Surfactant Therapy for Respiratory Distress Syndrome in High- and Ultra-High-Altitude Settings

Xudong Duan; Jiujun Li; Long Chen; Yuan Shi; Xianyang Chen; Teng Xue; Chongde Liu; Xiaorong Wang; Quanfang Qiu; Zhen Yu; Bacuozhen Qiang; Hong Wu; Tianqi Wu; Lihong Zhang; Zhangsheng Chen; Dobje Jigme; Aili Xu; Zhuoga Mima; Zhen Da; Min Ren; Deji Gesang; Zhaxi Pubu; Chun Li; Yanchao Lv; Haoquan Zhou; Xue Zhang; Zhuoma Dawa; Wujin Gongjue; Li Wang; Li Wu; Xuelian Li

doi:10.3389/fped.2022.777360

Surfactant Therapy for Respiratory Distress Syndrome in High- and Ultra-High-Altitude Settings

Front Pediatr. 2022 Mar 4:10:777360. doi: 10.3389/fped.2022.777360. eCollection 2022.

Authors

Xudong Duan^{1

2}, Jiujun Li^{1

2}, Long Chen³, Yuan Shi³, Xianyang Chen^{4

5}, Teng Xue^{5

6}, Chongde Liu⁷, Xiaorong Wang⁷, Quanfang Qiu⁸, Zhen Yu⁸, Bacuozhen Qiang⁸, Hong Wu⁹, Tianqi Wu⁹, Lihong Zhang¹⁰, Zhangsheng Chen¹¹, Dobje Jigme¹², Aili Xu¹³, Zhuoga Mima¹³, Zhen Da¹⁴, Min Ren¹⁴, Deji Gesang¹⁵, Zhaxi Pubu¹⁵, Chun Li¹⁶, Yanchao Lv¹⁶, Haoquan Zhou^{17

18}, Xue Zhang^{17

18}, Zhuoma Dawa¹⁹, Wujin Gongjue¹⁹, Li Wang²⁰, Li Wu²⁰, Xuelian Li²⁰

Affiliations

¹ Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
² Plateau Medical Research Center of China Medical University, Shenyang, China.
³ Department of Neonatology, Children's Hospital Affiliated Chongqing Medical University, Chongqing, China.
⁴ BaoFeng Key Laboratory of Genetics and Metabolism, Beijing, China.
⁵ Zhongguancun Biological and Medical Big Data Center, Beijing, China.
⁶ Zhongyuanborui (Hengqin, Zhuhai) Key Laboratory of Genetics and Metabolism, Zhuhai, China.
⁷ Department of Neonatology, Qinghai Women and Children's Hospital, Xining, China.
⁸ Department of Pediatrics, Lhasa People's Hospital, Lhasa, China.
⁹ Department of Pediatrics, People's Hospital of Tibet, Tibet, China.
¹⁰ Department of Pediatrics, Linzhi People's Hospital, Tibet, China.
¹¹ Center of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
¹² Department of Pediatrics, Naqu People's Hospital, Tibet, China.
¹³ Department of Pediatrics, Shigatse People's Hospital, Tibet, China.
¹⁴ Department of Pediatrics, Second People's Hospital of Tibet, Tibet, China.
¹⁵ Department of Pediatrics, Shannan People's Hospital, Tibet, China.
¹⁶ Department of Pediatrics, Changdu People's Hospital, Tibet, China.
¹⁷ Department of Pediatrics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
¹⁸ Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.
¹⁹ Department of Pediatrics, People's Hospital of Ali District, Tibet, China.
²⁰ Department of Pediatrics, Daping Hospital, Third Military Medical University, Chongqing, China.

Abstract

Objective: The objective of this study is to investigate the therapeutic effect of surfactant replacement therapy (SRT) on respiratory distress syndrome (RDS) in premature infants in the Qinghai-Tibet Plateau.

Materials and methods: This multi-center retrospective cohort study collected and screened reasonable clinical data of 337 premature infants with RDS from 10 hospitals in the Qinghai-Tibet Plateau from 2015 to 2017. We grouped the cases by rationally analyzing their baseline characteristics, using logistic analysis to evaluate each factor's effect on the prognosis of the infants, and comparing the short-term improvement in blood gas and mortality after SRT treatment at different altitudes, in high-altitude (1,500-3,500 m) and ultra-high-altitude (3,500-5,500 m) groups.

Results: Independent of altitude, the mortality rate of children with RDS in the SRT group was significantly lower than that of children in the non-SRT group (both P < 0.05). The effect of SRT on preterm infants with RDS in the high-altitude group [odds ratio (OR) = 0.44, 95% confidence interval (CI) = 0.22-0.87, P = 0.02] was better than that in the infants in the ultra-high-altitude group (OR = 0.26, 95% CI = 0.13-0.58, P < 0.01), with death rates of 34.34 and 49.71%, respectively. Similarly, after SRT, the improvement of PaO₂/FiO₂ and pH of children at high altitude was significantly better than those of children at ultra-high altitude (all P < 0.01).

Conclusions: SRT plays a prominent role in curing infants with RDS in both high- and ultra-high-altitude regions, although with better effects at high rather than ultra-high altitude. This study provides a basis for further large-scale studies on SRT for RDS treatment at high altitudes.

Keywords: high-altitude; logistic regression; premature infants; respiratory distress syndrome; surfactant replacement therapy; ultra-high-altitude.