INTRODUCTION Early targeted surfactant therapy for preterm infants is recommended but the best criteria to personalize treatment are unclear. We validate a previously published multivariate prognostic model based on gestational age (GA), lung ultrasound score (LUS), and oxygen saturation to inspire oxygen fraction ratio (SatO2/FiO2) using an independent data set. METHODS Pragmatic, observational study in 10 Italian and Spanish NICUs, including preterm babies (250 and 336 weeks divided into 3 GA intervals) with clinical signs of respiratory distress syndrome and stabilized on CPAP. LUS and SatO2/FiO2 were collected soon after stabilization. Their prognostic accuracy was evaluated on the subsequent surfactant administration by a rigorously masked physician. RESULTS One hundred seventy-five infants were included in the study. Surfactant was given to 74% infants born at 25-27 weeks, 38.5% at 28-30 weeks, and 26.5% at 31-33 weeks. The calibration curve comparing the validation and the development populations showed significant overlap with an intercept = 0.08, 95% CI (-0.34; 0.5) and a slope = 1.53, 95% CI (1.07-1.98). The validation cohort had a high predictive accuracy. Its ROC curve showed an AUC = 0.95, 95% CI (0.91-0.99) with sensitivity = 0.93, 95% CI (0.83-0.98), specificity = 0.81, 95% CI (0.73-0.88), PPV = 0.76, 95% CI (0.65-0.84), NPV = 0.95, 95% CI (0.88-0.98). LUS ≥9 demonstrated the highest sensitivity (0.91, 95% CI [0.82-0.97]) and specificity = 0.81, 95% CI (0.72-0.88) as individual predictor. LUS and SatO2/FiO2 prognostic performances varied with GA. CONCLUSION We validated a prognostic model based on LUS and Sat/FiO2 to facilitate early, customized surfactant administration that may improve respiratory management of preterm neonates.

中文翻译：

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目标表面活性剂替代的多元模型的外部验证。

简介 建议对早产儿进行早期靶向表面活性剂治疗，但个体化治疗的最佳标准尚不清楚。我们使用独立数据集验证了之前发布的基于胎龄 (GA)、肺部超声评分 (LUS) 和氧饱和度的多变量预后模型，以激发氧分数比 (SatO2/FiO2)。方法 在 10 个意大利和西班牙新生儿重症监护病房（NICU）中进行务实、观察性研究，其中包括具有呼吸窘迫综合征临床症状并通过 CPAP 稳定的早产儿（250 周和 336 周，分为 3 个 GA 间隔）。稳定后不久收集 LUS 和 SatO2/FiO2。他们的预后准确性是由一位严格佩戴口罩的医生根据随后的表面活性剂给药情况进行评估的。结果 研究纳入了一百七十五名婴儿。74%的25-27周出生的婴儿使用了表面活性剂，38.5%的婴儿在28-30周出生，26.5%的婴儿在31-33周出生。比较验证群体和开发群体的校准曲线显示出显着重叠，截距 = 0.08，95% CI (-0.34；0.5)，斜率 = 1.53，95% CI (1.07-1.98)。验证队列具有很高的预测准确性。其 ROC 曲线显示 AUC = 0.95，95% CI (0.91-0.99)，敏感性 = 0.93，95% CI (0.83-0.98)，特异性 = 0.81，95% CI (0.73-0.88)，PPV = 0.76，95% CI (0.65-0.84)，NPV = 0.95，95% CI (0.88-0.98)。LUS ≥9 表现出最高的敏感性（0.91，95% CI [0.82-0.97]）和特异性 = 0.81，95% CI（0.72-0.88）作为个体预测因子。LUS 和 SatO2/FiO2 预后表现随 GA 的不同而变化。结论 我们验证了基于 LUS 和 Sat/FiO2 的预后模型，以促进早期、定制的表面活性剂给药，从而改善早产新生儿的呼吸管理。