Choi Eui Kyung, Park Kyu Hee, Choi Byung Min
Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea.
Eur J Pediatr. 2022 Apr;181(4):1651-1660. doi: 10.1007/s00431-021-04317-3. Epub 2022 Jan 10.
The frequency of non-invasive respiratory support use has increased in neonates of all gestational ages with respiratory distress (RD). However, the impact of delayed initiation of non-invasive respiratory support in outborn neonates remains poorly understood. This study aimed to identify the impact of the delayed initiation of non-invasive respiratory support in outborn, late-preterm, and term neonates. Medical records of 277 infants (gestational age of ≥ 35 weeks) who received non-invasive respiratory support as primary respiratory therapy < 24 h of age between 2016 and 2020 were retrospectively reviewed. Factors associated with respiratory adverse outcomes were investigated in 190 outborn neonates. Infants with RD were divided into two groups: mild (fraction of inspired oxygen [FiO] ≤ 0.3) and moderate-to-severe RD (FiO > 0.3), depending on their initial oxygen requirements from non-invasive respiratory support. The median time for the initiation of non-invasive respiratory support at a tertiary center was 3.5 (2.2-5.0) h. Male sex, a high oxygen requirement (FiO > 0.3), high CO level, and respiratory distress syndrome were significant factors associated with adverse outcomes. Subgroup analysis revealed that in the moderate-to-severe RD group, delayed commencement of non-invasive respiratory support (≥ 3 h) was significantly associated with pulmonary air leakage (p = 0.033).
Our study shows that outborn neonates with moderate-to-severe RD, who were treated with delayed non-invasive respiratory support, were associated with an increased likelihood of pulmonary air leakage. Additional prospective studies are required to establish the optimal timing and methods of non-invasive respiratory support for outborn, late-preterm, and term infants.
• Non-invasive respiratory support is widely used in neonates of all gestational ages. • Little is known on the impact of delayed initiation of non-invasive respiratory support in outborn, late preterm, and term neonates.
• Male sex, high oxygen requirement (FiO2 >0.3), high initial CO2 level, and respiratory distress syndrome significantly correlated with adverse outcomes. • Outborn late-preterm and term neonates with high oxygen requirement who were treated with delayed non-invasive respiratory support indicated an increased likelihood of pulmonary air leakage.
在所有孕周有呼吸窘迫（RD）的新生儿中，无创呼吸支持的使用频率有所增加。然而，院外出生新生儿延迟开始无创呼吸支持的影响仍知之甚少。本研究旨在确定院外出生、晚期早产儿和足月儿延迟开始无创呼吸支持的影响。对2016年至2020年间277例（孕周≥35周）在出生后<24小时接受无创呼吸支持作为主要呼吸治疗的婴儿的病历进行回顾性分析。对190例院外出生的新生儿中与呼吸不良结局相关的因素进行了调查。根据无创呼吸支持的初始氧需求，将患有RD的婴儿分为两组：轻度（吸入氧分数[FiO]≤0.3）和中重度RD（FiO>0.3）。在三级中心开始无创呼吸支持的中位时间为3.5（2.2-5.0）小时。男性、高氧需求（FiO>0.3）、高二氧化碳水平和呼吸窘迫综合征是与不良结局相关的重要因素。亚组分析显示，在中重度RD组中，无创呼吸支持延迟开始（≥3小时）与肺漏气显著相关（p=0.033）。
我们的研究表明，接受延迟无创呼吸支持治疗的院外出生的中重度RD新生儿，发生肺漏气的可能性增加。需要进一步的前瞻性研究来确定院外出生、晚期早产儿和足月儿无创呼吸支持的最佳时机和方法。
•无创呼吸支持在所有孕周的新生儿中广泛使用。•关于院外出生、晚期早产儿和足月儿延迟开始无创呼吸支持的影响知之甚少。
•男性、高氧需求（FiO2>0.3）、高初始二氧化碳水平和呼吸窘迫综合征与不良结局显著相关。•接受延迟无创呼吸支持治疗的院外出生的晚期早产儿和足月儿，高氧需求者发生肺漏气的可能性增加。
