ABSTRACT
Objective:To study the risk factors of failure using nasal high frequency oscillatory ventilation (nHFOV) as initial therapy in the treatment of respiratory distress syndrome (RDS) in very low birth weight infants (VLBWIs).Methods:From January 2018 to December 2021, VLBWIs with RDS initially supported by nHFOV in NICU of our hospital were retrospectively analyzed. They were assigned into success and failure groups according to the ventilation efficacy. Demographic data and clinical outcomes of the two groups were compared. Risk factors of initial nHFOV failure were analyzed using binary Logistic regression method.Results:A total of 135 infants were included, including 103 in the success group and 32 in the failure group. The initial nHFOV failure rate was 23.7%. The failure group had lower pH (7.26±0.09 vs. 7.33±0.08) and PaO 2 [61.0 (49.6, 77.2) mmHg vs. 83.6 (64.4, 99.0) mmHg] than the success group ( P<0.05) and higher PaCO 2 than the success group [49.0 (42.3, 58.1) mmHg vs. 43.4 (36.0, 50.0) mmHg] ( P<0.05). Using PaCO 2 as predictor, the area under the curve (AUC) was 0.682 (95% CI 0.575-0.788) and the cut-off value was 44.8 mmHg for nHFOV failure and the AUC was 0.716 (95% CI 0.615-0.817) and the cut-off value was 67.1 mmHg for nHFOV success. The incidences of early onset sepsis (EOS), shock within 3 d and hemodynamically significant patent ductus arteriosus (hsPDA) in the failure group were significantly higher than the success group (40.6% vs. 7.8%, 53.1% vs. 2.9%, 31.3% vs. 13.6%, P<0.05, respectively). Binary logistic regression analysis found that PaO 2<67.1 mmHg ( OR=5.458,95% CI 1.730-17.220) on the first blood gas analysis and shock within 3 d ( OR=26.585,95% CI 3.854-183.396) were independent risk factors for initial nHFOV failure ( P<0.05). Conclusions:The failure of initial nHFOV is correlated with the first blood gas parameters, EOS, hsPDA and shock within 3 d. Shock within 3 d and low PaO 2(<67.1 mmHg) were independent risk factors for initial nHFOV failure.
ABSTRACT
Objective To study the expression of high mobility group box protein 4 (SOX4) and β-catenin in lung tissues of preterm rats with hyperoxia exposure,and to study its significance.Method One-day-old preterm Sprague Dawley rats were randomly assigned into 4 groups:95％ hyperoxia group,70％ hyperoxia group,45％ hyperoxia group and air group.After three days,pathological changes of the lung tissues were observed by hematoxylin eosin staining,the mRNA expressions of SOX4 and β-catenin in lung tissues were detected by semi-quantitative reverse transcription polymerase chain reaction,and the protein expressions of SOX4 and β-catenin in the lung tissues were measured by western blot.Result The structure of lung tissues in air group was normal.45％ hyperoxia group represented mainly effusion and inflammatory cell infiltration,70％ and 95％ hyperoxia group showed acute lung injury characterized by inflammatory cell infiltration,hyperaemia,hemorrhagic change,disorganization and collapse of alveolar.The expressions of SOX4 mRNA and protein were highly elevated in all hyperoxia groups than that in air group (P ＜ 0.01);Compared with 45％ hyperoxia group,the expressions of SOX4 mRNA and protein were higher in 95％ hyperoxia group (P ＜ 0.01).β-catenin mRNA,total β-catenin protein and nuclear β-catenin protein were also highly elevated in hyperoxia groups compared with air group (P ＜ 0.05).Compared with 45％ hyperoxia group,the expressions of β-catenin mRNA and total β-catenin protein were also highly raised in 70％ hyperoxia group and 95％ hyperoxia group (P ＜ 0.05).The expression of nuclear β-catenin protein was higher in 95％ hyperoxia group than that in 45％ hyperoxia group (P ＜ 0.01).Conclusion The mRNA and protein expressions of SOX4 and β-catenin in lung tissues of preterm rats were increased by hyperoxia exposure.This mechanism may take part in hyperoxia-induced preterm rats lung injury.