Yazici Aybuke, Buyuktiryaki Mehmet, Sari Fatma Nur, Alyamac Dizdar Evrim
Division of Neonatology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, 06800, Turkey.
Division of Neonatology, Istanbul Medipol University, Istanbul, 34815, Turkey.
J Trop Pediatr. 2024 Dec 5;71(1). doi: 10.1093/tropej/fmae051.
This study aimed to identify risk factors for noninvasive ventilation (NIV) failure in <30 weeks' gestation preterm neonates and compare morbidity in patients with and without NIV failure. This study included preterm neonates <30 weeks' gestation who received NIV support for respiratory distress syndrome (RDS). Demographic and clinical characteristics were compared between infants with and without NIV failure within the first 72 hours after birth. Of 443 preterm neonates, NIV failure occurred in 101 (22.8%). Of these, initial respiratory support was nasal continuous positive airway pressure (nCPAP) in 76 infants (75.2%) and nasal intermittent positive pressure ventilation (NIPPV) or bilevel positive airway pressure (BiPAP) in 25 infants (24.8%). Gestational age, birth weight, and antenatal steroid exposure were significantly lower in patients with NIV failure. Grade III-IV intraventricular hemorrhage, moderate/severe bronchopulmonary dysplasia, and retinopathy of prematurity requiring laser photocoagulation were significantly more common in the NIV failure group. Multivariate logistic regression analysis showed that antenatal steroid therapy reduced NIV failure [odds ratio (OR): 0.53, 95% confidence interval (CI): 0.29-0.94; P = .03], while nCPAP (OR: 2.61, 95% CI: 1.53-4.48; P < .001), surfactant requirement (OR: 2.40, 95% CI: 1.36-4.25; P = .003), and ≥2 doses of surfactant need (OR: 3.57, 95% CI: 1.89-6.74; P < .001) were associated with greater NIV failure. The results of this study indicated that administering antenatal steroids and using NIPPV or BiPAP instead of nCPAP as initial respiratory support reduced the likelihood of NIV failure in preterm infants with RDS.
本研究旨在确定孕周<30周的早产新生儿无创通气（NIV）失败的危险因素，并比较NIV失败和未失败患者的发病率。本研究纳入了孕周<30周、因呼吸窘迫综合征（RDS）接受NIV支持的早产新生儿。对出生后72小时内NIV失败和未失败的婴儿的人口统计学和临床特征进行了比较。在443例早产新生儿中，101例（22.8%）出现NIV失败。其中，76例（75.2%）婴儿最初的呼吸支持为鼻持续气道正压通气（nCPAP），25例（24.8%）婴儿为鼻间歇正压通气（NIPPV）或双水平气道正压通气（BiPAP）。NIV失败患者的孕周、出生体重和产前类固醇暴露显著更低。NIV失败组中III-IV级脑室内出血、中度/重度支气管肺发育不良和需要激光光凝治疗的早产儿视网膜病变明显更常见。多因素逻辑回归分析显示，产前类固醇治疗可降低NIV失败的风险[比值比（OR）：0.53，95%置信区间（CI）：0.29-0.94；P = 0.03]，而nCPAP（OR：2.61，95% CI：1.53-4.48；P < 0.001）、表面活性剂需求（OR：2.40，95% CI：1.36-4.25；P = 0.003）以及≥2剂表面活性剂需求（OR：3.57，95% CI：1.89-6.74；P < 0.001）与更高的NIV失败风险相关。本研究结果表明，给予产前类固醇，并使用NIPPV或BiPAP而非nCPAP作为初始呼吸支持，可降低RDS早产婴儿NIV失败的可能性。
