Caffeine combined with heated humidified high-flow nasal cannula in the treatment of respiratory distress syndrome in preterm infants / 中华急诊医学杂志

ABSTRACT

Objective To observe the clinical efficacy and safety of caffeine citrate combined with heated humidified high-flow nasal cannula (HHHFNC) in the treatment of respiratory distress syndrome (RDS) in preterm infants.Methods From June 2017 to December 2018,a total of 82 preterm infants with RDS (28 weeks ≤ gestational age＜32 weeks) who were hospitalized in Neonatal Intensive Care Unit of the Affiliated Xuzhou Hospital of Southeast University were chosen as research subjects.They were randomly (random number table method) divided into two groupsthe combined treatment group (n=42) and the control group (n=40).Infants in the combined treatment group were given caffeine citrate combined with HHHFNC,while infants in the control group were given nasal continuous positive airway pressure (NCPAP) without caffeine citrate.The general clinical data,results of blood gas analysis at 6 h and 24 h after breath support therapy,clinical efficacy,related complications and adverse drug reactions between the two groups were compared statistically by LSD-t test,Chi-square test and Kruskal-Wallis H rank sum test.Results ① No significant differences were found between the two groups in the general clinical data (all P＞0.05).② The results of intra-groups comparison within the combined treatment group or control group showed that the pH value,partial pressure of arterial carbon dioxide (PaCO2),partial pressure of arterial oxygen (PaO2) of blood gas analysis and PaO2/fraction of inspired oxygen (P/F) at 6 h and 24 h after breath support therapy were all significantly improved compared to those of before treatment (all P＜0.05);The PaO2 and P/F of premature infants in the combined treatment group at 6 h and 24 h after breath support therapy were significantly higher than those in the control group,while PaCO2 were significantly lower than that in the control group (all P＜0.05).③ The duration of noninvasive ventilation,total oxygen inhaling,failure rate of machine withdrawal,use of pulmonary surfactants,the rate of tracheal intubation within 72 h and the times of apnea in combined treatment group were 3.0 d (1.0,18.0)d,5.5 d (3.0,21.0)d,4 case(9.5％),10 case(23.8％),3 case(7.1％) and 6.0 times(3.0,21.0)times,which were significant shorter,or lower,or less than those in control group,which were 7.0 d (2.0,22.0),10.0 d (4.0,28.0),11 case(27.5％),19 case(47.5％),12 case(30.0％)and 15.0 times(4.0,28.0)times,and the differences were all statistically significant (all P＜0.05).④ The occurrence of nasal trauma,abdominal distention and head shaping in the combined treatment group were significantly lower than those in the control group (all P＜0.05).⑤ There were no significant differences between the two groups of premature infants in related complication and caffeine associated adverse reactions (all P＞0.05).Conclusions Caffeine citrate combined with HHHFNC treatment strategy for premature infants with RDS can effectively improve oxygenation,shorten the duration of noninvasive mechanical ventilation,increase the success rate of machine withdrawal,and reduce the incidence of nasal trauma and abdominal distention.