Sadeghnia Alireza, Foroshani Marzieh Zamani, Badiei Zohreh
Department of Pediatrics, School of Medicine, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Prev Med. 2017 Jun 1;8:41. doi: 10.4103/ijpvm.IJPVM_233_16. eCollection 2017.
Near-infrared spectroscopy (NIRS) provides the capability of monitoring oxygenation levels in cerebral microscopic vessels, enabling the operator to observe the spontaneous changes in the levels of hemoglobin concentration in tissue and interpret the resulting fluctuations. The current study tried to investigate whether brain's autoregulatory mechanisms in premature newborns have the potential to prevent the adverse effects caused by asynchronous changes of pressure in the rib cage. Therefore, NIRS method was applied to newborns that were alternatively shifted from nasal continuous positive airway pressure (nCPAP) to nasal intermittent positive pressure ventilation (NIPPV) and vice versa.
This study was done as a crossover randomized clinical trial on 30 very low-weight newborns under nCPAP, who had received surfactant as a result of respiratory distress syndrome diagnosis, from April 2015 to April 2016, in Isfahan Shahid Beheshti Educational Hospital. The newborns were 72 h old, experiencing continuous distending pressure (CDP) = 4-6 cmHO with FiO = 30%-40%. The respiratory support would alternate from nCPAP to NIPPV and vice versa (with indicators of expiratory PAP (EPAP) = CDP and inspiratory PAP = EPAP + 4 cmHO), and the cerebral regional oxygen saturation (CrSO) was monitored using NIRS.
The study results indicated that newborns significantly showed higher levels of CrSO84.93, = 0.005) and oxygenation (94.63, = 0.007) under nCPAP rather than NIPPV (82.43 and 93.43, respectively). The respiratory rate was also meaningfully slower when newborns were under nCPAP ( = 0.013).
This study revealed that applying NIPPV may have an unfavorable effect on the premature newborn's brain tissue perfusion. However, more studies are needed to ensure solid outcomes.
近红外光谱技术（NIRS）能够监测脑微血管中的氧合水平，使操作者能够观察组织中血红蛋白浓度水平的自发变化，并解读由此产生的波动。当前研究试图探究早产儿的大脑自动调节机制是否有潜力预防因胸廓压力异步变化所导致的不良影响。因此，NIRS方法被应用于交替接受鼻持续气道正压通气（nCPAP）和鼻间歇正压通气（NIPPV）的新生儿。
本研究作为一项交叉随机临床试验，于2015年4月至2016年4月在伊斯法罕沙希德·贝赫什提教育医院对30名接受nCPAP治疗的极低体重新生儿进行，这些新生儿因呼吸窘迫综合征诊断而接受了表面活性剂治疗。新生儿年龄为72小时，持续扩张压力（CDP）=4 - 6 cmH₂O，吸入氧分数（FiO₂）=30% - 40%。呼吸支持将在nCPAP和NIPPV之间交替（呼气末正压（EPAP）= CDP且吸气末正压= EPAP + 4 cmH₂O），并使用NIRS监测脑局部氧饱和度（CrSO₂）。
研究结果表明，新生儿在nCPAP下的CrSO₂水平（84.93，P = 0.005）和氧合水平（94.63，P = 0.007）显著高于NIPPV下（分别为82.43和93.43）。当新生儿处于nCPAP下时，呼吸频率也明显较慢（P = 0.013）。
本研究表明，应用NIPPV可能对早产新生儿的脑组织灌注产生不利影响。然而，需要更多研究来确保可靠的结果。
