational age of 31.9 [30.3; 32.9] weeks and birth weight 1490 [1230; 1816] g; 2 infants were excluded from the analysis for set-up malfunctioning. 14/59 infants received surfactant within 24 h. Xrs predicted surfactant need with a cut-off - 33.4 cmH O*s/L and AUC-ROC = 0.86 (0.76-0.96), with sensitivity 0.85 and specificity 0.83. An Xrs cut-off value of - 23.3 cmH O*s/L identified infants needing surfactant or respiratory support > 28 days with AUC-ROC = 0.89 (0.81-0.97), sensitivity 0.86 and specificity 0.77. Interestingly, 12 infants with Xrs 
doi_str_mv 10.1186/s12931-021-01906-6
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We first introduced an early, non-invasive assessment of lung mechanics by the Forced Oscillation Technique (FOT) and evaluated its role in predicting the need for surfactant therapy. To evaluate whether lung reactance (Xrs) assessment by FOT within 2 h of birth identifies infants who would need surfactant within 24 h; to eventually determine Xrs performance and a cut-off value for early detection of infants requiring surfactant. We conducted a prospective, observational, non-randomized study in our tertiary NICU in Milan. Eligible infants were born between 27 and 34  weeks' gestation, presenting respiratory distress after birth. endotracheal intubation at birth, major malformations participation in other interventional trials, parental consent denied. We assessed Xrs during nasal CPAP at 5 cmH O at 10 Hz within 2 h of life, recording flow and pressure tracing through a Fabian Ventilator for off-line analysis. Clinicians were blinded to FOT results. We enrolled 61 infants, with a median [IQR] gestational age of 31.9 [30.3; 32.9] weeks and birth weight 1490 [1230; 1816] g; 2 infants were excluded from the analysis for set-up malfunctioning. 14/59 infants received surfactant within 24 h. Xrs predicted surfactant need with a cut-off - 33.4 cmH O*s/L and AUC-ROC = 0.86 (0.76-0.96), with sensitivity 0.85 and specificity 0.83. An Xrs cut-off value of - 23.3 cmH O*s/L identified infants needing surfactant or respiratory support &gt; 28 days with AUC-ROC = 0.89 (0.81-0.97), sensitivity 0.86 and specificity 0.77. Interestingly, 12 infants with Xrs &lt; - 23.3 cmH O*s/L (i.e. de-recruited lungs) did not receive surfactant and subsequently required prolonged respiratory support. Xrs assessed within 2 h of life predicts surfactant need and respiratory support duration in preterm infants. 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The Author(s).</rights><rights>COPYRIGHT 2021 BioMed Central Ltd.</rights><rights>2021. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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We first introduced an early, non-invasive assessment of lung mechanics by the Forced Oscillation Technique (FOT) and evaluated its role in predicting the need for surfactant therapy. To evaluate whether lung reactance (Xrs) assessment by FOT within 2 h of birth identifies infants who would need surfactant within 24 h; to eventually determine Xrs performance and a cut-off value for early detection of infants requiring surfactant. We conducted a prospective, observational, non-randomized study in our tertiary NICU in Milan. Eligible infants were born between 27 and 34  weeks' gestation, presenting respiratory distress after birth. endotracheal intubation at birth, major malformations participation in other interventional trials, parental consent denied. We assessed Xrs during nasal CPAP at 5 cmH O at 10 Hz within 2 h of life, recording flow and pressure tracing through a Fabian Ventilator for off-line analysis. Clinicians were blinded to FOT results. We enrolled 61 infants, with a median [IQR] gestational age of 31.9 [30.3; 32.9] weeks and birth weight 1490 [1230; 1816] g; 2 infants were excluded from the analysis for set-up malfunctioning. 14/59 infants received surfactant within 24 h. Xrs predicted surfactant need with a cut-off - 33.4 cmH O*s/L and AUC-ROC = 0.86 (0.76-0.96), with sensitivity 0.85 and specificity 0.83. An Xrs cut-off value of - 23.3 cmH O*s/L identified infants needing surfactant or respiratory support &gt; 28 days with AUC-ROC = 0.89 (0.81-0.97), sensitivity 0.86 and specificity 0.77. Interestingly, 12 infants with Xrs &lt; - 23.3 cmH O*s/L (i.e. de-recruited lungs) did not receive surfactant and subsequently required prolonged respiratory support. Xrs assessed within 2 h of life predicts surfactant need and respiratory support duration in preterm infants. The possible role of Xrs in improving the individualization of respiratory management in preterm infants deserves further investigation.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>34930247</pmid><doi>10.1186/s12931-021-01906-6</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-5529-0787</orcidid><oa>free_for_read</oa></addata></record>
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subjects Birth weight
Breathing mechanics
Care and treatment
Clinical outcomes
Continuous Positive Airway Pressure
Criteria
Diagnosis
Dosage and administration
Female
Follow-Up Studies
Forced vibration
Gestational Age
Humans
Hypoxia
Infant, Newborn
Infant, Premature
Infants
Infants (Premature)
Intubation
Lung - physiopathology
Lungs
Male
Mechanics
Mechanics (physics)
Medical examination
Nasal continuous positive airway pressure
Neonatal respiratory distress syndrome
Neonates
Newborn babies
Observational studies
Pilot Projects
Premature infants
Prospective Studies
Pulmonary surfactant
Pulmonary Surfactants - administration & dosage
Reactance
Respiratory distress syndrome
Respiratory Distress Syndrome, Newborn - physiopathology
Respiratory Distress Syndrome, Newborn - therapy
Respiratory system
Risk factors
Sensitivity
Surfactants
Testing
Variables
Ventilators
title Oscillatory mechanics at birth for identifying infants requiring surfactant: a prospective, observational trial
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