Division of Neonatology, Tygerberg Children’s Hospital, Western Cape, South Africa.
Pediatrics. 2012 Apr;129(4):e952-9. doi: 10.1542/peds.2011-1365. Epub 2012 Mar 19.
Nasal continuous positive airway pressure (NCPAP) plus intubation, surfactant, and extubation (InSurE) with the option of back-up ventilation for those infants for whom noninvasive ventilatory support failed resulted in a significant increase in survival in extremely low birth weight (ELBW) infants. The authors sought to determine the outcome of ELBW infants treated with NCPAP and InSurE in a neonatal high care ward with limited back-up ventilation.
Three hundred eighteen inborn infants with birth weight 500-1000 g and gestational age ≥25 weeks who were admitted to the neonatal high care ward were included in this observational study. InSurE was administered to infants with respiratory distress syndrome on NCPAP who had severe in-drawing and recession, apneic spells, or an Fio(2) >0.4 within 1 hour of birth.
Two hundred twelve (68.6%) infants could be treated with NCPAP only and 97 (31.4%) required InSurE. Seventeen infants were admitted to the NICU; 90%, 87%, and 74.8% of the infants survived until day 3, 7, and discharge, respectively. Only 2 infants developed a pneumothorax and 2 had chronic lung disease. Seventy-nine percent of the infants of ≥750 g or >26 weeks' gestation survived to discharge compared with 56% and 60% of the infants of <750 g or ≤26 weeks' gestation, respectively. Maternal antenatal steroid administration contributed significantly to the survival of the infants (P = 0.0017, odds ratio 2.7, 95% confidence interval 1.44-5.07).
The use of NCPAP and InSurE in a neonatal high care ward with limited resources can improve the survival of ELBW infants. Maternal antenatal steroid administration contributed significantly to survival.
经鼻持续气道正压通气（NCPAP）联合气管插管、表面活性物质和拔管（InSurE），对于那些无法接受无创通气支持的患儿可选择后备通气，这使得极低出生体重儿（ELBW）的存活率显著提高。作者旨在探讨在新生儿重症监护病房（NICU）中，使用 NCPAP 和 InSurE 治疗 ELBW 患儿的结果，该 NICU 仅具备有限的后备通气能力。
本观察性研究纳入了 318 名出生体重为 500-1000 g、胎龄≥25 周的住院患儿。对在 NCPAP 治疗下出现呼吸窘迫综合征且有严重三凹征和呼吸暂停、或出生后 1 小时内吸入氧浓度（Fio(2)）>0.4 的患儿，给予 InSurE 治疗。
212 名（68.6%）患儿仅接受 NCPAP 治疗，97 名（31.4%）患儿需要 InSurE 治疗。17 名患儿被收入 NICU；分别有 90%、87%和 74.8%的患儿在第 3、7 和出院日存活；仅 2 名患儿发生气胸，2 名患儿发生慢性肺疾病。出生体重≥750 g 或胎龄>26 周的患儿中，79%存活至出院，而出生体重<750 g 或胎龄≤26 周的患儿中，分别有 56%和 60%存活至出院。母亲产前使用类固醇治疗显著提高了患儿的存活率（P = 0.0017，优势比 2.7，95%置信区间 1.44-5.07）。
在资源有限的新生儿重症监护病房中使用 NCPAP 和 InSurE 治疗 ELBW 患儿，可提高其存活率。母亲产前使用类固醇治疗对患儿的存活率有显著影响。
