Caffeine and Less Invasive Surfactant Administration for Respiratory Distress Syndrome of the Newborn.

BACKGROUND: Management strategies for preterm neonates with respiratory distress syndrome include early initiation of continuous positive airway pressure (CPAP) and titration of fractional inspired oxygen and may include the use of less invasive surfactant administration (LISA) to avoid the need for endotracheal intubation. This randomized trial investigated whether early administration of caffeine and LISA would decrease the need for endotracheal intubation in the first 72 hours of life (HoL) compared with caffeine and CPAP alone. METHODS: Eligible neonates born at 24 weeks 0 days to 29 weeks 6 days of gestational age were randomly assigned to receive intravenous caffeine in the first 2 HoL followed by surfactant administration via the LISA method (intervention) or caffeine followed by CPAP (control). The primary outcome was the frequency of neonates requiring endotracheal intubation or meeting respiratory failure criteria between groups (caffeine and LISA vs. caffeine and CPAP) within the first 72 HoL. Multivariable logistic regression modeling was used to adjust for gestational age strata in normally distributed primary and secondary outcomes. RESULTS: Enrollment occurred between January 2020 and December 2022. Endotracheal intubation or meeting respiratory failure criteria within the first 72 HoL occurred in 21 (23%) of 92 neonates randomly assigned to receive caffeine and LISA compared with 47 (53%) of 88 neonates in the caffeine and CPAP group (odds ratio, 0.258; 95% confidence interval, 0.136 to 0.490; P<0.001), which remained significant after adjusting for gestational age strata (odds ratio, 0.227; 95% confidence interval, 0.112 to 0.460; P<0.001). Adverse events were similar between groups, except bronchopulmonary dysplasia, which occurred in 26% of the LISA group and 39% of the control group (P=0.049). CONCLUSIONS: In preterm neonates supported with CPAP, early caffeine and LISA resulted in a lower frequency of endotracheal intubation within the first 72 HoL. (Funded by Chiesi USA; ClinicalTrials.gov number, NCT04209946.)

Implementation of a Clinical Prediction Model Using Daily Postnatal Weight Gain, Birth Weight, and Gestational Age to Risk Stratify ROP.

PURPOSE: To develop a simple prognostic model using postnatal weight gain, birth weight, and gestational age to identify infants at risk for developing severe retinopathy of prematurity (ROP). METHODS: Medical records from two tertiary referral centers with the diagnosis code "Retinopathy of Prematurity" were evaluated. Those with a birth weight of 1,500 g or less, gestational age of 30 weeks or younger, and unstable clinical courses were included. Multivariate regression analysis was applied to transform three independent variables into a growth rate algorithm. RESULTS: Seventeen of 191 neonates had severe ROP. Weight gain of at least 23 g/d was determined as a protective cut-off value against development of severe ROP. This value maintained 100% sensitivity with 62% specificity to ensure all neonates who require treatment would be captured. Overall, the Omaha (OMA)-ROP model calculated a 58% reduction in eye examinations within the cohort. CONCLUSIONS: Inclusion of postnatal growth rate in risk stratification will minimize the number of eye examinations performed without increasing adverse visual outcomes. The OMA-ROP model predicts neonates who gain less than 23 g/d are at higher risk for developing severe ROP. Although promising, larger cohort studies may be necessary to validate and implement new screening practices among preterm infants. [J Pediatr Ophthalmol Strabismus. 2018;55(5):326-334.].