Chen Wenqian, Chen Zhiqing, Lai Shuhua, Cai Wenhong, Lin Yunfeng
Wenqian Chen, Department of Neonatology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, China.
Zhiqing Chen, Department of Neonatology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, China.
Pak J Med Sci. 2022 May-Jun;38(5):1353-1359. doi: 10.12669/pjms.38.5.5939.
Noninvasive high-frequency oscillatory ventilation (nHFOV) is a novel respiratory support mode for premature infants. This retrospective study aimed to compare the effect of nHFOV and bi-level nasal continuous positive airway pressure (BiPAP) in premature infants with neonatal respiratory failure (NRF) as initial noninvasive ventilation (NIV) support mode.
We retrospectively analyzed medical records of preterm infants admitted to the tertiary neonatal intensive care units (NICUs) of Fujian Maternal and Child Health Hospital from January 2019 to December 2020. Preterm infants with the gestational age of 25-34 weeks, diagnosed with NRF, used nHFOV or BiPAP as the initial respiratory support mode were analyzed. The rates of invasive mechanical ventilation (IMV) within the first seven days after birth and adverse outcomes were compared between the two groups.
Two hundred fifty-five preterm infants were analyzed (128 in nHFOV group,127 in BiPAP group). There was no significant difference in baseline characteristics between the two groups. Compared with the BiPAP group, the nHFOV group had significantly lower need for IMV within the first seven days after birth (18/128 vs. 33/127, p = 0.01) and PCO2 at 12 and 24 hours post-treatment (46.34±5.24mmHg vs. 51.18±4.83mmHg, P<0.01; 40.72±4.02mmHg vs. 42.50±3.86mmHg, P<0.01). The incidence of BPD, ROP, air leak syndromes, IVH≥ grade 3, PVL, NEC≥II stage, abdominal distension, and nasal trauma were similar between the two groups.
nHFOV significantly reduced the need for IMV and improved the elimination of CO2 compared with BiPAP in preterm infants with NRF without increasing the incidence of adverse effects.
无创高频振荡通气（nHFOV）是一种用于早产儿的新型呼吸支持模式。本回顾性研究旨在比较nHFOV和双水平鼻持续气道正压通气（BiPAP）作为初始无创通气（NIV）支持模式对新生儿呼吸衰竭（NRF）早产儿的影响。
我们回顾性分析了2019年1月至2020年12月在福建省妇幼保健院三级新生儿重症监护病房（NICU）收治的早产儿的病历。分析胎龄为25 - 34周、诊断为NRF、使用nHFOV或BiPAP作为初始呼吸支持模式的早产儿。比较两组出生后前七天内有创机械通气（IMV）的发生率和不良结局。
共分析了255例早产儿（nHFOV组128例，BiPAP组127例）。两组基线特征无显著差异。与BiPAP组相比，nHFOV组出生后前七天内IMV的需求显著更低（18/128 vs. 33/127，p = 0.01），且治疗后12小时和24小时的PCO2更低（46.34±5.24mmHg vs. 51.18±4.83mmHg，P<0.0１；40.72±4.02mmHg vs. 42.50±3.86mmHg，P<0.01）。两组支气管肺发育不良（BPD）、视网膜病变（ROP）、气漏综合征、≥3级脑室内出血（IVH）、脑室周围白质软化（PVL）、≥II期坏死性小肠结肠炎（NEC）、腹胀和鼻外伤的发生率相似。
与BiPAP相比，nHFOV显著降低了NRF早产儿对IMV的需求，并改善了CO2的清除，且未增加不良反应的发生率。
