Nayeri Fatemeh Sadat, Esmaeilnia Shirvani Tahereh, Aminnezhad Majid, Amini Elaheh, Dalili Hossein, Moghimpour Bijani Faezeh
Department of Pediatrics, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Pediatrics, Maternal-Fetal & Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Acta Med Iran. 2014;52(8):596-600.
Administration of endotracheal surfactant is potentially the main treatment for neonates suffering from RDS (Respiratory Distress Syndrome), which is followed by mechanical ventilation. Late and severe complications may develop as a consequence of using mechanical ventilation. In this study, conventional methods for treatment of RDS are compared with surfactant administration, use of mechanical ventilation for a brief period and NCPAP (Nasal Continuous Positive Airway Pressure), (INSURE method ((Intubation, Surfactant administration and extubation)). A randomized clinical trial study was performed, including all newborn infants with diagnosed RDS and a gestational age of 35 weeks or less, who were admitted in NICU of Valiasr hospital. The patients were then divided randomly into two CMV (Conventional Mechanical Ventilation) and INSURE groups. Surfactant administration and consequent long-term mechanical ventilation were done in the first group (CMV group). In the second group (INSURE group), surfactant was administered followed by a short-term period of mechanical ventilation. The infants were then extubated, and NCPAP was embedded. The comparison included crucial duration of mechanical ventilation and oxygen therapy, IVH (Intraventricular Hemorrhage), PDA (Patent Ductus Arteriosus), air-leak syndromes, BPD (Broncho-Pulmonary Dysplasia) and mortality rate. The need for mechanical ventilation in 5th day of admission was 43% decreased (P=0.005) in INSURE group in comparison to CMV group. A decline (P=0.01) in the incidence of IVH and PDA was also achieved. Pneumothorax, chronic pulmonary disease and mortality rates, were not significantly different among two groups. (P=0.25, P=0.14, P=0.25, respectively). This study indicated that INSURE method in the treatment of RDS decreases the need for mechanical ventilation and oxygen-therapy in preterm neonates. Moreover, relevant complications as IVH and PDA were observed to be reduced. Thus, it seems rationale to perform this method as the initial treatment for neonates with mild to moderate RDS.
气管内注入表面活性剂可能是患有呼吸窘迫综合征（RDS）的新生儿的主要治疗方法，随后进行机械通气。使用机械通气可能会引发晚期和严重并发症。在本研究中，将治疗RDS的传统方法与表面活性剂给药、短期使用机械通气和鼻塞持续气道正压通气（NCPAP）（INSURE方法（插管、表面活性剂给药和拔管））进行了比较。进行了一项随机临床试验研究，纳入了所有诊断为RDS且胎龄在35周及以下、入住瓦利阿斯尔医院新生儿重症监护病房的新生儿。然后将患者随机分为两组，即传统机械通气（CMV）组和INSURE组。第一组（CMV组）进行表面活性剂给药及随后的长期机械通气。在第二组（INSURE组）中，先给予表面活性剂，然后进行短期机械通气。然后对婴儿进行拔管，并采用NCPAP。比较内容包括机械通气和氧疗的关键持续时间、脑室内出血（IVH）、动脉导管未闭（PDA）、气漏综合征、支气管肺发育不良（BPD）和死亡率。与CMV组相比，INSURE组入院第5天机械通气的需求降低了43%（P = 0.005）。IVH和PDA的发生率也有所下降（P = 0.01）。气胸、慢性肺病和死亡率在两组之间无显著差异（分别为P = 0.25、P = 0.14、P = 0.25）。本研究表明，INSURE方法治疗RDS可降低早产儿对机械通气和氧疗的需求。此外，还观察到IVH和PDA等相关并发症有所减少。因此，将该方法作为轻度至中度RDS新生儿的初始治疗方法似乎是合理的。
