Clinical application of three non-invasive ventilation strategies in initial treatment of neonatal respiratory distress syndrome / 中国小儿急救医学

ABSTRACT

Objective:To evaluate the clinical effectiveness and safety of three different non-invasive ventilation strategies in initial treatment of neonatal respiratory distress syndrome(RDS).Methods:A total of 111 premature infants with RDS who were admitted to the NICU from Jan 2019 to Dec 2019 were divided into nasal continuous positive airway pressure(NCPAP)group( n=35), bi-level positive airway pressure(BiPAP)group( n=30)and nasal intermittent positive pressure ventilation(NIPPV)group( n=46)as an initial respiratory support.A retrospective study was conducted to compare pH, PaCO 2, PaO 2, P/F value(PaO 2/FiO 2)before 4 to 6 hours after treatment, the incidence of non-invasive ventilation failure, non-invasive ventilation time, invasive ventilation time, duration of oxygen therapy and the incidence of complications among the three groups. Results:Four to 6 hours after treatment, the blood gas indexes of pH, PaO 2 and P/F were significantly higher and PaCO 2 was significantly lower than those before the treatment in the three groups ( P<0.05). PaO 2 and P/F in both BiPAP group and NIPPV group were higher than those in NCPAP group ( P<0.05). PaCO 2 was lower in BiPAP group than that in NCPAP group ( P<0.05), but there were no statistical differences of the blood gas indexes between BiPAP group and NIPPV group ( P>0.05). The incidence of non-invasive ventilation failure was significantly lower in the BiPAP group and NIPPV group than that in NCPAP group ( P<0.012 5), while no signifficant difference was observed between BiPAP group and NIPPV group ( P>0.05). Moreover, no signifficant differences were found among three groups regarding non-invasive ventilation time, ventilation time of successful non-invasive ventilation, invasive ventilation time, duration of oxygen therapy and the incidence rates of bronchopulmonary dysplasia, necrotizing enterocolitis, periventricular-intraventricular hemorrhages, retinopathy of prematurity( P>0.05). Conclusion:NIPPV and BiPAP as an initial respiratory support for RDS in preterm infants augment the beneficial effects of NCPAP contributing to improvement of oxygenation, reduction of the rate of intubation within five days postnatal life without the relevant complications.