Objectives: The aim of this study was to examine the success rate of less invasive surfactant administration (LISA), to identify early predictive factors for the outcome of LISA, and to compare neonatal outcomes between the LISA failure group and the group of infants who were successfully treated with LISA.Design: A retrospective cohort study.Patients: Infants born at less than 33 weeks of gestation (n = 158) and treated with LISA for respiratory distress syndrome.Results: LISA was successful in 86 cases (54.4%); 72 preterm infants (45.6%) needed additional surfactant therapy and/or mechanical ventilation in the first 72 h (LISA failure). In a multivariate logistic regression analysis, six independent predictors of LISA success were identified: core temperature at the time of admission (adjusted odds ratio (OR): 3.56), dose of poractant alfa (10 mg/L) at 24 h of life (adjusted OR: 0.28), highest respiratory severity score (RSS) during the first hour of life or at the time of LISA (adjusted OR: 0.463), maternal age (adjusted OR: 0.923), and birth weight (adjusted OR: 1.003). The receiver operating curve created by using the identified factors indicates good predictive power with an area under the curve of 0.85. LISA failure was associated with a substantially higher risk of complications.Conclusion: LISA success can be predicted by variables available before the intervention. Failure of LISA is relatively frequent event in very preterm infants and is associated with adverse outcomes. Prevention of hypothermia during early stabilization and appropriate dosing of surfactant may increase LISA success rates and improve patient outcome.

Less invasive surfactant administration techniques, together with nasal continuous airway pressure (LISA-nCPAP) ventilation, an emerging noninvasive ventilation (NIV) technique in neonatology, are gaining more significance, even in extremely premature newborns (ELBW), under 27 weeks of gestational age. In this review, studies on LISA-nCPAP are compiled with an emphasis on short- and long-term morbidities associated with prematurity. Several perinatal preventative and therapeutic investigations are also discussed in order to start integrated therapies as numerous organ-saving techniques in addition to lung-protective ventilations. Two thirds of immature newborns can start their lives on NIV, and one third of them never need mechanical ventilation. With adjuvant intervention, these ratios are expected to be increased, resulting in better outcomes. Optimized cardiopulmonary transition, especially physiologic cord clamping, could have an additively beneficial effect on patient outcomes gained from NIV. Organ development and angiogenesis are strictly linked not only in the immature lung and retina, but also possibly in the kidney, and optimized interventions using angiogenic growth factors could lead to better morbidity-free survival. Corticosteroids, caffeine, insulin, thyroid hormones, antioxidants, N-acetylcysteine, and, moreover, the immunomodulatory components of mother’s milk are also discussed as adjuvant treatments, since immature newborns deserve more complex neonatal interventions.

Bevezetés: Fenyegető koraszülés esetén in utero transzport javasolt, ez azonban nem mindig lehetséges. A postnatalis transzport alatti ellátás jelentősen befolyásolja a szállított betegek kimenetelét. Célkitűzés: Tanulmányunk célja volt a betegek jellemzőinek, ellátásuk és a neonatalis kimenetel trendjeinek vizsgálata a 2008 és 2021 között postnatalis szállítást igénylő koraszülöttekben. Módszer: Retrospektív vizsgálatot végeztünk az írott és az elektronikus betegdokumentáció áttekintésével. A vizsgált trendeket „joinpoint” regressziós analízissel értékeltük, illetve éves százalékos változással (APC) jellemeztük. Eredmények: A vizsgálatba 177 koraszülöttet választottunk be. A szállítások száma nem szignifikáns növekvő trendet mutatott (APC = 6,8%, p = 0,087). A 60 percnél hosszabb helyszíni ellátások aránya szignifikánsan emelkedett (APC = 7,4%, p = 0,016). 2008 és 2010 között a gépi lélegeztetés alkalmazása a szállítások során emelkedett (APC = 36,4%, p = 0,578), majd a vizsgálati időszak hátralévő részében csökkenő tendenciát mutatott (APC = –7,2%, p = 0,068). A 40% feletti oxigénkoncentráció használata szignifikánsan csökkent (APC = –9,5%, p = 0,043). A 150 mg/kg-nál kisebb surfactantdózisok aránya szintén csökkenő tendenciát mutatott (APC = –7,65%, p = 0,162), míg a 180 mg/kg felettiek száma szignifikánsan emelkedett (APC = 8,5%, p = 0,031). Az újszülöttek hosszú távú kimeneti mutatói egyaránt javuló tendenciát mutattak. Megbeszélés: Vizsgálatunk során az ellátás noninvazivitás felé mutató trendjei mellett a szállított koraszülöttek javuló kimenetelét észleltük. Következtetés: Vizsgálatunk felgyorsíthatja a szállítás alatti ellátás folyamatban lévő szemléletváltását, elősegítheti a vonatkozó protokollok, illetve eljárásrendek fejlesztését, melyek együttesen javíthatják a tercier centrumon kívül született koraszülöttek életkilátásait. Orv Hetil. 2023; 164(15): 571–576.

Sepsis remains one of the leading causes of childhood mortality today, although survival has substantially improved, thanks to an ever deeper and more thorough understanding of sepsis pathophysiology, developments in vaccination and intensive therapy, and goal-directed therapeutic approaches. The key to successful therapy is early recognition and antibiotic treatment, as well as supportive therapy aimed at correcting circulatory, respiratory, and metabolic derangements as soon as possible. Diagnosis and management of childhood sepsis mainly evolves along the path of studies conducted in adult patients; however, their applicability is limited due to a variability of cardiovascular and immune responses in each age group. In addition to childhood characteristics of hemodynamic responses in sepsis, this review looks at major areas of pediatric sepsis therapy, with the intention of providing bedside clinicians with pointers useful in their day-to-day work.

Objectives: To examine the success rate of less invasive surfactant administration (LISA), to identify early predictive factors for the outcome of LISA and to compare neonatal outcomes between the LISA failure group and the group of infants who were succesfully treated with LISA. Design: A retrospective cohort study. Patients: Infants born at less than 33 weeks of gestation (n=158) and treated with LISA for respiratory distress syndrome. Results: LISA was successful in 86 cases (54.4%), 72 preterm infants (45.6%) needed additional surfactant therapy and/or mechanical ventilation in the first 72 hours. In a multivariate logistic regression analysis, six independent predictors were identified: core temperature at the time of admission (adjusted OR 3.56), suboptimal dose of surfactant (adjusted OR 0.254), elevated CRP (>10 mg/L) at 24 hours of life (adjusted OR 0.28), highest respiratory severity score during the first hour of life or at the time of LISA (adjusted OR 0.463), maternal age (adjusted OR 0.923) and birth weight (adjusted OR 1.003). The ROC curve created by using the identified factors indicates good predictive power with an area under the curve of 0.85. LISA failure was associated with a substantially higher risk of pneumothorax, bronchopulmonary dysplasia, intraventricular hemorrhage, severe retinopathy of prematurity, longer duration of mechanical ventilation and prolonged length of hospital stay. Conclusion: Failure of LISA is relatively frequent event in very preterm infants and is associated with adverse outcomes. Prevention of hypothermia during early stabilization and appropriate dosing of surfactant increase may LISA success rates and improve patient outcome.