Templin Ludivine, Grosse Camille, Andres Virginie, Robert Clotilde Des, Fayol Laurence, Simeoni Umberto, Boubred Farid
Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France.
Division of Pediatrics, Lausanne University Hospital, University of Lausanne, Switzerland.
Am J Perinatol. 2017 Jul;34(8):759-764. doi: 10.1055/s-0037-1598106. Epub 2017 Jan 31.
Limiting early intubation and mechanical ventilation in extremely low gestational age neonates (ELGAN) may decrease neonatal morbidity and mortality. The aim of our study was to demonstrate the feasibility, efficacy, and tolerability of a delivery room respiratory management protocol, including delayed umbilical cord clamping (DUCC) in combination with optimized nCPAP with high PEEP levels and less invasive surfactant administration (LISA). This cohort quality improvement study analyzed the respiratory and neonatal outcomes of all consecutive infants born between 24 and 26 weeks' gestation before (period 1, = 40) and after (period 2, = 52) implementing the new protocol. Compared with the period 1 infants, the period 2 infants had a lower rate of intubation in the delivery room (31 vs. 90%, = 0.001) and were less likely to need mechanical ventilation on day 3 (28 vs. 62%, = 0.002) and during the hospital stay (75 vs. 92.5%, < 0.05). The two groups did not differ in terms of mortality or neonatal morbidity. A delivery room respiratory management protocol based on DUCC, optimized nCPAP with high PEEP levels, and LISA procedure is both feasible and safe, and improved ELGAN respiratory outcomes.
限制极低出生体重儿（ELGAN）的早期气管插管和机械通气可能会降低新生儿的发病率和死亡率。我们研究的目的是证明产房呼吸管理方案的可行性、有效性和耐受性，该方案包括延迟脐带结扎（DUCC），结合高呼气末正压水平的优化鼻塞持续气道正压通气（nCPAP）和微创表面活性剂给药（LISA）。 这项队列质量改进研究分析了在实施新方案之前（第1阶段，n = 40）和之后（第2阶段，n = 52）所有孕周在24至26周之间连续出生婴儿的呼吸和新生儿结局。 与第1阶段的婴儿相比，第2阶段的婴儿在产房的插管率较低（31% 对90%，P = 0.001），在第3天（28% 对62%，P = 0.002）和住院期间（75% 对92.5%，P < 0.05）需要机械通气的可能性较小。两组在死亡率或新生儿发病率方面没有差异。 基于DUCC、高呼气末正压水平的优化nCPAP和LISA程序的产房呼吸管理方案既可行又安全，并改善了ELGAN的呼吸结局。
