Soares Cleuma Oliveira, Campbell Caroline Almeida, Moura Mariana Souza Azevedo, Rocha Rodrigo Santiago Barbosa
Universidade Do Estado Do Pará - UEPA, Belém, Pará, Brazil.
Fundação Santa Casa de Misericórdia Do Pará, Brazil.
J Paediatr Child Health. 2025 Aug;61(8):1249-1255. doi: 10.1111/jpc.70102. Epub 2025 Jun 3.
In preterm newborns, Respiratory Distress Syndrome (RDS) is one of the leading causes of mortality. Treatment often requires invasive mechanical ventilation (IMV), which can cause diaphragmatic dysfunction. Ultrasonography is a promising tool for assessing diaphragmatic function in neonates. This study analyses changes in the diaphragm muscle of preterm newborns with RDS undergoing IMV.
A longitudinal study was conducted with preterm newborns diagnosed with RDS and subjected to IMV. Clinical data were collected, and ultrasonographic evaluations of diaphragm thickness and diaphragmatic thickening fraction (DTF) were performed at two time points: within the first 48 h of life and up to 48 h after extubation.
There was a significant reduction in diaphragmatic thickness (p < 0.0001), DTF index (p = 0.01), and diaphragmatic excursion (p = 0.02) during the intubation period. A moderate correlation was observed between DTF and IMV duration (R = 0.62), hospitalisation time (R = 0.52), and the risk of reintubation (R = 0.55). A moderate correlation was also identified between IMV duration and hospitalisation time (R = 0.64) and between diaphragmatic thickness and gestational age (R = 0.58). However, the correlation between DTF and gestational age was weak (R = 0.48).
IMV leads to diaphragmatic deterioration with increased muscle atrophy in preterm newborns with respiratory distress syndrome.
在早产新生儿中，呼吸窘迫综合征（RDS）是主要死亡原因之一。治疗通常需要有创机械通气（IMV），这可能导致膈肌功能障碍。超声检查是评估新生儿膈肌功能的一种有前景的工具。本研究分析了接受IMV的RDS早产新生儿膈肌肌肉的变化。
对诊断为RDS并接受IMV的早产新生儿进行了一项纵向研究。收集临床数据，并在两个时间点进行膈肌厚度和膈肌增厚分数（DTF）的超声评估：出生后48小时内以及拔管后48小时内。
在插管期间，膈肌厚度（p < 0.0001）、DTF指数（p = 0.01）和膈肌偏移（p = 0.02）均显著降低。观察到DTF与IMV持续时间（R = 0.62）、住院时间（R = 0.52）和再次插管风险（R = 0.55）之间存在中度相关性。还确定了IMV持续时间与住院时间之间（R = 0.64）以及膈肌厚度与胎龄之间（R = 0.58）存在中度相关性。然而，DTF与胎龄之间的相关性较弱（R = 0.48）。
IMV会导致呼吸窘迫综合征早产新生儿的膈肌退化，肌肉萎缩增加。
