Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
PLoS One. 2007 Feb 7;2(2):e192. doi: 10.1371/journal.pone.0000192.
In the period immediately after birth, preterm infants are highly susceptible to lung injury. Early nasal continuous positive airway pressure (ENCPAP) is an attempt to avoid intubation and may minimize lung injury. In contrast, ENCPAP can fail, and at that time surfactant rescue can be less effective.
To compare the pulmonary clinical course and outcome of very preterm infants (gestational age 25-32 weeks) with respiratory distress syndrome (RDS) who started with ENCPAP and failed (ECF group), with a control group of infants matched for gestational age, who were directly intubated in the delivery room (DRI group). Primary outcome consisted of death during admission or bronchopulmonary dysplasia (BPD).
25 infants were included in the ECF group and 50 control infants matched for gestational age were included in the DRI group. Mean gestational age and birth weight in the ECF group were 29.7 weeks and 1,393 g and in the DRI group 29.1 weeks and 1,261 g (p = NS). The incidence of BPD was significantly lower in the ECF group than in the DRI group (4% vs. 35%; P<0.004; OR 12.6 (95% CI 1.6-101)). Neonatal mortality was similar in both groups (4%). The incidence of neonatal morbidities such as severe cerebral injury, patent ductus arteriosus, necrotizing enterocolitis and retinopathy of prematurity, was not significantly different between the two groups.
A trial of ENCPAP at birth may reduce the incidence of BPD and does not seem to be detrimental in very preterm infants. Randomized controlled trials are needed to test whether early respiratory management of preterm infants with RDS plays an important role in the development of BPD.
在出生后的早期阶段，早产儿极易受到肺损伤的影响。早期鼻持续气道正压通气（ENCPAP）是一种避免插管的尝试，可最大程度地减少肺损伤。相比之下，ENCPAP 可能会失败，此时表面活性物质抢救可能效果较差。
比较患有呼吸窘迫综合征（RDS）的极早产儿（胎龄 25-32 周）接受 ENCPAP 治疗但失败（ECF 组）与直接在产房行气管插管的对照组（DRI 组）的肺部临床病程和结局。主要结局包括住院期间死亡或支气管肺发育不良（BPD）。
25 例 ECF 组患儿和 50 例胎龄匹配的 DRI 组对照组患儿纳入研究。ECF 组患儿的平均胎龄和出生体重分别为 29.7 周和 1393g，DRI 组分别为 29.1 周和 1261g（p=NS）。ECF 组患儿的 BPD 发生率明显低于 DRI 组（4%比 35%；P<0.004；OR 12.6（95%CI 1.6-101））。两组患儿的新生儿死亡率相似（4%）。两组患儿严重脑损伤、动脉导管未闭、坏死性小肠结肠炎和早产儿视网膜病变等新生儿并发症的发生率无显著差异。
在出生时尝试 ENCPAP 可能会降低 BPD 的发生率，并且似乎对极早产儿没有不利影响。需要开展随机对照试验，以检验 RDS 早产儿的早期呼吸管理是否对 BPD 的发生发展有重要作用。
