Effects of Different Surfactant Administrations on Cerebral Autoregulation in Preterm Infants with Respiratory Distress Syndrome

To treat respiratory distress syndrome,surfactant is currently delivered via less invasive surfactant administration（LISA） or INtubation SURfactant Extubation（INSURE）.The aim of this study was to compare the effect of the two delivery methods of surfactant on cerebral autoregulation.Near infrared spectroscopy monitoring was carried out to detect cerebral oxygen saturation（Sc O2）,and the mean arterial blood pressure（MABP） was simultaneously recorded.Of 44 preterm infants included,the surfactant was administrated to 22 via LISA and 22 via INSURE.The clinical characteristics,treatments and outcomes of the infants showed no significant differences between the two groups.The correlation coefficient of Sc O2 and MABP（rSc O2-MABP） 5 min before administration was similar in the two groups.During surfactant administration,rSc O2-MABP increased in both groups（0.44±0.10 to 0.54±0.12 in LISA,0.45±0.11 to 0.69±0.09 in INSURE）.In the first and second 5 min after instillation,rSc O2-MABP was not significantly different from baseline in the LISA group,but increased in the first 5 min after instillation（0.59±0.13,P=0.000 compared with the baseline in the same group） and recovered in the second 5 min after instillation（0.48±0.10,P=0.321） in the INSURE group.There were significant differences in the change rates of rSc O2-MABP between the two groups during and after surfactant administration.Our results suggest that cerebral autoregulation may be affected transiently by surfactant administration.The effect duration of LISA is shorter than that of INSURE（〈5 min in LISA vs.5–10 min in INSURE）.

Early Intratracheal Administration of Corticosteroid and Pulmonary Surfactant for Preventing Bronchopulmonary Dysplasia in Preterm Infants with Neonatal Respiratory Distress Syndrome: A Meta-analysis

There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of early airway administration (within 2 days after birth) of corticosteroids and pulmonary surfactant (PS) for preventing bronchopulmonary dysplasia (BPD) in premature infants with neonatal respiratory distress syndrome (NRDS). The related studies were retrieved in PubMed, EMBASE, the Cochrane Library, Clinical Trial, CNKI, Wanfang and VIP Database from inception to August 2018. Two reviewers independently screened the studies to ensure that all patients with diagnosis of NRDS were enrolled to studies within 1 day after birth, assessed the quality of included studies by GRADEpro system and extracted the data for review. The meta-analysis was performed by RevMan 5.2 software. A subgroup analysis about inhaled corticosteroid (ICS) delivery method was made between ICS inhalation subgroup [inhalation of ICS by nebulizer or metered dose inhaler (MDI)] and ICS intratracheal instillation subgroup (PS used as a vehicle). Eight randomized controlled trials were enrolled in the meta-analysis, 5 trials of which stated the randomized method, grouping and blinded method, and the follow-up procedures were reported. GRADEpro system showed high quality of 4 trials (5 articles), and the rest 4 trials had moderate quality. Meta-analysis showed that the incidence of BPD was decreased in ICS group, the relative risk (RR) was 0.56 (95% CI: 0.42-0.76), and similar trends were found in ICS inhalation subgroup and ICS intratracheal instillation subgroup, with the corresponding RR being 0.58 (95% CI: 0.41-0.82) and 0.47 (95% CI: 0.24-0.95) respectively. ICS could also significantly reduce the mortality risk as compared with placebo control group (RR: 0.67;95% CI: 0.45-0.99), with RR of ICS inhalation subgroup and ICS intratracheal instillation subgroup being 0.81 (95% CI: 0.34-1.94) and 0.64 (95% CI: 0.41-0.99) respectively. Moreover, the percentage of infants using PS more than one time was lower in ICS group than in the placebo control group, with the RR and 95% CI being 0.55 (95% CI: 0.45-0.67), and that in ICS intratracheal instillation subgroup lower than in ICS inhalation subgroup (RR: 0.56;95% CI: 0.45-0.69, and RR: 0.35;95% CI:0.08-1.52 respectively). There was no significant difference in the incidence of infection or retinopathy of prematurity and neuro-motor system impairment between ICS group and placebo control group, with the corresponding RR being 0.95 (95% CI:0.59-1.52), 0.92 (95% CI: 0.62-1.38) and 1.13 (95% CI: 0.92-1.39), respectively. It was concluded that early administration of ICS and PS is an effective and safe option for preterm infants with NRDS in preventing BPD and reducing mortality, decreasing the additional PS usage, especially for the ICS intratracheal instillation subgroup. Furthermore, the appropriate dose and duration of ICS, combined use of inhalation or instillation of ICS with PS and the long-term safety of airway administration of corticosteroids need to be assessed in large trials.

The Incidence of Respiratory Distress Syndrome among Preterm Infants Admitted to Neonatal Intensive Care Unit: A Retrospective Study

Background: Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD) is the most common cause of neonatal morbidity and mortality in preterm infants. We aimed to determine the frequency of RDS among 3 groups of preterm infants and the value of some related factors. Methods: A cross-sectional, descriptive analytical investigation was carried out in the NICU ward of Akbarabadi Hospital (Tehran-Iran) during spring 2011. Newborns’ data were collected and assessed by using their hospital medical records. Seventy-three preterm infants with gestational age < 34 weeks were hospitalized in the NICU. All participants were divided into 3 groups: extremely preterm (<28 weeks), very preterm (28 to <32 weeks) and moderate preterm (32 to 34 weeks). Frequency of RDS and some related factors were compared among 3 groups. Results: RDS was observed in 65.6% of all participants;however frequency of RDS was not different between three groups. An inversely correlation was found between gestational age and mortality rate (p = 0.05). In regard to Betamethasone administration prior to birth, this interval was significantly longer in alive neonates in comparison to infants who died (p < 0.05). Conclusion: RDS was frequent in preterm neonates with gestational age < 32 weeks. Time of Betamethasone administration prior to birth can significantly influence on neonatal mortality rate.

A Comparison between Late Preterm and Term Infants with Respiratory Distress Syndrome, Early-Onset Sepsis, and Neonatal Jaundice in Ecuadorian Newborns

Background: To examine the differences in prevalence of respiratory distress syndrome, early-onset sepsis and jaundice, between late preterm infants versus term infants in Ecuadorian newborns. Methods: Study design: Epidemiological, observational, and cross-sectional, with two cohorts of patients. Settings: IESS Quito Sur Hospital at Quito, Ecuador, from February to April of 2020. Participants: This study included 204 newborns, 102 preterm infants, 102 term infants. Results: There are significant differences between late preterm infants and term infants, with a p-value of 0.000 in the prevalence of early sepsis, 70.59% vs. 35.29%. In respiratory distress syndrome between late and term premature infants, significant differences were observed with a p-value of 0.000, the proportion being 55.58% vs. 24.51% respectively. The prevalence of jaundice is higher in term infants with a p value of 0.002, 72.55%, versus 51.96% in late preterm infants, and the mean value of bilirubins in mg/dL was higher in term infants 14.32 versus 12.33 in late preterm infants;this difference is statistically significant with a p value of 0.004. Admission to the NICU is more frequent in late preterm infants with a p-value of 0.000, being 42.16% for late preterm infants vs. 7.84% in term infants;the mean of the hospital days with p-value 0.005, was higher in late preterm infants 4.97 days vs. 3.55 days for term newborns. Conclusion: Due to the conditions of their immaturity, late preterm infants are 2.86 times more likely to present early sepsis than full-term newborns. It is shown that late preterm infants are 2.69 times more likely to have respiratory distress syndrome compared to term infants, therefore, late preterm infants have a longer hospital stay of 4.97 days versus 3.55 days in term infants. Jaundice and mean bilirubin levels are higher in term infants due to blood group incompatibility and insufficient breastfeeding.

The Relation between Role of Serum Cortisol Level and Response to Various Respiratory Support Strategies among Preterm Infants

Introduction: Preterm infants are liable to various health problems including respiratory distress syndrome (RDS). There is variation in response to respiratory support. In preterm infants, cortisol hormone is secreted by the adrenocortical gland in response to stress. Objectives: To compare the serum cortisol levels in blood among preterm infants who needed different respiratory support strategies e.g. headbox, continuous positive airway pressure (CPAP), intubation surfactant extubation (INSURE) and mechanical ventilation (MV) and to correlate the cortisol levels to the severity of respiratory distress syndrome (RDS). Material and Methods: Observational prospective study that assessed the serum cortisol levels in preterm infants with RDS after initial respiratory support aged 28 - 34 gestational weeks that were admitted to the neonatal intensive care unit of Al Zahraa hospital of Al-Azhar University and Al-Estekama hospital between February 2019 and November 2019. Infants were classified into three groups, Group 1: 29 infants with severe RDS who needed a mechanical ventilator. Ten of them needed surfactant therapy. Group 2: 33 infants with moderate RDS who needed CPAP. Three of them needed surfactant therapy. Group 3: 28 infants with symptoms of mild RDS who needed headbox. None of them needed surfactant therapy. Blood samples were collected on the first day of life and were processed using the colorimetric ELISA method. Demographic and medical information was collected. Results: A total of 90 preterm infants were included. The serum cortisol reference was 4.3 - 22.4 mg/dl. Group 1 showed significantly higher serum cortisol levels compared to group 2 and group 3 (39.22 ± 9.91 mg/dl vs 28.96 ± 6.48 mg/dl vs 25.88 ± 5.42 mg/dl) respectively, (P-value = 0.001). Infants in group 2 who needed surfactant therapy had higher serum cortisol levels than those who did not need surfactant therapy (32.30 ± 5.92 mg/dl vs 28.33 ± 6.27 mg/dl). The serum cortisol levels were observed having a negative correlation with gestational age and birth weight. No significant differences were observed in terms of gender or type of delivery. Conclusion: Cortisol levels had a positive correlation with the severity of RDS who needed various respiratory support strategies.

Surfactant Protein D for Pathological Evaluation of Infant Acute Respiratory Distress Syndrome Caused by Respiratory Syncytial Virus Infection

Pediatric respiratory syncytial viral infection (RS) usually shows relatively good outcome;however, when it accompanies acute respiratory distress syndrome (ARDS), this becomes fatal. We experienced three pediatric patients with RS + ARDS, with all showing good outcome with steroid pulse therapy. We wish to emphasize;1) steroid pulse therapy may become an option for this condition, and 2) plasma KL-6 and surfactant protein D levels may become a biomarker reflecting the disease progression/condition. Patients were, aged 1 month, 1 year 5 months, and 1 year 11 months. In all three, the respiratory condition deteriorated rapidly, requiring invasive ventilator management. Although the effectiveness of steroid treatment for ARDS is controversial, very severe condition prompted us to employ steroid pulse therapy, after which, oxygenation rapidly improved without adverse events. Plasma KL-6 and surfactant protein D levels were measured during exacerbations of ARDS, steroid pulse therapy, and recovery. Surfactant protein D levels were closely associated with oxygenation, suggesting this substance level might be a biomarker of ARDS caused by the disruption of the alveolar epithelial lining and to understand oxygenation without time lag.

Epidemiology of respiratory distress and the illness severity in late preterm or term infants： a prospective multi-center study

Background The severity of respiratory distress was associated with neonatal prognosis. This study aimed to explore the clinical characteristics, therapeutic interventions and short-term outcomes of late preterm or term infants who required respiratory support, and compare the usage of different illness severity assessment tools.Methods Seven neonatal intensive care units in tertiary hospitals were recruited. From November 2008 to October 2009, neonates born at ≥34 weeks＇ gestational age, admitted at 〈72 hours of age, requiring continuous positive airway pressure （CPAP） or mechanical ventilation for respiratory support were enrolled. Clinical data including demographic variables, underlying disease, complications, therapeutic interventions and short-term outcomes were collected. All infants were divided into three groups by Acute care of at-risk newborns （ACoRN） Respiratory Score 〈5, 5-8, and 〉8.Results During the study period, 503 newborn late preterm or term infants required respiratory support. The mean gestational age was （36.8±2.2） weeks, mean birth weight was （2734.5±603.5） g. The majority of the neonates were male （69.4%）, late preterm （63.3%）, delivered by cesarean section （74.8%）, admitted in the first day of life （89.3%） and outborn （born at other hospitals, 76.9%）. Of the cesarean section, 51.1% were performed electively. Infants in the severe group were more mature, had the highest rate of elective cesarean section, Apgar score 〈7 at 5 minutes and resuscitated with intubation, the in-hospital mortality increased significantly. In total, 58.1% of the patients were supported with mechanical ventilation and 17.3% received high frequency oscillation. Adjunctive therapies were commonly needed.Higher rate of infants in severe group needed mechanical ventilation or high frequency oscillation, volume expansion,bicarbonate infusion or vasopressors therapy （P 〈0.05）. The incidence of complications was also increased significantly in severe group （P 〈0.05）. The in-hospital mortality in the severe group was significantly higher than other two groups （P〈0.05）. ACoRN Respiratory Score was correlated with Score for Neonatal Acute Physiology-Version Ⅱ （SNAP-Ⅱ） （P〈0.01）. High gestational age, high SNAP-Ⅱ score and oxygenation index （OI）, and Apgar score at 5 minutes 〈5 were independent risks for death.Conclusions Neonatal respiratory distress is still a common cause of hospitalization in China. Illness severity assessment is important for the management. ACoRN Respiratory Score which correlated with SNAP-Ⅱ score is easy to use and may be helpful in facilitating the caregivers in local hospital to identify the early signs and make the transfer decision promptly.

新生儿急性肺损伤的发病机制

新生儿由于气道较窄、肺泡发育不完全等因素易发生新生儿急性肺损伤(ALI),严重者可发展为新生儿急性呼吸窘迫综合征(ARDS)。导致新生儿ALI发生及进展的机制涉及各个方面,主要包括氧化应激、铁死亡、炎性反应和肺表面活性物质的减少。期待相关机制的进一步研究可以为探索新型治疗方案提供方向。

微创肺表面活性物质联合无创高频振荡通气治疗早产儿呼吸窘迫综合征的临床效果

目的观察微创肺表面活性物质联合无创高频振荡通气治疗早产儿呼吸窘迫综合征(RDS)的临床效果。方法选取2022年1月至2024年4月广州市从化区妇幼保健院收治的40例RDS早产儿,采用随机数字表法将其分为对照组(20例,微创肺表面活性物质+经鼻持续正压通气治疗)和观察组(20例,微创肺表面活性物质+无创高频振荡通气治疗),比较两组临床疗效、血气指标、并发症、临床指标(机械通气时间、呼吸支持时间、呼吸暂停次数)。结果观察组临床疗效优于对照组(P<0.05)。两组治疗前动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、PaO_(2)/吸入氧浓度分数(FiO_(2))均无显著差异(P>0.05);治疗后,两组PaCO_(2)均低于治疗前,PaO_(2)、PaO_(2)/FiO_(2)均高于治疗前,且观察组PaCO_(2)低于对照组,PaO_(2)、PaO_(2)/FiO均高于对照组(P<0.05)。两组并发症总发生率无显著差异(P>0.05)。观察组的机械通气时间、呼吸支持时间短于对照组,呼吸暂停次数少于对照组(P<0.05)。结论微创肺表面活性物质联合无创高频振荡通气治疗早产儿RDS的效果显著,可改善血气指标,缩短机械通气时间、呼吸支持时间,减少呼吸暂停次数,值得推广。

Lamellar Bodies Count (LBC) as a Predictor of Fetal Lung Maturity in Preterm Premature Rupture of Membranes Compared to Neonatal Assessment

Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality, affecting approximately 1% of all live births and 10% of all preterm infants. Lamellar bodies represent a storage form of pulmonary surfactant within Type II pneumocytes, secretion of which increases with advancing gestational age, thus enabling prediction of the degree of FLM. Preterm premature rupture of membranes (PPROM) complicates approximately 1/3 of all preterm births. Birth within 1 week is the most likely outcome for any patient with PPROM in the absence of adjunctive treatments. Respiratory distress has been reported to be the most common complication of preterm birth. Sepsis, intraventricular haemorrhage, and necrotizing enterocolitis also are associated with prematurity, but these are less common near to term. Objective: To assess the efficacy of the amniotic fluid lamellar body counting from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Methods: This study was conducted at Ain Shams University Maternity Hospital in the emergency ward from January 2019 to September 2019. It included 106 women with singleton pregnancies, gestational age from 28 - 36 weeks with preterm premature rupture of membranes. This study is designed to assess the efficacy of the amniotic fluid lamellar body counting (LBC) from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Results: The current study revealed a highly significant increase in the lamellar body count in cases giving birth to neonates without RDS compared to that cases giving birth to neonates with RDS. Also, no statistically significant difference between LBC and age, parity and number of previous miscarriages in the mother was found. Gestational age at delivery was significantly lower among cases with respiratory distress. Steroid administration was significantly less frequent among cases with respiratory distress. However, lamellar bodies had high diagnostic performance in the prediction of respiratory distress. Conclusion: Lamellar body count (LBC) is an effective, safe, easy, and cost-effective method to assess fetal lung maturity (FLM). It does not need a highly equipped laboratory or specially trained personnel, it just needs the conventional blood count analyzer. Measurement of LBC is now replacing the conventional Lecithin/Sphyngomyelin L/S ratio. LBC cut-off value of ≤42.5 × 103/μL can be used safely to decide fetal lung maturity with sensitivity of 95.7% and specificity of 97.6%.

LISA技术与INSURE技术治疗早产儿呼吸窘迫综合征的效果比较

目的:探讨微创注入肺表面活性物质(less invasive surfactant administration,LISA)与气管插管-肺表面活性物质-拔管(intubation-surfactant-extubate,INSURE)两种不同给药方法在早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)中的应用效果。方法:选取2019年1月1日—2022年8月31日江西省儿童医院收治的55例NRDS患儿,运用随机数字表法,分为LISA组(给予LISA技术,n=29)和INSURE组(给予INSURE技术,n=26)。比较两组治疗相关指标、并发症发生情况。结果:两组二次牛肺表面活性剂(CPS)使用率比较,差异无统计学意义(P>0.05);LISA组72 h内有创机械通气治疗率低于INSURE组,机械通气时间、总用氧时间及住院时间均短于INSURE组,差异均有统计学意义(P<0.05)。LISA组支气管肺发育不良(BPD)和早产儿视网膜病变(ROP)发生率均低于INSUR组,差异均有统计学意义(P<0.05),但两组其他并发症发生率比较,差异均无统计学意义(P>0.05)。结论:与INSURE技术相比,LISA技术治疗早产儿RDS,能有效降低有创机械通气率,缩短用氧时间,并减少BPD及ROP的发生。

微创给药对极早产儿呼吸窘迫综合征的疗效观察

目的观察微创法(less invasive surfactant administration,LISA)给药对极早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的临床疗效及安全性。方法选取2021年1月至2023年12月孝感市中心医院新生儿科收治的胎龄28+0~31+6周被诊断为呼吸窘迫综合征的极早产儿65例作为研究对象,采用随机数字表法分为LISA组(n=33)和气管插管-注入肺表面活性物质-拔管(intubation,administration of surfactant,extubation,InSurE)组(n=32),比较两组给药过程中不良事件发生率、给药前后血气分析、经皮血氧饱和度(pulse oxygen saturation,SpO2)、血压的变化情况及临床疗效、并发症和转归。结果操作过程中,两组患者的药物反流、心动过缓、呼吸暂停或SpO2<80%发生率差异无统计学意义(P>0.05)。LISA组患者的SpO2低于InSurE组,第2、4分钟血压监测低于InSurE组,差异均有统计学意义(P<0.05)。LISA组患者治疗后1h的动脉血氧分压高于InSurE组,动脉血二氧化碳分压低于InSurE组,差异均有统计学意义(P<0.05)。LISA组患者72h内机械通气比例及氧疗时间均低于InSurE组、差异均有统计学意义(P<0.05)。两组患者的肺表面活性物质(pulmonary surfactant,PS)再利用率、住院时间比较,差异无统计学意义(P>0.05)。LISA组患者3~4级脑室旁-脑室内出血(periventricular intraventricular hemorrhage,P-IVH)发生率低于InSurE组,差异有统计学意义(P<0.05)。两组患者其他并发症发生率差异均无统计学意义(P>0.05)。结论微创法给予PS治疗极早产儿RDS可减少机械通气发生率、缩短氧疗时间、减少严重P-IVH的发生。

不同胎龄早产儿发生病因及临床结局分析

目的总结75例不同胎龄早产儿发生病因及预后转归,以提高早产儿生存质量。方法回顾性选取2012年1月至2022年2月出生的75例早产儿作为研究对象,按照胎龄分为早期组(28~<34周)21例和晚期组(34~<37周)54例。统计不同时期早产儿早产病因、不同时期早产儿并发症、不同出生体质量早产儿并发症情况。结果早期组病因主要为未足月胎膜早破[42.86%(9/21)]、妊娠期高血压[14.29%(3/21)];晚期组病因主要为未足月胎膜早破[37.04%(20/54)]、瘢痕子宫[16.67%(9/54)]、胎盘早剥/前置[11.11%(6/54)]。早期组早产儿呼吸窘迫综合征(NRDS)、颅内出血、高胆红素血症、硬肿症、呼吸暂停、呼吸衰竭、窒息、肺炎发生率高于晚期组(P<0.05,P<0.01);出生体质量<1500 g早产儿凝血功能障碍、脓毒症、缺氧缺血性脑病、NRDS、颅内出血、高胆红素血症、硬肿症、呼吸暂停、呼吸衰竭发生率高于出生体质量1500~<2500 g早产儿(P<0.05,P<0.01)。结论不同胎龄早产儿早产病因有所差别,胎龄越小、出生体质量越轻,早产儿并发症发生风险越高,临床应早期识别早产病因并及时采取相应防治措施以延长孕周,减少并发症,改善临床结局。

经微创肺表面活性物质给药治疗早产儿呼吸窘迫综合征的效果及对动脉血气分析指标的影响

目的 分析经微创肺表面活性物质(LISA)给药治疗早产儿呼吸窘迫综合征(RDS)的效果及对动脉血气分析指标的影响。方法 选取2022年6月至2023年6月山西省儿童医院新生儿重症医学科收治的早产儿RDS148例,按随机数字表法分为常规给药组和微创给药组,各74例。微创给药组给予LISA治疗,常规给药组按照常规给药方法治疗。观察2组治疗情况、治疗前后动脉血气分析指标、住院期间并发症发生情况。结果 与常规给药组比较,微创给药组72 h内有创机械通气率、再次使用肺表面活性物质率更低(P <0.05),无创通气时间、住院时间更短(P <0.05)。与治疗前相比,治疗后2组动脉血氧分压(PaO2)、酸碱度(pH)升高(P <0.05),微创给药组高于常规给药组(P <0.05);2组动脉血二氧化碳分压(PaCO_(2))降低(P <0.05),微创给药组低于常规给药组(P <0.05)。与常规给药组比较,微创给药组支气管肺发育不良发生率更低(P <0.05)。结论 早产儿RDS经LISA治疗可改善治疗情况,改善动脉血气指标,控制并发症的发生风险。

呼吸窘迫综合征早产儿血清NGAL的动态变化及其对支气管肺发育不良的早期预测价值

目的探讨呼吸窘迫综合征早产儿血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的动态变化情况,并分析其对患儿发生支气管肺发育不良(BPD)的早期预测价值。方法前瞻性选取平顶山市第一人民医院儿科2019年8月至2023年1月收治的81例呼吸窘迫综合征早产儿作为研究对象。分别检测出生24 h内及出生后3、7、14 d的血清NGAL水平,并收集基线资料。根据患儿出生后28 d是否发生BPD分为发生组与未发生组,比较两组患儿不同时点的血清NGAL水平及基线资料,使用点二列相关性检验血清NGAL动态变化与呼吸窘迫综合征患儿发生BPD之间的关系,再绘制受试者工作特征(ROC)曲线,分析血清NGAL动态变化对呼吸窘迫综合征早产儿发生BPD的早期预测价值。结果共纳入81例呼吸窘迫综合征早产儿,因出现不良结局脱落1例,因家长申请退出研究脱落1例,最终79例患儿完成研究。其中有30例患儿出现BPD,发生率为37.97%(30/79)。发生组肿瘤坏死因子-α(TNF-α)、血浆Ⅱ型肺泡细胞表面抗原(KL-6)高于未发生组(P<0.05)。出生24 h内两组血清NGAL差异无统计学意义(P>0.05);出生后3、7、14 d发生组血清NGAL水平高于未发生组(P<0.05)。点二列相关性检验显示,出生3、7、14 d的血清NGAL水平、TNF-α、血浆KL-6与呼吸窘迫综合征患儿出现BPD呈正相关关系(r>0,P<0.05)。ROC曲线显示出生后3 d血清NGAL对呼吸窘迫综合征患儿出现BPD的预测价值较低,曲线下面积(AUC)为0.643,而出生后7 d血清NGAL对患儿出现BPD具有中等预测价值,AUC为0.866;出生后14 d的血清NGAL对患儿出现BPD具有较高预测价值,AUC为0.935。结论血清NGAL动态变化对呼吸窘迫综合征患儿出现BPD具有一定的预测价值,且出生后14 d预测价值最高。

不同无创通气法治疗早产儿呼吸窘迫综合征的效果比较

目的比较无创高频振荡通气(NHFOV)、经鼻间歇正压通气(NIPPV)疗法、经鼻持续气道正压通气(NCPAP)治疗早产儿呼吸窘迫综合征(RDS)的效果。方法选取2021年1月至2022年12月贵港市人民医院收治的150例RDS早产儿,采用抽签法分为三组,每组各50例,分别给予NHFOV、NIPPV、NCPAP。比较三组呼吸情况与用氧情况、撤机成功率、血气指标、并发症发生情况。结果三组的无创呼吸时间、总用氧时间比较,差异无统计学意义(P>0.05)。NHFOV组的撤机成功率较高(P<0.05)。治疗前,三组血气指标比较,差异无统计学意义(P>0.05);治疗后,三组动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、氧合指数(P/F)比较,差异有统计学意义(P<0.05),NHFOV组的PaCO_(2)低于NIPPV组和NCPAP组,PaO_(2)、P/F高于NIPPV组和NCPAP组(P<0.05);三组pH值比较,差异无统计学意义(P>0.05)。三组并发症总发生率比较,差异无统计学意义(P>0.05)。结论与NIPPV、NCPAP相比,NHFOV可提升RDS早产儿撤机成功率,促进血气指标恢复。

LISA技术治疗超低出生体质量儿呼吸窘迫综合征28例

目的探讨经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)下经微管气管内注入肺表面活性物质(less invasive surfactant administration,LISA)技术在超低出生体质量儿呼吸窘迫综合征(respiratory distress syndrome,RDS)治疗中的应用与疗效。方法采取前瞻性研究方法,选取潍坊市妇幼保健院新生儿科重症监护病房(neonatalintensive careunit,NICU)2019年7月至2021年4月收治的超低出生体质量儿(58例)为研究对象。应用随机数字表法分为LISA组(28例)和气管插管-注入PS-拔管给予经鼻持续气道正压通气(intubation-surfactant-extubation,INSURE)组(30例)。LISA组采用LISA技术,在nCPAP下,气管内置入微管并注入肺表面活性物质(pulmonarysurfactant,PS);INSURE组采用INSURE技术,拔管后给予nCPAP辅助通气。观察并比较两组病儿给药过程、给药前后呼吸机参数、动脉血气、用氧时间及并发症的发生率。结果LISA组病儿72 h内机械通气率低于INSURE组,差异有统计学意义(21.4%比46.7%,P=0.043);LISA组病儿住院期间无创正压通气时间(404.50 h比483.50 h,P=0.033)及总用氧时间(520.00 h比612.50 h,P=0.040)低于INSURE组;LISA组给药1 h后动脉血氧分压(arterial partialpressureof O_(2),PaO_(2))变化高于INSURE组[(54.29±5.69)mmHg比(52.87±3.27)mmHg,P=0.038],差异有统计学意义;LISA组支气管肺发育不良(25.0%比53.3%,P=0.028)及有血流动力学意义的动脉导管未闭发生率(28.6%比56.7%,P=0.031)低于INSURE组,均差异有统计学意义。结论在超低出生体质量儿RDS治疗中,LISA技术在减少72 h内机械通气率、住院期间用氧时间、近期并发症等方面具有优势,是一种安全有效的治疗超低出生体质量儿RDS的方法。

晚期早产儿NRDS合并ARDS的围产期高危因素分析

目的:探讨晚期早产儿(胎龄34周至36^(+6)周)新生儿呼吸窘迫综合征(NRDS)合并新生儿急性呼吸窘迫综合征(ARDS)的高危因素。方法:回顾性分析2019年9月至2023年1月某院新生儿重症监护病房住院治疗的晚期早产儿NRDS病例为研究对象。根据是否发生ARDS分为观察组(NRDS合并ARDS组)和对照组(单纯NRDS组),对两组的围产期高危因素进行对比分析。结果:研究对象共92例,其中观察组44例、对照组48例。两组在性别、胎龄、体重、分娩方式的差异无统计学意义(P>0.05)。观察组妊娠晚期呼吸道感染、妊娠晚期阴道炎、妊娠晚期维生素D缺乏、羊水粪染、窒息发生率高于对照组,差异具有统计学意义(P<0.05)。两组妊娠期糖尿病、妊娠期高血压、产前促肺治疗、胎膜早破、脐带缠绕、前置胎盘、胎盘早剥、低体重、宫内窘迫的发生率无统计学意义(P>0.05)。将单因素分析中有统计学意义的变量(妊娠晚期呼吸道感染、妊娠晚期阴道炎、妊娠晚期维生素D缺乏、羊水粪染、窒息)纳入到Logistics回归分析中,经逐步Logistics回归分析妊娠晚期呼吸道感染(OR=9.613,95%CI 1.056-87.489,P<0.05);妊娠晚期阴道炎(OR=11.469,95%CI 1.286-102.294,P<0.05);妊娠晚期维生素D缺乏具有统计学意义(OR=7.499,95%CI 1.887-29.802,P<0.05),与晚期早产儿NRDS合并ARDS的关联均有统计学意义。结论:妊娠晚期呼吸道感染、妊娠晚期阴道炎、妊娠晚期维生素D缺乏是晚期早产儿NRDS合并ARDS的独立危险因素。

肺超声评分对晚期早产儿并发呼吸窘迫综合征应用机械通气及肺表面活性物质的预测价值

目的:探讨使用肺超声评分(LUS)对晚期早产儿并发呼吸窘迫综合征(RDS)应用机械通气(MV)和肺表面活性物质(PS)的预测价值。方法:选择并发RDS的晚期早产儿(胎龄34^(0/7)~36^(6/7)周)进行前瞻性分析,共纳入67例并发RDS的晚期早产儿。根据患儿生后48 h内是否需要应用MV和PS,分为MV组(n=36)、非MV组(n=31)、PS组(n=30)和非PS组(n=37)。各组患儿在入院后2 h和应用PS前进行肺超声检查,并分别计算6分区、10分区和12分区LUS。绘制不同分区LUS预测晚期早产儿并发RDS应用MV和PS的受试者工作特征(ROC)曲线,采用Delong检验比较不同分区方法的预测价值。结果:与非PS组比较,PS组患儿出生体质量、LUS、呼气末正压(PEEP)、平均气道压(MAP)、MAP×吸入氧浓度(FiO_(2))/动脉血分压(PaO_(2))比值、呼吸机使用时间和住院时间均升高(P<0.05或P<0.01),PaO_(2)/FiO_(2)比值降低(P<0.01)。与非MV组比较,MV组患儿出生体质量、LUS、PEEP、MAP、MAP×FiO_(2)/PaO_(2)值、呼吸机使用时间和住院时间均升高(P<0.05或P<0.01),PaO_(2)/FiO_(2)比值降低(P<0.01)。6分区LUS测PS应用时,PEEP、MAP和LUS是晚期早产儿并发RDS应用PS的危险因素[比值比(OR)>1,P<0.05]。10分区和12分区LUS预测PS应用时,MAP×FiO_(2)/PaO_(2)比值和LUS是晚期早产儿并发RDS应用PS的危险因素(OR>1,P<0.05)。6分区、10分区和12分区LUS预测MV应用时,MAP和LUS是晚期早产儿并发RDS应用MV的危险因素(OR>1,P<0.05)。6分区、10分区和12分区LUS预测晚期早产儿并发RDS的ROC曲线下面积(AUC)分别为0.909、 0.904和0.915,均具有较好的预测价值;使用6分区、10分区和12分区LUS预测晚期早产儿并发RDS应用MV的AUC分别为0.868、0.872和0.887,均具有较好的预测价值。结论:LUS可有效预测晚期早产儿并发RDS是否需要应用MV和PS,MAP联合LUS可以提高单独使用LUS预测应用MV的能力。

经鼻无创高频振荡通气联合TcPCO_(2)和TcPO_(2)监测在早产儿呼吸窘迫综合征中的应用

目的分析经鼻无创高频震荡通气联合经皮二氧化碳分压(TcPCO_(2))和经皮氧分压(TcPO_(2))监测在早产儿呼吸窘迫综合征中的应用。方法选择2019年10月至2021年10月收治的新生儿呼吸窘迫综合征无创呼吸支持治疗的早产儿80例,采用随机数字法分为改良组(经鼻无创高频震荡通气)和对照组(经鼻持续正压通气)。每组40例。2组均联合TcPCO_(2)和TcPO_(2)监测。观察2组通气0、6、12、24 h后的pH值、TcPCO_(2)/TcPO_(2)指标、无创通气时间、治疗失败转为气管插管机械通气率、并发症发生率及病死率。结果通气0 h,2组血液pH值、TcPCO_(2)、TcPO_(2)比较差异无统计学意义(P>0.05);与对照组比较,改良组通气6、12、24 h血液pH值、TcPO_(2)均明显升高,TcPCO_(2)均明显降低(P<0.05)。与对照组比较,无创通气时间和治疗失败转为气管插管机械通气率均明显降低(P<0.05)。2组气漏、腹胀、鼻部损伤、肺出血、感染性肺炎等并发症发生率比较差异无统计学意义(P>0.05)。对照组病死率为5.00%(2/40),改良组病死率为2.50%(1/40),差异无统计学意义(P>0.05)。结论经鼻无创高频震荡通气联合TcPCO_(2)和TcPO_(2)监测在早产儿呼吸窘迫综合征中应用价值较高,可改善患儿呼吸功能,降低气管插管机械通气率,且不会增加并发症的发生。