Department of Paediatrics and Child Health, Aga Khan University, P.o Box 38129, Dar es Salaam, Tanzania.
Department of Paediatrics and Child Health, Muhimbili National Hospital and Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
BMC Pediatr. 2023 May 3;23(1):211. doi: 10.1186/s12887-023-04038-6.
The mainstay in the management of preterm neonates with respiratory distress syndrome (RDS) include early Continuous Positive Airway Pressure (CPAP), timely surfactant replacement and mechanical ventilation. Preterm neonates with RDS who fail CPAP are at higher risk for chronic lung disease as well as death. Unfortunately, in low resource settings CPAP may be the only treatment available for these neonates.
To determine the prevalence of CPAP failure among premature newborns with RDS and associated factors.
We conducted a prospective observational study over the first 72 h of life on 174 preterm newborns with RDS receiving CPAP at Muhimbili National Hospital (MNH). At MNH newborns with Silverman Andersen Score (SAS) of ≥ 3 are commenced on CPAP; surfactant and mechanical ventilation are very scarce. Study newborns not maintaining oxygen saturation > 90% or with SAS score ≥ 6 despite being on 50% oxygen and PEEP of 6 cmHO and those with > 2 episodes of apnoea needing stimulation or positive pressure ventilation in 24 h were considered as CPAP failure. The prevalence of CPAP failure was determined as a percentage and factors associated were determined by logistic regression. A p-value of < 0.05 was considered significant and 95% confidence interval was used.
Of the enrolled newborns, 48% were male and 91.4% were in-born. The mean gestational age and weight were 29 weeks (range 24-34 weeks) and 1157.7 g (range 800-1500 g) respectively. Of the mothers 44 (25%) received antenatal corticosteroids. Overall CPAP failure was 37.4% and among those weighing ≤ 1200g, it was 44.1% . Most failure occurred within the first 24 h. No factor was identified to be independently associated with CPAP failure. Mortality among those who failed CPAP was 33.8% and 12.8% among those who did not.
In resource limited settings like ours with low up take of antenatal corticosteroids and scarce surfactant replacement a significant portion of preterm neonates especially those weighing ≤ 1200 g with RDS fail CPAP therapy.
治疗呼吸窘迫综合征（RDS）早产儿的主要方法包括早期持续气道正压通气（CPAP）、适时补充肺表面活性物质和机械通气。CPAP 治疗失败的 RDS 早产儿有更高的慢性肺病和死亡风险。不幸的是，在资源有限的环境中，CPAP 可能是这些早产儿唯一可用的治疗方法。
确定 RDS 早产儿 CPAP 治疗失败的发生率及相关因素。
我们在坦桑尼亚达累斯萨拉姆的穆希比利国家医院（MNH）对 174 例接受 CPAP 治疗的 RDS 早产儿进行了一项前瞻性观察研究，这些早产儿在生命的头 72 小时内接受了 CPAP 治疗。在 MNH，Silverman Andersen 评分（SAS）≥3 的新生儿开始接受 CPAP 治疗；肺表面活性物质和机械通气非常稀缺。氧饱和度>90%或在 50%氧气和 6cmH2O PEEP 下 SAS 评分≥6 且 24 小时内需要 2 次以上刺激或正压通气的新生儿以及 24 小时内需要 2 次以上刺激或正压通气的新生儿被认为 CPAP 治疗失败。CPAP 治疗失败的发生率以百分比表示，并通过逻辑回归确定相关因素。p 值<0.05 被认为具有统计学意义，并使用 95%置信区间。
在纳入的新生儿中，48%为男性，91.4%为顺产。平均胎龄和体重分别为 29 周（范围 24-34 周）和 1157.7g（范围 800-1500g）。母亲中 44 人（25%）接受了产前皮质激素治疗。总体 CPAP 治疗失败率为 37.4%，体重<1200g 的患儿 CPAP 治疗失败率为 44.1%。大多数失败发生在最初的 24 小时内。没有发现任何因素与 CPAP 治疗失败有独立相关性。CPAP 治疗失败患儿的死亡率为 33.8%，未失败患儿的死亡率为 12.8%。
在资源有限的环境中，产前皮质激素使用率低，肺表面活性物质补充不足，我们发现很大一部分 RDS 早产儿，尤其是体重<1200g 的早产儿，CPAP 治疗失败。
