Mannan M A, Hossain M A, Nasim J, Sabina Y, Navila F, Subir D
Dr Md Abdul Mannan, Associate Professor of Neonatology, Department of Neonatology, Ad-din Medical College Hospital (AMCH), Dhaka, Bangladesh.
Mymensingh Med J. 2018 Jan;27(1):130-135.
Since its inception, the neonatal mechanical ventilator has been considered an essential tool for managing preterm neonates with Respiratory Distress Syndrome (RDS) and is still regarded as an integral component in the neonatal respiratory care continuum. Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. This clinical intervention study was done to analyze immediate outcome of preterm neonates with RDS required mechanical ventilation and conducted on preterm neonates with RDS required mechanical ventilation from July 2014 to June 2015. Total of 31 preterm neonates with RDS were mechanically ventilated during the study period, of which 77.42% (N=24) survived. The survival rate was highest among 30- <34 weeks (100%) gestational age (GA) group and lowest in 27- <30 weeks (56%) GA, (p=0.0036). The neonates with Birth Weight (BW) 1500gm -1800gm were higher rate of recovery which was 100% and gradually declined in 1000-1499gm (93.75%) and 800-999gm (33.33%) BW groups (p=0.00083). In this study most of the neonates were male (61.29%) but recovery rate was relatively better among baby girls (83.33%) than baby boys (73.68%) (p=0.53). RDS with surfactant therapy was better outcome than non surfactant group & survival of neonates who got surfactant were 93.33% & non surfactant neonates were 62.50%, (p=0.040). Majority (71.43%) of RDS with surfactant therapy recovered earlier <7 days than non surfactant therapy neonates (30.00%) and most of non surfactant neonates (70.00%) required prolonged ventilator support >7days (p=0.045). During the period of ventilation a total 17(54.84%) neonates developed different complications, of which ventilator associated pneumonia was (16.13%), sepsis (16.13%), pneumothorax (9.68%), pulmonary hemorrhage (6.45%) and intraventricular hemorrhage (6.45%) and among them 10 neonates recovered. No complications encountered in 14(45.16%) neonates, all of them survived, (p=0.0064). All (N=31) preterm neonates were candidate for surfactant therapy but only 15 neonates got surfactant therapy, remaining (N=16) did not get for their financial issue. As mechanical ventilation with surfactant therapy reduces the neonatal mortality; hence, facilities for neonatal ventilation and cost effective surfactant therapy should be included in the regional and central hospitals providing intensive care for neonates.
自问世以来，新生儿机械通气一直被视为治疗患有呼吸窘迫综合征（RDS）的早产儿的重要工具，至今仍是新生儿呼吸护理连续过程中不可或缺的组成部分。新生儿机械通气已应用多年，在这方面取得了多项进展。本临床干预研究旨在分析需要机械通气的RDS早产儿的近期结局，研究对象为2014年7月至2015年6月期间需要机械通气的RDS早产儿。研究期间共有31例RDS早产儿接受了机械通气，其中77.42%（N = 24）存活。30 - <34周胎龄（GA）组的存活率最高（100%），而27 - <30周GA组最低（56%），（p = 0.0036）。出生体重（BW）为1500克 - 1800克的新生儿恢复率较高，为100%，而BW在1000 - 1499克（93.75%）和800 - 999克（33.33%）组中逐渐下降（p = 0.00083）。在本研究中，大多数新生儿为男性（61.29%），但女婴的恢复率（83.33%）相对高于男婴（73.68%）（p = 0.53）。接受表面活性剂治疗的RDS患儿结局优于未接受治疗的患儿，接受表面活性剂治疗的新生儿存活率为93.33%，未接受治疗的为62.50%，（p = 0.040）。接受表面活性剂治疗的大多数RDS患儿（71.43%）在<7天内较早恢复，而未接受治疗的新生儿大多数（70.00%）需要>7天的长期通气支持（p = 0.045）。在通气期间，共有17例（54.84%）新生儿出现了不同并发症，其中呼吸机相关性肺炎（16.13%）、败血症（16.13%）、气胸（9.68%）、肺出血（6.45%）和脑室内出血（6.45%），其中10例新生儿恢复。14例（45.16%）新生儿未出现并发症，全部存活，（p = 0.006）。所有31例早产儿均适合接受表面活性剂治疗，但只有15例新生儿接受了表面活性剂治疗，其余16例因经济问题未接受治疗。由于机械通气联合表面活性剂治疗可降低新生儿死亡率；因此，在为新生儿提供重症监护的地区和中心医院应配备新生儿通气设施及具有成本效益的表面活性剂治疗。
