Kraaijenga Juliette V, de Waal Cornelia G, Hutten Gerard J, de Jongh Frans H, van Kaam Anton H
Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Arch Dis Child Fetal Neonatal Ed. 2017 Jul;102(4):F307-F311. doi: 10.1136/archdischild-2016-311440. Epub 2016 Oct 31.
To determine if weaning from nasal continuous positive airway pressure (nCPAP) to lesser supportive low flow nasal cannula (LFNC) results in a change in electrical activity of the diaphragm in preterm infants.
Prospective observational study.
Neonatal intensive care unit.
Stable preterm infants weaned from nCPAP to LFNC (1 L/min).
Change in diaphragmatic activity, expressed as amplitude, peak and tonic activity, measured by transcutaneous electromyography (dEMG) from 30 min before (baseline) until 180 min after weaning. Subgroup analysis was performed based on success or failure of the weaning attempt.
Fifty-nine preterm infants (gestational age: 29.0±2.4 weeks, birth weight: 1210±443 g) accounting for 74 weaning attempts were included. A significant increase in dEMG amplitude (median, IQR: 21.3%, 3.6-41.4), peak (22.1%, 8.7-40.5) and tonic activity (14.3%, -1.9-38.1) was seen directly after weaning. This effect slowly decreased over time. Infants failing the weaning attempt tended to have a higher diaphragmatic activity than those successfully weaned.
Weaning from nCPAP to LFNC leads to an increase in diaphragmatic activity measured by dEMG and is most prominent in preterm infants failing the weaning attempt. dEMG monitoring might be a useful parameter to guide weaning from respiratory support in preterm infants.
确定从鼻持续气道正压通气（nCPAP）撤机至支持力度较小的低流量鼻导管吸氧（LFNC）是否会导致早产儿膈肌电活动发生变化。
前瞻性观察性研究。
新生儿重症监护病房。
从nCPAP撤机至LFNC（1升/分钟）的稳定早产儿。
通过经皮肌电图（dEMG）测量撤机前30分钟（基线）至撤机后180分钟膈肌活动的变化，以振幅、峰值和强直活动表示。根据撤机尝试的成功或失败进行亚组分析。
纳入了59例早产儿（胎龄：29.0±2.4周，出生体重：1210±443克），共进行了74次撤机尝试。撤机后即刻可见dEMG振幅（中位数，四分位间距：21.3%，3.6 - 41.4）、峰值（22.1%，8.7 - 40.5）和强直活动（14.3%，-1.9 - 38.1）显著增加。这种效应随时间缓慢下降。撤机尝试失败的婴儿膈肌活动往往高于成功撤机的婴儿。
从nCPAP撤机至LFNC会导致通过dEMG测量的膈肌活动增加，且在撤机尝试失败的早产儿中最为明显。dEMG监测可能是指导早产儿撤机的一个有用参数。
