ABSTRACT
Objective To explore the effect of different method in preventing broncho-pulmonary dysplasia(BPD) in very low birth weight infants(VLBWI) during mechanical ventilation.Methods The gestational age of 71 infants with VLBWI was (30?2) weeks and the average weight was (1235.2?160.6)g.The infants were randomly divided into three groups,they received different therapeutic regimens during mechanical ventilation:32 cases were treated with permissive hypercapnia(PHC) ventilation in group Ⅰ;20 cases were treated by intratracheal instillation of pulmonary surfactant(PS) in group Ⅱ;19 cases were treated by inhalation of becotide(beclomethasone dipropionate,BDP) in group Ⅲ.The ventilator settings,blood gas analysis,clinical symptoms and therapeutic effect were statistically analyzed and compared.Results The peak inspiratory pressure(PIP) and ventilation rate(VR) of ventilator parameter were (18.3?1.6)cmH_2O and (35?5)bpm in group Ⅰ,there was significantly lower than that in group Ⅱ and group Ⅲ(P0.05).The incidence of BPD was 16%(5/32) in group Ⅰ,5%(1/20) in group Ⅱ and 5%(1/19) in group Ⅲ;The mortality rate of PHC group(group Ⅰ) was 6%(2/32) and 5%(1/20) in group Ⅱ.Conclusion The application of permissive hypercapnia,intracheal instillation of pumlonary surfactant and inhalation of becotide all can prevent effectively the occurrence of severe broncho-pulmonary dysplasia in VLBWI during mechanical ventilation.
ABSTRACT
Objective To explore the risk factors, pathogenic bacteria, drug resistance and corresponding measures of prevention and treatment on lower respiratory tract infection caused by extended-spectrum beta-lactamase-producing bacteria (ESBLPB) in neonates. Methods The patieats were from the neonatal intensive care unit(NICU) of The First People's Hospital of Zhaoqing from Jan. 1998 to Apr. 2001. The secretions of the lower respiratory tract were collected, and bacterial culture and antimicrobial susceptibility testing were done. Results There were 23 positive cases in the 42 cultured cases, and 12 cases out of 23 cases were ESBLPB positive. The positive rate of ESBLPB was 52%(12/23). Of them, 9 cases (75%) had the history of using the third generation cephalosporins, 10(83%) were under mechanical ventilations, 8(67%) were lowbirth weight infants and/or premature infants. There were 21 strains in 12 cases. They were 8(38%)Klebsiella pneumoniae, 5(24%)Enterobacter cloacae, 3(14%) Escherichia coli, 3(14%) Pseudomonas aeruginosa, 1(5%)Stenotrophomonas maltophilia, 1(5%) brevi-flavobacterium strains. The ESBLPBs were sensitive to imipenem, ciprofloxacin, amikacin, levofloxacin, ticarcillin-clavulanic acid, meropenem, piperacillin but resistant to other antibiotics. Ten out of the 12 cases were fully recovered from their infection. Conclusion There are multiple factors to increase the lower respiratory tract infections caused by ESBLPB in neonates. The effective measures associated with the infection prevention include intensive sterilization and isolation, and timely immunigation.