Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands.
Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands.
Resuscitation. 2024 Jan;194:110053. doi: 10.1016/j.resuscitation.2023.110053. Epub 2023 Nov 17.
Studies in animals have shown that vocal cords (VCs) close during apnoea before and after birth, thereby impairing the effect of non-invasive ventilation. We tested the feasibility of visualising VCs using ultrasonography (US) and investigated the position and movement of the VCs during non-invasive respiratory support of preterm infants at birth.
In an observational study, VCs were visualised using US in infants <30 weeks gestation during both stabilisation after birth and at one hour after birth. Respiratory efforts were simultaneously recorded. The percentage of time the VCs were closed in the first ten minutes was determined from videoframes acquired at 15 Hz and compared with respiratory flow patterns measured using a respiratory function monitor.
US of the VCs could be performed in 20/20 infants included (median (IQR) gestational age 27 (27-28) weeks) without interfering with stabilisation, of whom 60% (12/20) were initially breathing and 40% (8/20) were apnoeic at birth. In breathing infants, the VCs closed between breaths and during breath holds, which accounted for 57% (49-66) of the time. In apnoeic infants receiving positive pressure ventilation, the VCs were closed for 93% (81-99) of the time. US at one hour after birth could be performed in 14/20 infants, VCs were closed between breaths and during breath holds, accounting for 46% (27-52) of the time.
Visualising VCs in preterm infants at birth using US is feasible. The VCs were closed during apnoea, in between breaths and during breath holds, impairing the effect of ventilation given.
动物研究表明，声带（VC）在出生前后的呼吸暂停期间关闭，从而削弱了无创通气的效果。我们测试了使用超声（US）可视化 VC 的可行性，并研究了在出生时对早产儿进行无创呼吸支持期间 VC 的位置和运动。
在一项观察性研究中，在出生后稳定期和出生后 1 小时对 <30 周妊娠的婴儿使用 US 可视化 VC。同时记录呼吸努力。从 15 Hz 获取的视频帧中确定 VC 在最初 10 分钟内关闭的时间百分比，并将其与使用呼吸功能监测器测量的呼吸流量模式进行比较。
20/20 名纳入婴儿（中位（IQR）胎龄 27（27-28）周）的 VC 超声检查均可进行，而不会干扰稳定，其中 60%（12/20）最初在呼吸，40%（8/20）在出生时呼吸暂停。在呼吸的婴儿中，VC 在呼吸之间和呼吸暂停期间关闭，占总时间的 57%（49-66）。在接受正压通气的呼吸暂停婴儿中，VC 关闭时间为 93%（81-99）。在 20 名婴儿中有 14 名可以在出生后 1 小时进行 US，VC 在呼吸之间和呼吸暂停期间关闭，占总时间的 46%（27-52）。
使用 US 在出生时可视化早产儿的 VC 是可行的。VC 在呼吸暂停、呼吸之间和呼吸暂停期间关闭，从而削弱了通气的效果。
