Ueda-Kuramochi Akiho, Morisawa Kazumi, Arimitsu Takeshi, Shimura Kazuma, Hara-Isono Kaori, Kin Takane, Hida Mariko
Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Respir Med Case Rep. 2025 May 2;56:102226. doi: 10.1016/j.rmcr.2025.102226. eCollection 2025.
To prevent the worsening of bronchopulmonary disease (BPD), early extubation is desirable. However, in extremely preterm infants, BPD tends to become severe, making early extubation difficult and leading to prolonged intubation. Even if the intubation period is prolonged, feasible respiratory strategies for extubation in extremely preterm infants during the chronic phase of severe BPD are necessary. In preterm infants, nasal high-frequency oscillatory ventilation (NHFOV) can support breathing after extubation immediately after birth, but whether NHFOV is effective as respiratory support after extubation in the chronic phase of severe BPD in extremely preterm infants is unclear. Especially for extremely preterm births or infants with extremely low birth weights, early extubation is difficult. Although such infants' postmenstrual age and weight increase during long-term ventilator support, their respiratory function is very poor compared with that of preterm infants born at a gestational age equivalent to such infants' postmenstrual age owing to substantial lung damage caused by the ventilator. For this reason, extubation in the chronic phase of BPD may also be challenging. In this report, we describe a case of a marginally viable infant who was born at 23 weeks' gestation weighing 374 g, required 2 months of intubation after birth owing to severe BPD, and was successfully extubated using NHFOV. This case report suggests that NHFOV may be an effective respiratory strategy for very low birth weight infants with severe BPD.
为预防支气管肺疾病（BPD）恶化，早期拔管是可取的。然而，在极早产儿中，BPD往往会加重，导致早期拔管困难并延长插管时间。即使插管时间延长，对于极早产儿在重度BPD慢性期进行拔管时可行的呼吸策略也是必要的。在早产儿中，鼻高频振荡通气（NHFOV）可在出生后立即支持拔管后的呼吸，但NHFOV在极早产儿重度BPD慢性期作为拔管后呼吸支持是否有效尚不清楚。特别是对于极早产或极低出生体重的婴儿，早期拔管很困难。尽管这些婴儿在长期呼吸机支持期间月经龄和体重增加，但由于呼吸机造成的严重肺损伤，其呼吸功能与在相当于这些婴儿月经龄的孕周出生的早产儿相比非常差。因此，BPD慢性期的拔管也可能具有挑战性。在本报告中，我们描述了一例边缘存活婴儿的病例，该婴儿孕23周出生，体重374克，因重度BPD出生后需要插管2个月，并使用NHFOV成功拔管。本病例报告表明，NHFOV可能是重度BPD极低出生体重婴儿的一种有效呼吸策略。
