Prevalence and factors associated with surfactant use in Brazilian Neonatal Intensive Care Units: A multilevel analysis

Abstract The treatment with exogenous surfactant reduces mortality and the risk of complications in preterm newborns with Respiratory Distress Syndrome. Higher usage levels have been associated with individual and institutional factors. The study aimed to identify these factors associated with use of this technology in 16 public Brazilian Neonatal Units using logistic multilevel analysis. In a sample of 630 newborns the use at some time was 82.6%. Only 24.7% made use of this technology up to two hours after birth. An intraclass correlation of 0.30 showed that 30% of the variance in the use of exogenous surfactant could be assigned to the contextual level. In the final model, a greater severity score (SNAPPE-II) was associated with increased surfactant use (OR = 2.64), whereas being small for gestational age (SGA) (OR = 0.59) was associated with lower use of this technology. At the contextual level the number of beds in the unit >15 (OR = 5.86), units with higher complexity (OR = 1.73) or units with implemented Kangaroo Mother Care (OR = 2.91), especially units in Rio de Janeiro state (OR = 16.17) were associated with greater surfactant use. Although individual clinical features explained most of the variation in the use of this technology, factors linked to the institution were also of utmost importance.

摘要：外源性肺表面活性物质（exogenous surfactant）治疗可降低新生儿呼吸窘迫综合征（Respiratory Distress Syndrome）早产儿的死亡率及并发症风险。其临床使用量的提升与个体及医疗机构相关因素存在关联。本研究旨在通过多水平logistic回归分析，明确巴西16家公立新生儿病房中与该技术使用相关的影响因素。在630名新生儿的研究样本中，该技术的总体使用率为82.6%；仅24.7%的患儿在出生后2小时内接受了该治疗。组内相关系数（intraclass correlation）为0.30，提示外源性肺表面活性物质使用情况中30%的变异可归因于机构层面的环境因素。在最终模型中，较高的新生儿急性生理学评分Ⅱ（SNAPPE-II）与肺表面活性物质使用量增加相关（优势比OR=2.64）；而小于胎龄儿（small for gestational age, SGA）则与该技术使用量降低相关（OR=0.59）。在机构层面，床位数量＞15张的病房（OR=5.86）、复杂度更高的病房（OR=1.73）、开展袋鼠母亲护理（Kangaroo Mother Care, KMC）的病房（OR=2.91），尤其是位于里约热内卢州的病房（OR=16.17），均与肺表面活性物质使用量增加显著相关。尽管个体临床特征可解释该技术使用情况的大部分变异，但医疗机构相关因素同样至关重要。