Lung UltrasouNd Guided surfactant therapy in preterm infants: an international multicenter randomized control trial (LUNG study).

BACKGROUND: The management of respiratory distress syndrome (RDS) in premature newborns is based on different types of non-invasive respiratory support and on surfactant replacement therapy (SRT) to avoid mechanical ventilation as it may eventually result in lung damage. European guidelines currently recommend SRT only when the fraction of inspired oxygen (FiO2) exceeds 0.30. The literature describes that early SRT decreases the risk of bronchopulmonary dysplasia (BPD) and mortality. Lung ultrasound score (LUS) in preterm infants affected by RDS has proven to be able to predict the need for SRT and different single-center studies have shown that LUS may increase the proportion of infants that received early SRT. Therefore, the aim of this study is to determine if the use of LUS as a decision tool for SRT in preterm infants affected by RDS allows for the reduction of the incidence of BPD or death in the study group. METHODS/DESIGN: In this study, 668 spontaneously-breathing preterm infants, born at 25+0 to 29+6 weeks' gestation, in nasal continuous positive airway pressure (nCPAP) will be randomized to receive SRT only when the FiO2 cut-off exceeds 0.3 (control group) or if the LUS score is higher than 8 or the FiO2 requirements exceed 0.3 (study group) (334 infants per arm). The primary outcome will be the difference in proportion of infants with BPD or death in the study group managed compared to the control group. DISCUSSION: Based on previous published studies, it seems that LUS may decrease the time to administer surfactant therapy. It is known that early surfactant administration decreases BPD and mortality. Therefore, there is rationale for hypothesizing a reduction in BPD or death in the group of patients in which the decision to administer exogenous surfactant is based on lung ultrasound scores. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT05198375 . Registered on 20 January 2022.

Failure of early non-invasive ventilation in preterm infants with respiratory distress syndrome in current care practice in Spanish level-III neonatal intensive care units - a prospective observational study.

Introduction: Despite advances in respiratory distress syndrome (RDS) management over the past decade, non-invasive ventilation (NIV) failure is frequent and associated with adverse outcomes. There are insufficient data on the failure of different NIV strategies currently used in clinical practice in preterm infants. Methods: This was a prospective, multicenter, observational study of very preterm infants [gestational age (GA) <32 weeks] admitted to the neonatal intensive care unit for RDS that required NIV from the first 30 min after birth. The primary outcome was the incidence of NIV failure, defined as the need for mechanical ventilation for <72 h of life. Secondary outcomes were risk factors associated with NIV failure and complication rates. Results: The study included 173 preterm infants with a median GA of 28 (IQR 27-30) weeks and a median birth weight of 1,100 (IQR 800-1,333) g. The incidence of NIV failure was 15.6%. In the multivariate analysis, lower GA (OR, 0.728; 95% CI, 0.576-0.920) independently increased the risk of NIV failure. Compared to NIV success, NIV failure was associated with higher rates of unfavorable outcomes, including pneumothorax, intraventricular hemorrhage, periventricular leukomalacia, pulmonary hemorrhage, and a combined outcome of moderate-to-severe bronchopulmonary dysplasia or death. Conclusion: NIV failure occurred in 15.6% of the preterm neonates and was associated with adverse outcomes. The use of LISA and newer NIV modalities most likely accounts for the reduced failure rate. Gestational age remains the best predictor of NIV failure and is more reliable than the fraction of inspired oxygen during the first hour of life.

Mastoïditis aguda: estudi clínic i microbiològic de 116 casos / No disponible

Objectiu. Estudi de les característiques clíniques i microbiològiques de les mastoïditis agudes al nostre medi. Investigació de la influència de l'ús i l'abús d'antibiòtics en l'otitis mitjana en la freqüència i la gravetat de les mastoïditis.Mètode. Estudi retrospectiu de 116 casos de mastoïditisaguda diagnosticats a l'Hospital Sant Joan de Déu durantun període de 5 anys (1996-2000).Resultats. La mitjana d'edat va ser d'1.8 anys, amb unrang de 2 mesos a 15 anys d'edat (56 % de sexe masculí).La incidència va ser més gran els darrers 2 anys. El 61% presentaven otitis mitjana aguda i el 62% estaven rebentantibiòtic. Noranta set nens presentaven eritema i edemaretroauricular, 90 desplaçament del pavelló auricular i 84 febre. Es va fer hemocultiu a 65 pacients (positiu en 3 casos) i cultiu de secreció òtica a 58 (positiu en 25 pacients). El germen aïllat més sovint va ser el pneumococ (14 casos), principalment els serotips 6B i 19. El percentatge d'aïllament bacterià va ser més alt en pacients no tractats prèviament (52%) que en pacients tractats (36.4%). Les cefalosporines van ser el tractament d'elecció en 105 pacients. Es va fer miringotomia en 48 pacients. Van requerir mastoidectomia 11 pacients. Les mastoïditis més greus es van observar en pacients amb tractament antibiòtic previ.Conclusions. La incidència de mastoïditis aguda estàaugmentant al nostre medi i en aquest estudi són més greus en pacients tractats prèviament. El pneumococ és el principal microorganisme implicat i la majoria de soques estan incloses a la vacuna heptavalent. En tots els casos de mastoïditis aguda s'hauria de fer miringotomia per tal de poder obtenir el microorganisme implicat i el seu antibiograma

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