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OBJECTIVE@#To study the clinical effect of calsurf, a domestic exogenous pulmonary surfactant, in the treatment of severe neonatal infectious pneumonia.@*METHODS@#A total of 208 neonates with severe infectious pneumonia who hospitalized in 5 hospitals of China were enrolled. According to their parents' wishes on admission, these neonates were administered with conventional treatment (control group; n=81) and calsurf treatment + conventional treatment (calsurf treatment group, n=127). The two groups were compared in terms of the degree of oxygen dependence on admission, blood gas parameters before and after treatment, lung ultrasound results, duration of mechanical ventilation, length of hospital stay, hospital costs, complications and prognosis.@*RESULTS@#Compared with the control group on admission, the calsurf treatment group had significantly higher inhaled oxygen concentration and partial pressure of carbon dioxide and significantly lower arterial partial pressure of oxygen and oxygenation index (P<0.01). After 1 hour of treatment, both groups had significant improvements in the above indices (P<0.05), and the improvements were more significant in the calsurf treatment group (P<0.05). After 4-6 hours of calsurf administration, there was a significant reduction in the degree of pulmonary consolidation. The calsurf treatment group had significantly shorter duration of mechanical ventilation and length of hospital stay than the control group, while there was no significant difference in the incidence rate of complications between the two groups. The neonates of both groups had a good prognosis.@*CONCLUSIONS@#In neonates with severe infectious pneumonia, calsurf treatment can significantly improve oxygenation, reduce the degree of pulmonary consolidation, and shorten the duration of mechanical ventilation and length of hospital stay. Therefore, it should be considered in neonates with severe infectious pneumonia.
Subject(s)
Humans , Infant, Newborn , China , Pneumonia , Prospective Studies , Pulmonary Surfactants , Respiration, ArtificialABSTRACT
Objective To investigate the effect of neurally adjusted ventilator assist(NAVA) and synchronized intermittent mandatory ventilation(SIMV) on respiratory function in premature infants with respiratory distress syndrome.Methods A total of 54 preterm infants who were diagnosed neonatal respira-tory distress syndrome after birth and needed invasion mechanical ventilation in our hospital from Oct.2014 to Dec.2016 were given SIMV for 4 hours and NAVA mode ventilation for 4 hours,with a total of 4 cycles.The peak inspiratory pressure(PIP),tidal volume(TV),Compliance,respiratory rate(RR),Edi peak,Edi min, FiO2and mean airway pressure(MAP) were monitored every 30 minutes, and pressure of carbon dioxide (PaCO2)were monitored every 2 hours in different modes.Results The mean values of PIP[(19.5 ± 3.1) cmH2O,1 cmH2O=0.098 kPa],RR[(51.4 ± 7.9)breaths/min],Edi peak[(5.1 ± 3.2)μV],FiO2[(38.2 ± 12.9)%],MAP[(12.0 ± 0.8)cmH2O],PaCO2[(41.2 ± 9.3)mmHg,1 mmHg=0.133 kPa] and Edi min[(1.2 ± 1.4)μV] in NAVA mode were significantly lower than those in SIMV mode[(22.9 ± 3.4) cmH2O,(56.9 ± 8.3)breaths/min,(7.9 ± 4.9)μV,(39.9 ± 14.1)%,(13.2 ± 0.7)cmH2O,(47.1 ± 10.4)mmHg,(2.0 ± 1.7)μV,respectively](P<0.05).But the mean values of TV,Compliance in SIMV mode[(6.2 ± 1.0)ml/kg,(0.25 ± 0.33)ml/cmH2O,respectively] were significantly lower than those in the NAVA mode[(7.2 ± 0.9)ml/kg,(0.37 ± 0.21)ml/cmH2O,respectively](P<0.05).The downward trend of PIP,RR,Edi peak,FiO2,Edi min,MAP and upward trend of TV,Compliance were found during the first circle from NAVA mode to SIMV mode.The decrease and increase of above ventilator parameters were more obvious in NAVA mode compared with SIMV mode.Conclusion The respiratory muscle load is reduced, TV increases,and pulmonary compliance improves during NAVA ventilation.NAVA is better than SIMV in improving respiratory function of premature infants with respiratory distress syndrome. NAVA has lung protective effect.
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Objective To investigate the dynamic changes and influencing factors of peripheral blood white blood cells (WBC), differential counts (DCs) and platelet (PLT) count in preterm infants to understand the changing characteristics of these blood parameters in preterm infants of different postnatal age, gestational age, and birth weight.Methods Totally 2 849 preterm infants admitted to the Department of Neonatology of Northwest Women's and Children's Hospital from November 30, 2011 to November 30, 2014 were retrospectively analyzed except for those diagnosed with infectious diseases, hematological system diseases, or immunologic diseases.All of the subjects were divided into seven groups based on their postnatal age, three groups based on gestational age and three groups based on birth weight, or male and female groups, respectively.Peripheral blood samples were obtained for determination of WBC, DCs and PLT.Statistical analysis was performed with oneway analysis of variance, t-test and Spearman linear correlation analysis.Results WBC, neutrophil (Ne), lymphocyte (Ly), monocyte (Mo), eosinophil (Eo), basophil (Ba) and PLT counts were significantly different among the seven groups of preterm babies of different postnatal age (F=172.00, 364.90, 34.88, 14.22, 80.82, 168.10 and 86.64, respectively, all P ＜ 0.01).WBC was found to be at the peak value within one day after birth [(18.40±6.87)× 109/L], followed by remarkable decrease in day ＞ 2-≤ 5 [(10.62±4.68)× 109/L], further gradual decrease thereafter, and then being stable in day ＞ 14-≤ 21 and ＞ 21 ≤≤ 30 [(10.54±3.09)× 109/L and (10.27 ± 3.70) × 109/L, respectively].PLT counts showed no significant change within one day after birth and in day ＞ 1-≤ 2 [(240.56± 63.54)× 109/L and (240.85 ± 71.47) × 109/L, respectively], then began to increase in day ＞ 2-≤ 5 [(249.21 ±80.55)× 109/L], peaked in day ＞ 7-≤ 14 [(339.11 ± 121.84)× 109/L], and decreased gently and became stable finally.The changing trends of Ne and Ly were cross and inverted in day ＞ 5-≤ 7.WBC, Ne, Ly, Mo, Eo, Ba and PLT counts of the preterm infants were all correlated with the postnatal age shown by Spearman linear correlation analysis (r=-0.46,-0.60, 0.18,-0.07, 0.33,-0.47 and 0.29, respectively, all P ＜ 0.01).With the increase of gestational age, WBC, Ne, Mo, and PLT counts increased, but Ly and Eo counts decreased.And all of the above showed significant difference (F=81.00, 124.49, 13.34, 18.35, 5.35 and 4.11, respectively, all P ＜ 0.05).While, the WBC, Ne, Mo, Ba and PLT counts showed positive relationship with the increase of birth weight (F=122.12, 133.09, 39.38, 13.77 and 21.24, respectively, all P ＜ 0.05).WBC, Ne and PLT counts of female infants were higher than those of male babies (t=l 6.35, 16.72 and 13.19, respectively, all P ＜ 0.05).Conclusions The peripheral WBC, DCs and PLT counts of preterm infants change dynamically with postnatal age with the remarkable variations on day ＞2-≤ 5 after birth and stable after 14 days of age.WBC, DCs and PLT counts might all be influenced by gestational age, birth weight and gender to some cxtend.