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Objective:To evaluate the effects of quality improvement (QI) program on the incidence of bronchopulmonary dysplasia (BPD) in very preterm infants (VPIs) [gestational age (GA)<32 weeks].Methods:From July to December 2017,VPIs admitted to the Department of Neonatology of Yancheng Maternity and Child Health Care Hospital were retrospectively enrolled and were assigned into pre-quality improvement program group (Pre-QI group).From July to December 2018, VPIs were assigned into post-quality improvement program group (Post-QI group). QI program included delayed umbilical cord clamping (DCC), early postnatal nasal continuous positive airway pressure ventilation (nCPAP) and minimally invasive pulmonary surfactant therapy (MIST). The clinical data and prognostic indicators of the two groups of VPIs and their mothers were compared. Independent sample t-test or continuity-adjusted Chi-square test (or Fisher's exact test) and Logistic regression were used for statistical analysis. Results:A total of 204 VPIs were enrolled, including 96 cases in Pre-QI group and 108 cases in Post-QI group. 1 min Apgar score and hematocrit on admission to the neonatal intensive care unit (NICU) in the Post-QI group were significantly higher than the Pre-QI group( P<0.05). The incidence of delivery room resuscitation, endotracheal intubation at birth and endotracheal intubation in NICU in the Post-QI group were significantly lower than the Pre-QI group( P<0.05). The application of pulmonary surfactant and mechanical ventilation, the incidence of neonatal respiratory distress syndrome and BPD in the Post-QI group were lower than the Pre-QI group ( P<0.05). After adjusting for confounding factors, Logistic regression analysis showed that DCC ( aOR=0.261,95% CI 0.091~0.718, P=0.023), nCPAP ( aOR=0.284,95% CI 0.123~0.667, P=0.015), MIST ( aOR=0.276,95% CI 0.114~0.627, P=0.011) were protective factors of BPD, and MV ( aOR=2.023,95% CI 1.048~3.918, P=0.036) was risk factor of BPD. Conclusions:The QI program consisting of DCC, early nCPAP and MIST for VPIs can reduce the incidence of BPD.
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Background:Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly leading to progressive left ventricular dysfunction and mitral regurgitation. We conducted this study to investigate various measures to optimize the outcomes of surgical correction for ALCAPA. Materials And Methods: This was a single?centre, retrospective, observational study including consecutive patients operated for ALCAPA. The main outcomes evaluated were in?hospital mortality, duration of mechanical ventilation, and duration of intensive care unit (ICU) stay. Independent sample t? test and Fisher’s exact test were used for the analysis of continuous and categorical variables respectively. Results: 31 patients underwent surgical correction for ALCAPA during the study duration. The median age was 7.3 months with a range of 21 days to 25 months. All patients underwent coronary re?implantation with the coronary button transfer technique. There was no in?hospital mortality, the mean duration of mechanical ventilation and ICU stay was 117.6 hours and 10.7 days respectively. Age at admission, development of acute kidney injury after surgery, lactate levels at 12? and 24?hours post?surgery, and heart rate at ICU admission and 12?hours post?surgery were significantly associated with mechanical ventilation duration longer than 48 hours. Use of a combination of levosimendan and milrinone and elective intermittent nasal continuous positive airway pressure ventilation after extubation in all patients with severe left ventricular dysfunction were helpful in preventing low cardiac output and need for reintubation post?surgery respectively. Conclusion: Surgical correction for ALCAPA by coronary re?implantation has an excellent short?term outcome. Optimal postoperative management is of utmost importance for achieving the best results.
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Objective To describe the early use of nasal continuous positive airway pressure (nCPAP) ventilation for infants presenting acute congestive heart failure (CHF) complicated by congenital heart disease (CHD) and pulmonary artery hypertension (PH).Methods Sixty infants with CHD treated for acute CHF were randomly divided into the nCPAP group (n =32) and the non-nCPAP group (n =28).Data were analyzed,which included lactic acid value (Lac) by arterial blood gas analysis,calculation of oxygenation index [pa (O2)/FiO2],detection of serum N-terminal pro-brain natriuretic peptide of type B (NT-proBNP) level,determination of left ventricular end diastolic volume index (LVEDVI),left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) by noninvasive bedside ultrasonic cardiogram (UCG).Results 1.Comparison of arterial blood gas between the 2 groups:1 d after treatment,there were significant differences in pa (O2)/FiO2 and Lac between the 2 groups (t =4.743,5.402,all P ＜ 0.05).A significant difference was found in the pa (O2)/FiO2 between the nCPAP group and the non-nCPAP group 3-7 d after treatment(t =6.366,P ＜ 0.05).The level of Lac had no significant difference between the 2 groups 3-7 d after treatment(t =1.812,P ＞ 0.05).2.Comparison of index of heart function between the 2 groups:after 3-7 d treatment,LVEDVI,LVEF,and PASP were statistically different between the 2 groups (t =2.052,2.704,2.019,all P ＜0.05).3.Comparison of serum indexes between the 2 groups:3-7 d after treatment,serum NT-proBNP level was improved dramatically compared with the non-nCPAP group(t =9.869,P ＜0.05).4.Comparison of clinical prognosis between the 2 groups:the differences in needing endobronchial intubation rate,mechanical ventilation time,time in PICU and mortality rate were all statistically significant between the 2 groups (x2 =5.505,P =0.019; t =4.788,P =0.000;t =5.068,P =0.000 ;x2 =4.284 ;P =0.038).Conclusions The early use of noninvasive nCPAP for eligible patients with acute CHF complicated by CHD and PH seems to improve their prognosis by improving pa (O2)/FiO2,reducing left ventricular and right ventricular afterload and improving the left ventricular function.
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The objective of this study was to determine the feasibility of the use of continuous positive airway pressure installed prophylactically in the delivery room (DR-CPAP), for infants with a birth weight between 500 and 1000 g in settings with limited resources. During 23 months, infants with a birth weight between 500 and 1000 g consecutively received DR-CPAP. A total of 33 infants with low birth weight were enrolled, 16 (48.5%) were females. Only 14 (42.4%) received antenatal corticosteroids and only 2 of those 14 (14.3%) infants weighing 500-750 g were not intubated in the delivery room, and apnea was given as the reason for intubation of these patients. Of the 19 infants in the 751-1000 g weight range, 9 (47.4%) were intubated in the delivery room, 6 due to apnea and 3 due to respiratory discomfort. For DR-CPAP to be successful, it is probably necessary for preterm babies to be more prepared at birth to withstand the respiratory effort without the need for intubation. Antenatal corticosteroids and better prenatal monitoring are fundamental for success of DR-CPAP.
Subject(s)
Female , Humans , Infant, Newborn , Male , Continuous Positive Airway Pressure , Infant, Very Low Birth Weight , Respiratory Distress Syndrome, Newborn/therapy , Brazil , Delivery Rooms , Developing Countries , Feasibility Studies , Infant, PrematureABSTRACT
Objective To study the influence of long-term home noninvasive positive pressure ventilation (HNPPV) on respiratory muscle strength in patients with stable severe chronic obstructive pulmonary disease (COPD).Methods Sixty-four patients with stable severe COPD discharged from Huabei Oil-field Hospital,Renqiu,Hebei were divided into two groups,one (n=24) with HNPPV plus conventional therapy,and the other (n=40) with conventional therapy plus long-term oxygen therapy as controls.All parameters were followed-up for one-year and compared for the two groups,including maximal iuspiratory pressure (MIP),transdiaphragmatic pressure (Pdi),maximal transdiaphragmatic pressure (Pdimax),ratio of Pdi/Pdimax,arterial partial pressure of carbon dioxide (PaCO2),forced expiratory volume in one second (FEV1),6-min walking distance (6MWD),mortality and re-hospitalization rate.Results Age,gender,course of the disease,body mass index (BMI),arterial PaCO2,PaO2,MIP,Pdi,Pdiraax,ratio of Pdi/ Pdimax,FEV1,ratio of FEV1/FVC%,6MWD and re-hospitalization rate of the patients between the two groups were all comparable (P>0.05).In one-year follow-up,PaCO2averaged (52±8)mm Hg,MIP (64±7) cm H2O,Pdi (33±5) cm H2O,Pdimax (101±9) cm H2O,Pdi/Pdimax (0.31±0.04),FEV1 (35±4) %,FEV1/FVC% (44±4) %,6MWD (272±26) m and (2.6 ± 0.8) admissions per year in the HNPPV group,significantly different from those in the control group [ (57 ± 6) mm Hg,(59 ± 6) cm H2O,(31±4) cm H2O,(84±7) cm H2O,(0.35±0.05),(33±3)%,(41±4)%,(212±28) m,and (3.7±0.8) admissions per year] (P<0.05).One death was observed in the HNPPV group (1/24) and three in the control group (3/4 0) in one - year follow - up,with no statistically significant difference (X2=0.00,P>0.05).Conclusions Long-term use of HNPPV for patients with stable severe COPD could efficiently improve their respiratory muscle strength and endurance,thus improving their pulmonary ventilation and treatment efficcacy.
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Objective To explore the changes of arterial pressure in patients with snore during sleep and to increase the acknowledge for the relationship between obstructive sleep apnea syndrome(OSAS) and hypertension(HT).Methods 266 patients with snoring were monitored during overnight nocturnal sleep monitored with Autoset diagnosis-treatment system and measured arterial pressure before and after sleep.166 patients of them as OSAS group,the other 100 patients as controls.Data for each group such as Apnea Index,SaO 2 and arterial pressure were chosen for statistical analysis.Results The blood pressure in OSAS group before sleep was(128 94?19 32/87 46?12 30)mmHg,after sleep was(139 66?19 38/99 68?16 28)mmHg(P