胎龄<32周极低出生体重儿初始无创通气失败的影响因素分析:一项多中心回顾性研究

Risk factors for initial non-invasive ventilation failure in very low birth weight infants with gestational age<32 weeks:a multicenter retrospective study

目的研究胎龄<32周极低出生体重儿初始无创通气(non-invasive ventilation,NIV)失败相关危险因素及不良预后。方法回顾性收集2019年1月—2021年12月江苏省28家三级医院新生儿重症监护室(neonatal intensive care unit,NICU)收治的早产儿的临床资料,依据生后初始NIV结局分为成功组和失败组,分析NIV失败危险因素及不良预后。结果共纳入817例患儿,男性453例(55.4%),失败139例(17.0%)。失败组胎龄、出生体重、1 min和5 min Apgar评分均低于成功组(P<0.05)。失败组入NICU诊断呼吸窘迫综合征(respiratory distress syndrome,RDS)比例、NIV最大呼气末正压,以及初始NIV全过程中达到所需最高吸入气氧浓度(fraction of inspired oxygen,FiO2)≥30%、≥35%、≥40%比例均高于成功组(P<0.05)。胎龄(OR=0.671,95%CI:0.581~0.772)、入NICU诊断RDS(OR=1.955,95%CI:1.181~3.366)和初始NIV全过程中达到所需最高FiO2≥30%(OR=2.053,95%CI:1.106~4.044)是胎龄<32周极低出生体重儿初始NIV失败的危险因素(P<0.05)。失败组住院期间并发肺部感染、气胸、早产儿视网膜病、中重度支气管肺发育不良、重度脑室内出血的发生率,以及住院时长和总费用均高于成功组(P<0.05)。结论小胎龄、入NICU诊断RDS以及初始NIV全过程中达到所需最高FiO2≥30%是胎龄<32周极低出生体重儿初始NIV失败的高危因素,初始NIV失败将显著增加该人群不良结局的风险。

Objective To investigate the risk factors and adverse prognosis associated with initial non-invasive ventilation(NIV)failure in very low birth weight infants(VLBWI)with gestational age<32 weeks.Methods A retrospective collection of clinical data from preterm infants admitted to the neonatal intensive care unit(NICU)in 28 tertiary hospitals in Jiangsu Province from January 2019 to December 2021 was conducted.Based on the outcomes of initial NIV,the infants were divided into a successful group and a failure group to analyze the risk factors for NIV failure and adverse prognosis.Results A total of 817 infants were included,with 453 males(55.4%)and 139 failures(17.0%).The failure group had lower gestational age,birth weight,and 1-minute and 5-minute Apgar scores compared to the successful group(P<0.05).The failure group also had a higher proportion of respiratory distress syndrome(RDS)diagnosed upon NICU admission,higher maximum positive end-expiratory pressure during NIV,and higher percentages of reaching the required maximum fraction of inspired oxygen(FiO2)≥30%,≥35%,and≥40%throughout the initial NIV process compared to the successful group(P<0.05).Gestational age(OR=0.671,95%CI:0.581-0.772),RDS(OR=1.955,95%CI:1.181-3.366),and FiO2≥30%(OR=2.053,95%CI:1.106-4.044)were identified as risk factors for initial NIV failure in these infants with gestational age<32 weeks(P<0.05).The failure group had higher incidences of complications such as pulmonary infections,pneumothorax,retinopathy of prematurity,moderate to severe bronchopulmonary dysplasia,and severe intraventricular hemorrhage during hospitalization,as well as longer hospital stays and higher total costs compared to the successful group(P<0.05).Conclusions Smaller gestational age,a diagnosis of RDS in the NICU,and achieving a maximum FiO2≥30%during the initial NIV process are risk factors for initial NIV failure in infants with gestational age<32 weeks.Initial NIV failure significantly increases the risk of adverse outcomes in this population.