Dassios Theodore, Sindelar Richard, Williams Emma, Kaltsogianni Ourania, Greenough Anne
Women and Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Paediatrics, University of Patras, Patras, Greece.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Respir Physiol Neurobiol. 2025 Jan;331:104339. doi: 10.1016/j.resp.2024.104339. Epub 2024 Sep 3.
Invasive ventilation of infants born before 24 weeks of gestation is critical for survival and long-term respiratory outcomes, but currently there is a lack of evidence to guide respiratory management. We aimed to compare respiratory mechanics and gas exchange in ventilated extremely preterm infants born before and after 24 weeks of gestation.
Secondary analysis of two prospective observational cohort studies, comparing respiratory mechanics and indices of gas exchange in ventilated infants born at 22-24 weeks of gestation (N=14) compared to infants born at 25-27 weeks (N=37). The ventilation/perfusion ratio (V/Q), intrapulmonary shunt, alveolar dead space (V) and adjusted alveolar surface area (S) were measured in infants born at the Neonatal Unit of King's College Hospital NHS Foundation Trust, London, UK.
Compared to infants of 25-27 weeks, infants of 22-24 weeks had higher median (IQR) intrapulmonary shunt [18 (4 - 29) % vs 8 (2 - 12) %, p=0.044] and higher V [0.9 (0.6 - 1.4) vs 0.6 (0.5 - 0.7) ml/kg, p=0.036], but did not differ in V/Q. Compared to infants of 25-27 weeks, the infants of 22-24 weeks had a lower adjusted S [509 (322- 687) vs 706 (564 - 800) cm, p=0.044]. The infants in the two groups did not differ in any of the indices of respiratory mechanics.
Ventilated infants born before 24 completed weeks of gestation exhibit abnormal gas exchange, with higher alveolar dead space and intrapulmonary shunt and a decreased alveolar surface area compared to extreme preterms born after 24 weeks of gestation.
对妊娠24周前出生的婴儿进行有创通气对于其生存及长期呼吸结局至关重要，但目前缺乏指导呼吸管理的证据。我们旨在比较妊娠24周前后出生的接受通气的极早产儿的呼吸力学和气体交换情况。
对两项前瞻性观察队列研究进行二次分析，比较妊娠22 - 24周出生的接受通气的婴儿（N = 14）与妊娠25 - 27周出生的婴儿（N = 37）的呼吸力学和气体交换指标。在英国伦敦国王学院医院国民保健服务基金会信托新生儿科出生的婴儿中测量通气/灌注比（V/Q）、肺内分流、肺泡死腔（V）和调整后的肺泡表面积（S）。
与妊娠25 - 27周的婴儿相比，妊娠22 - 24周的婴儿肺内分流中位数（IQR）更高[18（4 - 29）% 对 8（2 - 12）%，p = 0.044]，V更高[0.9（0.6 - 1.4）对 0.6（0.5 - 0.7）ml/kg，p = 0.036]，但V/Q无差异。与妊娠25 - 27周的婴儿相比，妊娠22 - 24周的婴儿调整后的S更低[509（322 - 687）对 706（564 - 800）cm，p = 0.044]。两组婴儿在任何呼吸力学指标上均无差异。
妊娠24周前出生的接受通气的婴儿表现出异常的气体交换，与妊娠24周后出生的极早产儿相比，其肺泡死腔和肺内分流更高，肺泡表面积减小。
