鼻塞持续气道正压通气、早期表面活性剂治疗和快速拔管与极低出生体重儿支气管肺发育不良发生率降低相关：疗效和安全性考虑。

Bubble nasal CPAP, early surfactant treatment, and rapid extubation are associated with decreased incidence of bronchopulmonary dysplasia in very-low-birth-weight newborns: efficacy and safety considerations.

机构信息

Division of Neonatology, Memorial Hermann Southwest Hospital, Houston, TX, USA.

出版信息

Respir Care. 2013 Jul;58(7):1134-42. doi: 10.4187/respcare.01998.

DOI:10.4187/respcare.01998

PMID:23106970

Abstract

BACKGROUND

Current literature has been inconsistent in demonstrating that minimizing the duration of mechanical ventilation in very-low-birth-weight (VLBW) newborns reduces lung damage.

OBJECTIVE

To determine if introduction of bubble nasal CPAP (bnCPAP), early surfactant treatment, and rapid extubation (combined bnCPAP strategy) in our community-based neonatal ICU reduced bronchopulmonary dysplasia (BPD).

METHODS

This was a 7-year retrospective,single-institution review of respiratory outcomes in 633 VLBW babies before and after introduction of the combined bnCPAP strategy. Coincident changes in newborn care were taken into account with a logistic regression model.

RESULTS

The average percentage of VLBW newborns with BPD decreased to 25.8% from 35.4% (P = .02), reaching a minimum in the last post-bnCPAP year of22.1% (P = .02). When other coincident changes in newborn care during the study years were taken into account, VLBW babies in the post-bnCPAP years had a 43% lower chance of developing BPD(P = .003, odds ratio 0.43, 95% CI 0.25– 0.75). Decreases occurred in mechanical ventilation and the percentage of infants discharged on diuretics and on supplemental oxygen. Among the subset of extremely-low-birth-weight newborns, improved respiratory outcomes in the post-bnCPAP years,as compared to outcomes in the pre-bnCPAP years, included an increase in the percentage alive and off mechanical ventilation at 1 week postnatal age (P < .001), a more rapid extubation rate(P < .03), a decrease in the median days on mechanical ventilation (P = .002), and a decrease in the percentage with BPD plus died (P = .01). Post-bnCPAP extremely-low-birth-weight babies had a statistically significant decrease in retinopathy of prematurity, an increase in low-grade intraventricular hemorrhage, and a decrease in ductal ligations.

CONCLUSIONS

A combined BnCPAP strategy may contribute to a reduction of BPD, after adjusting for concurrent treatments.

摘要

背景

目前的文献在证明将极低出生体重（VLBW）新生儿机械通气时间最小化可减少肺损伤方面一直存在不一致。

目的

确定我们社区新生儿重症监护病房（NICU）中引入鼻塞持续气道正压通气（nCPAP）、早期表面活性剂治疗和快速拔管（联合 nCPAP 策略）是否会降低支气管肺发育不良（BPD）的发生率。

方法

这是一项对 633 例 VLBW 婴儿的回顾性、单机构研究，研究时间为 7 年，在引入联合 nCPAP 策略前后对呼吸结局进行了评估。使用逻辑回归模型考虑了新生儿护理方面的同期变化。

结果

VLBW 新生儿中患有 BPD 的比例从 35.4%降至 25.8%（P =.02），在联合 nCPAP 策略实施后的最后一年达到最低的 22.1%（P =.02）。当考虑到研究期间新生儿护理方面的其他同期变化时，接受联合 nCPAP 策略后的 VLBW 婴儿发生 BPD 的几率降低了 43%（P =.003，比值比 0.43，95%可信区间 0.25-0.75）。机械通气时间减少，使用利尿剂和补充氧气的婴儿比例降低。在极低出生体重儿亚组中，与联合 nCPAP 策略实施前相比，联合 nCPAP 策略实施后呼吸结局得到改善，包括在出生后 1 周时存活率和脱离机械通气的婴儿比例增加（P <.001）、更快的拔管率（P <.03）、机械通气中位时间减少（P =.002）和患有 BPD 并死亡的婴儿比例降低（P =.01）。接受联合 nCPAP 策略的极低出生体重儿早产儿视网膜病变的发生率显著降低，低级别脑室内出血的发生率增加，而结扎的比例降低。