Jónsson B, Katz-Salamon M, Faxelius G, Broberger U, Lagercrantz H
Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
Acta Paediatr Suppl. 1997 Apr;419:4-10. doi: 10.1111/j.1651-2227.1997.tb18303.x.
Very-low-birthweight (VLBW) infants are usually intubated at birth and mechanically ventilated at neonatal intensive-care units (NICUs). The objectives of this study were to evaluate the use of early nasal continuous positive airway pressure (NCPAP) in a regional cohort and to determine to what extent VLBW infants need transfer to a regional NICU from special-care units (SCUs) that primarily use early NCPAP for respiratory care. We compared the outcome for infants at SCUs and NICUs in Stockholm County, Sweden, from 1988 to 1993. All infants with birthweights of less than 1501 g were included in this study (n = 687). Fifty-nine per cent of the infants (400/687) were supported using only supplemental oxygen or NCPAP. Of these, 170 (25%) received only supplemental oxygen and 230 (34%) were supported only by NCPAP. A total of 350 (51%) infants received early NCPAP. Of these infants, 120 (34%) later required mechanical ventilation. Only 167 (24%) infants received mechanical ventilation from the beginning Failure of NCPAP was significantly associated with the presence of respiratory distress syndrome. A total of 161/412 (39%) infants were transferred from SCUs to NICUs. Of infants < or = 26 weeks' gestation and infants > 26 weeks, 71% and 34% were transferred, respectively. Total mortality was 16%. The mortality for transfers was 20% compared to an overall mortality in SCU and NICU infants of 9% and 15%, respectively. The overall incidence of intraventricular haemorrhage (IVH), grade III-IV was 8%, periventricular leucomalacia (PVL) grade I-IV was 7%, retinopathy of prematurity (ROP) requiring cryotherapy was 4.3% and chronic lung disease (CLD) was 14%. There were significant differences in the incidence IVH, PVL, CLD and ROP between SCU and NICU infants in matched gestational age groups. In conclusion, infants with a gestational age of 27 weeks or more may often be adequately cared for at SCUs without mechanical ventilation by using early NCPAP. However, infants with a gestational age of 26 weeks or less should be transferred to tertiary-care centres preferably before birth, because they will often require mechanical ventilation.
极低出生体重（VLBW）婴儿通常在出生时即行气管插管，并在新生儿重症监护病房（NICU）接受机械通气。本研究的目的是评估区域队列中早期鼻持续气道正压通气（NCPAP）的使用情况，并确定极低出生体重婴儿在多大程度上需要从主要使用早期NCPAP进行呼吸护理的特殊护理单元（SCU）转至区域NICU。我们比较了1988年至1993年瑞典斯德哥尔摩县SCU和NICU中婴儿的结局。所有出生体重小于1501g的婴儿均纳入本研究（n = 687）。59%的婴儿（400/687）仅使用补充氧气或NCPAP进行支持。其中，170例（25%）仅接受补充氧气，230例（34%）仅接受NCPAP支持。共有350例（51%）婴儿接受早期NCPAP。在这些婴儿中，120例（34%）后来需要机械通气。仅167例（24%）婴儿从一开始就接受机械通气。NCPAP失败与呼吸窘迫综合征的存在显著相关。共有161/412例（39%）婴儿从SCU转至NICU。孕周≤26周和孕周＞26周的婴儿分别有71%和34%被转运。总死亡率为16%。转运婴儿的死亡率为20%，而SCU和NICU婴儿的总体死亡率分别为9%和15%。脑室内出血（IVH）Ⅲ-Ⅳ级的总体发生率为8%，脑室周围白质软化（PVL）Ⅰ-Ⅳ级为7%，需要冷冻治疗的早产儿视网膜病变（ROP）为4.3%，慢性肺病（CLD）为14%。在匹配孕周组的SCU和NICU婴儿中，IVH、PVL、CLD和ROP的发生率存在显著差异。总之，孕周27周及以上的婴儿通过使用早期NCPAP，在SCU通常可在无需机械通气的情况下得到充分护理。然而，孕周26周及以下的婴儿应最好在出生前转至三级护理中心，因为他们通常需要机械通气。
