Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
Ital J Pediatr. 2019 Jan 4;45(1):2. doi: 10.1186/s13052-018-0582-x.
A physiologic test for estimating BPD rate has been developed by Walsh and collaborators. Actually there are not standard criteria for weaning from CPAP and/or oxygen therapy the premature babies. Aim of this study was to verify if a physiologic test, modified respect to that developed by Walsh and collaborators for estimating BPD rate, can be used as a clinical tool for weaning the premature babies from CPAP and/or oxygen therapy.
Neonates with BW 500-1250 g and GA ≤ 32 weeks, receiving FiO ≤ 0.30 by hood or CPAP, were prospectively studied at 28 days of life and at 36 weeks of postmestrual age. The test was performed in 3 steps: baseline, challenge (FiO and CPAP reduction to room air) and post test (room air). Monitoring of transcutaneous CO was added to SpO and the newborns passing the test were left in room air.
Six of 23 tested babies (26%) passed the challenge at 28 days of life, 4 of 10 tested babies (40%) passed the challenge at 36 weeks. Median values of SpO were significantly higher in the neonates passing the test, respect to the failing patients. At the same time median values of TcPCO were significantly higher in the latter babies.
TcPCO monitoring appeared to be a new useful parameter for failure prediction of weaning. The test represented a clinical guide because the newborns passing it were left in room air.
Walsh 及其合作者开发了一种用于估计 BPD 发生率的生理测试。实际上，早产儿从 CPAP 和/或氧气治疗中脱机没有标准标准。本研究的目的是验证一种生理测试，该测试对 Walsh 及其合作者开发的用于估计 BPD 发生率的测试进行了修改，是否可以用作从 CPAP 和/或氧气治疗中脱机早产儿的临床工具。
BW 为 500-1250g 且 GA ≤ 32 周、通过面罩或 CPAP 接受 FiO ≤ 0.30 的新生儿在 28 天龄和胎龄 36 周时进行前瞻性研究。该测试分 3 步进行：基线、挑战（FiO 和 CPAP 降低至室内空气）和后测试（室内空气）。在 SpO 监测的基础上增加了经皮 CO 监测，通过测试的新生儿留在室内空气中。
28 天龄时有 6 名（26%）接受测试的婴儿通过了挑战，10 名接受测试的婴儿中有 4 名（40%）在 36 周时通过了挑战。通过测试的新生儿的 SpO 中位数明显高于未通过测试的婴儿。同时，后者婴儿的 TcPCO 中位数明显更高。
TcPCO 监测似乎是预测脱机失败的新有用参数。该测试是一种临床指南，因为通过测试的新生儿留在室内空气中。
