Division of Neonatology, Ankara City Hospital, Bilkent, 06800 Ankara, Turkey.
Division of Neonatology, Ankara City Hospital, Bilkent, 06800 Ankara, Turkey.
Arch Pediatr. 2020 Aug;27(6):322-327. doi: 10.1016/j.arcped.2020.06.002. Epub 2020 Jul 7.
There is inadequate evidence regarding which noninvasive ventilation (NIV) is superior for initial respiratory support of preterm infants with respiratory distress syndrome.
To compare the failure of noninvasive ventilation (NIV) and neonatal outcomes between nasal continuous positive airway pressure (NCPAP), bi-level positive airway pressure (BiPAP), and nasal intermittent positive pressure ventilation (NIPPV) as the initial respiratory support with less invasive surfactant administration (LISA) in very low birth weight (VLBW) infants.
Medical records of 419 VLBW infants born at 26-30weeks' gestation who did not require intubation in the delivery room and were initially supported with either NCPAP (n=221), BiPAP (n=101), or NIPPV (n=97) were retrospectively reviewed. The LISA approach was preferred in cases of surfactant requirement. The primary outcome was the failure of NIV within the first 72h of life. Failure of NIV was defined as the persistence or recurrence of one or more of the following: hypoxemia, respiratory acidosis, more than one episode of apnea requiring bag and mask ventilation or more than six episodes of apnea requiring stimulation over a 6-h period. Data were analyzed using univariate and multivariate logistic regression analysis.
Failure of NIV within the first 72h of life was significantly higher in the NCPAP group (29.4%) compared with the BiPAP (12.9%) or NIPPV (12.4%) group (P<0.001). However, the BiPAP and NIPPV groups were not different in terms of NIV failure (P=0.91). Multivariable logistic regression analysis showed that antenatal steroid administration (OR: 0.49, 95% CI: 0.27-0.90; P=0.02) and gestational age˂28weeks (OR: 2.03, 95% CI: 1.18-3.49; P=0.01) were independent factors that influence failure of NIV within the first 72h of life.
Compared with NCPAP, the use of NIPPV/BiPAP strategies for initial respiratory support can reduce the need for invasive ventilation in infants born at 26-30weeks' gestation.
对于患有呼吸窘迫综合征的早产儿，哪种无创通气（NIV）更适合初始呼吸支持，目前尚无足够的证据。
比较经鼻持续气道正压通气（NCPAP）、双水平气道正压通气（BiPAP）和经鼻间歇正压通气（NIPPV）与经鼻给予表面活性物质（LISA）作为初始呼吸支持在极低出生体重（VLBW）儿中的应用，比较其 NIV 失败率和新生儿结局。
回顾性分析 26-30 周出生、产房内无需插管且最初采用 NCPAP（n=221）、BiPAP（n=101）或 NIPPV（n=97）进行初始呼吸支持的 419 例 VLBW 婴儿的病历资料。如果需要使用表面活性物质，则采用 LISA 方法。主要结局为出生后 72 小时内 NIV 失败。NIV 失败定义为出现以下一种或多种情况持续或复发：低氧血症、呼吸性酸中毒、需要气囊面罩通气 1 次以上或 6 小时内需要刺激 6 次以上的呼吸暂停。采用单变量和多变量逻辑回归分析数据。
出生后 72 小时内 NIV 失败率在 NCPAP 组（29.4%）明显高于 BiPAP（12.9%）或 NIPPV（12.4%）组（P<0.001）。然而，BiPAP 和 NIPPV 组之间的 NIV 失败率无差异（P=0.91）。多变量逻辑回归分析显示，产前使用类固醇（OR：0.49，95%CI：0.27-0.90；P=0.02）和胎龄<28 周（OR：2.03，95%CI：1.18-3.49；P=0.01）是影响出生后 72 小时内 NIV 失败的独立因素。
与 NCPAP 相比，26-30 周出生的婴儿采用 NIPPV/BiPAP 策略作为初始呼吸支持可减少有创通气的需求。
