Zhonghua Er Ke Za Zhi. 2021 Apr 2;59(4):273-279. doi: 10.3760/cma.j.cn112140-20201117-01034.
To analyze the risk factors and the adverse outcomes of failure in non-invasive continuous positive airway pressure (CPAP) as the initial respiratory support in very preterm infants with gestational age at birth <32 weeks. This multicenter prospective cohort study was conducted from January 1, 2019 to December 31, 2019 based on the data from Shandong Neonatal Network (SNN). Perinatal information, clinical treatment, and the short-term outcomes of very preterm infants with gestational age at birth of 25-31 weeks in 30 neonatal intensive care units (NICU) in SNN were collected. The very preterm infants with non-invasive CPAP as the initial respiratory support were divided into the group of non-invasive CPAP failure and the group of non-invasive CPAP success. The difference in the risk factors between the two groups were tested by χ test or Fisher exact and the Mann-Whitney test, followed by Logistic regression analysis for all the risk factors with statistically significant difference. A total of 1 040 very preterm infants were included in this study, including 577 males (55.5%) and 463 females (44.5%). There were 195 cases (18.8%) with gestational age of 25-28 weeks, 845 cases (81.2%) with gestational age of 29-31 weeks, 81 cases (7.8%) with birth weight<1 000 g and 959 cases (92.2%) with birth weight≥1 000 g. Overall, the rate of CPAP success (=902, 86.7%) was higher than that of CPAP failure (=138, 13.3%). The incidence of CPAP failure was 24.6% (48/195) and 10.7% (90/845) respectively for infants with gestational age of 25-28 weeks and of 29-31 weeks. The Logistic regression analysis showed that smaller gestational age at birth, maternal gestational hypertension disease, and severe respiratory distress syndrome (RDS, grade Ⅲ-Ⅳ) requiring pulmonary surfactant (PS) for more than twice and fraction of inspired oxygen (FiO)>0.30 after birth were independent risk factors for the failure of initially used non-invasive CPAP (=0.718, 1.847, 4.003, 6.712, 1.948; 95%:0.590-0.873, 1.130-3.018, 2.435-6.579, 3.160-14.259, 1.189-3.192; all <0.05). The incidence of adverse outcomes in the group of failure was significantly higher than in the group of success, including death, neonatal pulmonary hemorrhage, moderate or severe broncho pulmonary dysplasia (BPD), and severe intraventricular hemorrhage (IVH) (=4.436, 26.393, 1.998, 4.545; 95%:2.106-9.344, 9.690-71.885, 1.031-3.875, 1.615-12.795; all <0.05). The very preterm infants with gestational age at birth<32 weeks have a higher incidence of major adverse outcomes after the failure of initially used non-invasive CPAP. Smaller gestational age at birth, maternal gestational hypertension disease and severe RDS (grade Ⅲ-Ⅳ) requiring PS for more than twice and FiO>0.30 after birth are independent risk factors for the failure of initially used non-invasive CPAP.
分析出生胎龄<32周的极早产儿以无创持续气道正压通气（CPAP）作为初始呼吸支持失败的危险因素及不良结局。本多中心前瞻性队列研究基于山东新生儿网络（SNN）的数据，于2019年1月1日至2019年12月31日开展。收集了SNN中30家新生儿重症监护病房（NICU）中出生胎龄为25 - 31周的极早产儿的围产期信息、临床治疗及短期结局。以无创CPAP作为初始呼吸支持的极早产儿被分为无创CPAP失败组和无创CPAP成功组。两组间危险因素的差异采用χ检验或Fisher确切概率法以及Mann - Whitney检验进行检验，随后对所有具有统计学显著差异的危险因素进行Logistic回归分析。本研究共纳入1040例极早产儿，其中男577例（55.5%），女463例（44.5%）。胎龄25 - 28周的有195例（18.8%），胎龄29 - 31周的有845例（81.2%），出生体重<1000g的有81例（7.8%），出生体重≥1000g的有959例（92.2%）。总体而言，CPAP成功的比例（=902，86.7%）高于CPAP失败的比例（=138，13.3%）。胎龄25 - 28周和29 - 31周的婴儿CPAP失败发生率分别为24.6%（48/195）和10.7%（90/845）。Logistic回归分析显示，出生胎龄较小、母亲妊娠期高血压疾病、需要使用肺表面活性物质（PS）超过两次的重度呼吸窘迫综合征（RDS，Ⅲ - Ⅳ级）以及出生后吸入氧分数（FiO）>0.30是初始使用无创CPAP失败的独立危险因素（=0.718，1.847，4.003，6.712，1.948；95%可信区间：0.590 - 0.873，1.130 - 3.018，2.435 - 6.579，3.160 - 14.259，1.189 - 3.192；均<0.05）。失败组的不良结局发生率显著高于成功组，包括死亡､新生儿肺出血､中度或重度支气管肺发育不良（BPD）以及重度脑室内出血（IVH）（=4.436，26.393，1.998，4.545；95%可信区间：2.106 - 9.344，9.690 - 71.885，1.031 - 3.875，1.615 - 12.795；均<0.05）。出生胎龄<32周的极早产儿初始使用无创CPAP失败后主要不良结局的发生率较高。出生胎龄较小、母亲妊娠期高血压疾病以及需要使用PS超过两次的重度RDS（Ⅲ - Ⅳ级）和出生后FiO>0.30是初始使用无创CPAP失败的独立危险因素。
