Risk factors for failure of nasal high frequency oscillatory ventilation as initial therapy in very low birth weight infants with respiratory distress syndrome / 中国新生儿科杂志

ABSTRACT

Objective:To study the risk factors of failure using nasal high frequency oscillatory ventilation (nHFOV) as initial therapy in the treatment of respiratory distress syndrome (RDS) in very low birth weight infants (VLBWIs).Methods:From January 2018 to December 2021, VLBWIs with RDS initially supported by nHFOV in NICU of our hospital were retrospectively analyzed. They were assigned into success and failure groups according to the ventilation efficacy. Demographic data and clinical outcomes of the two groups were compared. Risk factors of initial nHFOV failure were analyzed using binary Logistic regression method.Results:A total of 135 infants were included, including 103 in the success group and 32 in the failure group. The initial nHFOV failure rate was 23.7%. The failure group had lower pH (7.26±0.09 vs. 7.33±0.08) and PaO 2 [61.0 (49.6, 77.2) mmHg vs. 83.6 (64.4, 99.0) mmHg] than the success group ( P<0.05) and higher PaCO 2 than the success group [49.0 (42.3, 58.1) mmHg vs. 43.4 (36.0, 50.0) mmHg] ( P<0.05). Using PaCO 2 as predictor, the area under the curve (AUC) was 0.682 (95% CI 0.575-0.788) and the cut-off value was 44.8 mmHg for nHFOV failure and the AUC was 0.716 (95% CI 0.615-0.817) and the cut-off value was 67.1 mmHg for nHFOV success. The incidences of early onset sepsis (EOS), shock within 3 d and hemodynamically significant patent ductus arteriosus (hsPDA) in the failure group were significantly higher than the success group (40.6% vs. 7.8%, 53.1% vs. 2.9%, 31.3% vs. 13.6%, P<0.05, respectively). Binary logistic regression analysis found that PaO 2<67.1 mmHg ( OR=5.458,95% CI 1.730-17.220) on the first blood gas analysis and shock within 3 d ( OR=26.585,95% CI 3.854-183.396) were independent risk factors for initial nHFOV failure ( P<0.05). Conclusions:The failure of initial nHFOV is correlated with the first blood gas parameters, EOS, hsPDA and shock within 3 d. Shock within 3 d and low PaO 2(<67.1 mmHg) were independent risk factors for initial nHFOV failure.