ABSTRACT
Objective@#To explore the effect and security of minimally invasive surfactant therapy (MIST) in treatment of preterm infants with neonatal respiratory distress syndrome (NRDS).@*Methods@#A total of 48 pretrm infants with gestational ages between 30-36 weeks diagnosed with NRDS in Guangzhou Women and Children′s Medical Center from January 2017 to January 2018 were randomly divided into MIST group (23 cases) and intubation-surfactant-extubation+ continuous positive airway pressure ventilation (INSURE) group (25 cases) by adopting random number table method.The patients in MIST group were put on nasal continuous positive airway pressure (nCPAP) and a thin vascular catheter was inserted through the vocal cords under direct vision with direct laryngoscope then infused pulmonary surfactant(PS) into the lung; the patients in INSURE group were endotracheally intubated and infused with PS into the lung through endotracheal tube with positive airway pressure, then extubated and put on nCPAP again.The incidences of adverse reactions and various complications related to the 2 groups were observed.@*Results@#There were no significant differences between 2 groups in oxygen saturation decrease(26.1% vs.36.0%), bradycardia (13.0% vs.24.0%) and reuse PS (8.7% vs.4.0%) (all P>0.05). There were no significant differences between 2 groups in noninvasive ventilation time [8 d (5.5-12.5 d) vs.7 d(5.0-14.0 d)], total oxygen intake time [12 d(7.0-26.5 d) vs.10 d(10.0-23.0 d)] and length of hospital stay [(34.22±16.06) d vs.(30.88±14.35) d] (all P>0.05). There was no death or intraventricular hemorrhage in both groups, and there were no significant differences between 2 groups in the incidences of pneumothorax (0 vs.4.0%), bronchopulmonary dysplasia (21.7% vs.16.0%), retinopathy of prematurity (21.7% vs.12.0%) and necrotizing enterocolitis (21.7% vs.12.0%) (all P>0.05).@*Conclusions@#MIST technique is a safe and effective method to administrate surfactant in preterm infants with NRDS.In the NRDS patients who do not need intubation and mechanical ventilation, MIST technique can be used to administrate PS.
ABSTRACT
Objective To investigate effects of different ventilation methods during pulmonary surfactant(PS) administration on cerebral oxygen metabolism in preterm infants with neonatal respiratory distress syndrome.Methods Newborns met the inclusion criteria were enrolled into this study,and they were randomly divided into manual group and mechanical group.During PS administration,the proximal end of the tracheal tube was connected to a bag valve mask device in the manual group or a mechanical ventilator in the mechanical group.Brain near infrared spectroscopy monitoring was carried out to detect the cerebral oxygen saturation(ScO2),and the mean arterial blood pressure (MABP) was simultaneously recorded.Results For all 49 preterm infants,PS was administered to preterm infants with severe respiratory distress syndrome treated with mechanical ventilation,including 24 cases of manual ventilation and 25 cases of mechanical ventilation.The left cerebral ScO2 and correlation coefficient of ScO2 and MABP(rScO2-MABP) showed no difference in both groups before PS administration.During administration,ScO2 dramatically increased in both groups [manual group:(85.88 ± 5.54) ％ vs.(77.31 ± 5.40) ％,t =5.521,P =0.000;mechanical group:(83.88 ± 3.18) ％ vs.(76.53 ±4.38)％,t =6.741,P =0.000],and gradually decreased after administration,the level of ScO2 didn't return to the baseline till the 2nd 5 minutes after PS administration [manual group:(79.25 ± 3.02) ％ vs.(77.31 ± 5.40) ％,t =1.560,P =0.220;mechanical group:(78.59 ± 3.45) ％ vs.(76.53 ± 4.38) ％,t =1.832,P =0.074].The same trend of ScO2 change rate was shown simultaneously in both groups.The rScO2-MABP markedly increased during administration in both groups (manual group:2.34 ±0.16 vs.1.86 ±0.21,t =9.022,P =0.000;mechanical group:2.12 ± 0.15 vs.1.87 ±0.21,t =4.810,P =0.000).The rScO2-MABt,in mechanical group rapidly decreased to baseline during the 1st5 minutes (1.84 ± 0.18 vs.1.87 ± 0.21,t =0.538,P =0.635) but went back to baseline in manual group during the 2nd 5 minutes(1.84 ±0.19 vs.1.86-0.21,t =0.350,P =0.809).Change rates of rScO2-MABP were markedly higher in manual group than those in mechanical group during the 1 st 5 minutes (1.15 ± 0.13 vs.1.00 ± 0.15,t =4.943,P =0.000).Conclusions ScO2 could be affected transiently by PS administration with different methods of ventilation.The effect on cerebral autoregulation in mechanical group is shorter than that in manual group.
ABSTRACT
Objective To observe the changes of abdominal oxygen saturation in very low birth weight infants (VLBWI)with feeding intolerance (FI)within 1 4 days after birth monitored by near infrared spectroscopy (NIRS).Methods VLBWI fitting entry criteria were enrolled into this study.NIRS monitoring was carried out to detect cerebral oxygen saturation (ScO2 )and abdominal oxygen saturation (SsO2 ).Data were analyzed between FI infants and feeding tolerance (FT)infants.FI was defined as follows:gastric residual of more than 50% of the previous feeding volume;emesis or abdominal distention or both;decrease,delay or discontinuation of enteral feedings. Results 93 VLBWI were enrolled.52 cases(55.91 %)presented with FI,including 29 cases(31 .1 9%)of gastric residual increasing and 23 cases(24.73%)of emesis with or without abdominal distention within 1 4 days after birth. The levels of SsO2 and SsO2 /ScO2 showed no differences in infants with FT and with FI within 24h after birth (P >0.05).The change rates of the median of SsO2 and SsO2 /ScO2 in FT infants were similar during 1 4 days (P >0.05).While both the change rates of SsO2 and SsO2 /ScO2 were markedly decreased 1 day before and the day of FI (P <0.01 ).The decreasing degree of SsO2 was similar between infants with gastric residual increasing and infants with emesis with or without abdominal distention[(1 6.2 ±5.1 )vs (1 7.4 ±3.6)%,t =0.733,P =0.476]. Conclusion Abdominal oxygen saturation measured by NIRS may be a useful method for infants adjusting the feeding plan.