Predictors of CPAP failure after less-invasive surfactant administration in preterm infants.

Introduction: Less-invasive surfactant administration (LISA) is associated with better respiratory outcomes in preterm infants with respiratory distress syndrome. However, mechanical ventilation (MV) shortly after the LISA procedure has been related to lower survival. This study aimed to analyze the trends and main predictors of continuous positive airway pressure (CPAP) failure after LISA. Material and methods: Preterm infants born between 230 and 336 weeks gestational age (GA) in two level III neonatal units who received surfactant were included (2017-2022). Demographic data, lung ultrasound (LUS) scores, the saturation/fraction of inspired oxygen (SF) ratio, technique, time to surfactant administration, and the main neonatal outcomes were collected. Results: Over the study period, 289 inborn preterm infants received surfactant, 174 with the LISA method (60.2%). Patients who received surfactant after intubation in the delivery room (n = 56) were more immature and exhibited worse outcomes. Patients who received surfactant via an endotracheal tube in the neonatal intensive care unit (n = 59) had higher LUS scores and a lower SF ratio than those treated with LISA. The LISA method was associated with less death or bronchopulmonary dysplasia (BPD), with an adjusted odds ratio (aOR) = 0.37 [95% confidence interval (CI), 0.18-0.74, p = 0.006]. CPAP failure after LISA (defined as the need for intubation and MV in the first 72 h of life) occurred in 38 patients (21.8%), inversely proportional to GA (38.7% at 23-26 weeks, 26.3% at 27-30 weeks, and 7.9% at 30-33 weeks (p < 0.001). CPAP failure after LISA was significantly related to death, with an aOR = 12.0 (95% CI, 3.0-47.8, p < 0.001), and moderate to severe BPD, with an aOR = 2.9 (95% CI, 1.1-8.0, p = 0.035), when adjusting for GA. The best predictors of CPAP failure after LISA were GA, intrauterine growth restriction, temperature at admission, the SF ratio, and the LUS score, with a Nagelkerke's R 2 = 0.458 (p < 0.001). The predictive model showed an area under the curve = 0.84 (95% CI, 0.75-0.93, p < 0.001). Conclusions: CPAP failure after LISA is still common in extremely preterm infants, leading to an increase in death or disability. Clinicians must acknowledge the main risk factors of CPAP failure to choose wisely the right patient and the best technique. LUS and the SF ratio at admission can be useful when making these decisions.

Zika virus infection in pregnant travellers and impact on childhood neurodevelopment in the first two years of life: A prospective observational study.

BACKGROUND: The emergence of Zika virus (ZIKV) represents a threat with consequences on maternal and children's health. We aimed to assess the clinical and epidemiological characteristics of pregnant women returning from ZIKV affected areas, and the effects of maternal ZIKV infection on birth outcomes and children's health. METHODS: This was a hospital-based prospective observational study conducted at the Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain, from January 2016 to February 2020. RESULTS: One hundred and ninety-five pregnant women who had travelled to ZIKV affected areas during pregnancy were recruited. Four women (2.1%) had a confirmed ZIKV infection, 40 women (20.5%) a probable infection, and 151 (77.4%) were negative for ZIKV. Among the ZIKV confirmed cases, a pregnant woman suffered a miscarriage, highly plausible to be associated with ZIKV infection. Brain cysts and microcalcifications were detected in 7% of fetuses or infants from women with confirmed or probable ZIKV infection. Neurodevelopmental delay in the language function was found in 33.3% out of the 21 children evaluated. CONCLUSIONS: These findings contribute to the understanding of ZIKV prevalence estimates, and the impact of maternal ZIKV infection on pregnancy outcomes and children's health. Results highlight the importance of long-term surveillance in pregnant travellers and their children.