ABSTRACT
Objective:To explore the clinical therapeutic effect and follow-up prognosis of preterm infants with neonatal respiratory distress syndrome (NRDS) managed by less invasive surfactant administration (LISA) and traditional intubation-surfactant-extubation (INSURE) of pulmonary surfactant (PS).Methods:Data during hospitalization and follow-up period of 187 NRDS preterm infants (gestational age 24 weeks to 31 + 6 weeks, and birth weight <1 500 g) admitted to the Department of Neonatology, the Women and Children′s Hospital of Chongqing Medical University from March 2019 to February 2021 were retrospectively analyzed.NRDS preterm infants who were injected with PS by LISA were included in the LISA group (144 cases), and those who were injected with PS by INSURE were included in the INSURE group (43 cases). The propensity score matching method was used to correct the confounding factors between groups, and the covariate equilibrium samples between groups were obtained (39 cases in each group). Clinical treatment effect and prognosis of physical development, hearing and vision development, nervous system development, respiratory system diseases and other conditions of the two groups of children were compared using the t test, Chi- square test and other statistical analysis methods as appropriate. Results:(1)Compared with that of the INSURE group, the incidence of BPD [12 cases (33.3%) vs.23 cases (63.9%), χ2=6.727, P=0.009] and ROP [13 cases (36.1%) vs.26 cases (72.2%), χ2=9.455, P=0.002] in the LISA group were significantly lower.The incidence of mild BPD [8 cases (22.2%) vs.16 cases (44.4%), χ2=4.000, P=0.046] and stage Ⅰ-Ⅱ ROP [11 cases (30.6%) vs.22 cases (61.1%), χ2=6.769, P=0.009] in the LISA group was significantly lower than that of the INSURE group.There was no significant difference in the incidence of moderate and severe BPD and stageⅢ ROP and above between groups (all P>0.05). (2)There were no statistical differences in the repeated use of PS, mechanical ventilation rate within 72 h, pneumothorax/pulmonary hemorrhage, grade Ⅲ-Ⅳ periventricula-rintraventricular hemorrhage, stage Ⅱ-Ⅲ neonatal necrotizing enterocolitis, sepsis, abnormal amplitude integrated electroencephalogram, mortality in 36 weeks of corrected gestational age, total oxygen inhalation duration and hospitalization duration between the two groups (all P>0.05). (3)Follow-up within 1 year of corrected age after discharge.There were no significant differences in extrauterine body mass, body length and head circumference development, visual development, hearing development, Neonatal Behavioral Neurological Assessment score at corrected gestational age of 40 weeks, Bayley Scales of Infants Development score at corrected gestational age of 6 months and age of 1 year, pneumonia and re-hospitalization due to respiratory diseases between groups (all P>0.05). Conclusions:PS administration with LISA technology can reduce the incidence of mild BPD and stage Ⅰ-Ⅱ ROP in premature infants with NRDS who had the gestational age of 24-31 + 6 weeks and birth weight<1 500 g, without increasing the risk of other complications.The long-term prognosis of them treated with PS administration with LISA and INSURE is similar.
ABSTRACT
Objective:To understand quality improvement (QI) in resuscitation and its impacts on the outcomes in very low birth weight infants (VLBWI).Methods:This was a retrospective study involving 318 cases of VLBWI born in Chongqing Health Center for Women and Children and transferred to the Neonatal Intensive Care Unit (NICU) in the same hospital from January 1, 2017 to December 31, 2019. All recruited VLBWIs were divided into three groups based on chronological order: pre-QI group (born in 2017, n=83), under-QI group (born in 2018, n=102) and post-QI group (born in 2019, n=133). The implementation and effects of different resuscitation strategies, including body temperature management, delayed cord clamping (DCC), respiratory support [continuous positive airway pressure (CPAP) in the delivery room, positive pressure ventilation or tracheal intubation] and oxygen therapy [initial fraction of inspired oxygen (FiO 2), maximum FiO 2 and pure oxygen resuscitation], and the neonatal outcomes in each year were analyzed and compared by trend Chi-square test, Kruskal-Wallis H test, Wilcoxon rank-sum test, analysis of variance and LSD test. Results:(1) The proportion of antenatal steroid exposure increased gradually during the three years [44.6% (37/83), 47.1% (48/102), 72.2% (96/133); χ2trend=18.218, P<0.001]. (2) From 2017 to 2019, the incidence of hypothermia on admission decreased [100.0% (83/83), 90.2% (92/102), 33.8% (45/133); χ2trend=136.042, P<0.001], without increasing the proportion of hyperthermia [0.0% (0/83), 1.0% (1/102), 0.0% (0/133); χ2trend=2.124, P=0.346]. (3) The proportion of VLBWIs receiving DCC increased annually [0.0% (0/83), 29.4% (30/102), 90.2% (120/133); χ2trend=178.659, P<0.001], and the concentration of capillary hemoglobin within 12-24 h after birth also increased [(190.1±34.8), (202.0±29.7), (213.6±32.3) g/L; LSD test, P<0.05]. The incidence of suspected polycythemia (capillary hematocrit >68%) increased annually[7.2%(6/83), 7.8%(8/102), 17.3(23/133); χ2trend=5.825, P=0.016]; While the incidence of confirmed polycythemia (venous hematocrit >65%) was not increased[1.3%(1/80), 2.0%(2/100), 4.8%(6/126); χ2trend=2.333, P=0.127] after excluding those untested cases. (4) The use of CPAP in delivery room increased annually [0.0% (0/83), 28.4% (29/102), 87.2%(116/133); χ2trend=167.721, P<0.001], while that of positive pressure ventilation [44.6% (37/83), 31.9% (32/102), 28.6% (38/133); χ2trend=5.371, P=0.020], and the proportion of intubation within 1 min after birth [100.0% (31/31), 45.0% (9/20), 35.0%(7/20); χ2trend=37.467, P<0.001] and overall intubation [37.3% (31/83), 19.6% (20/102), 15.0% (20/133); χ2trend=13.566, P<0.001] decreased year by year. There was no difference in the percentage of infants receiving chest compression or epinephrine, or with low Apgar scores during the three years (all P>0.05). (5) The initial inhaled FiO 2 [30%(21%-100%), 30%(21%-100%) vs 40(25%-100%)] as well as the highest FiO 2 [40%(21%-100%), 30%(21%-100%) vs 40%(25%-100%)] were significantly lower in 2018 and 2019 than in 2017(all P<0.017). The proportion of infants receiving pure oxygen resuscitation decreased year by year [13.3% (11/83), 1.0% (1/102), 0.8% (1/133); χ2trend=17.719, P<0.001]. There was no statistical difference in radial artery blood gas analysis, the proportion of infants receiving pulmonary surfactant or mechanical ventilation, the highest value of percutaneous bilirubin, the incidence of hyperbilirubinemia, necrotizing enterocolitis, periventricular intraventricular hemorrhage, bronchopulmonary dysplasia, or mortality during hospitalization (all P>0.05). Conclusions:Resuscitation QI program helps reduce the incidence of hypothermia, increased the hemoglobin level after birth, and lessen the use of positive pressure ventilation and tracheal intubation in VLBWIs, without influencing the resuscitation effect or increasing the risk of short-term adverse outcomes.