Синдром дыхательных расстройств у детей с экстремально низкой массой тела при рождении: особенности проведения неинвазивной респираторной терапии в раннем неонатальном периоде

Abstract

The aim of this study was to evaluate the efficacy of non-invasive respiratory therapy using the method of dual positive airway pressure (DuoPAP) via nasal prongs performed in the intensive care unit and neonatal intensive care unit in premature newborns with extremely low body weight and respiratory distress syndrome in the early neonatal period. We conducted a retrospective analysis of 55 medical records of premature newborns treated in the intensive care unit of the Perinatal Center at S.S. Yudin City Clinical Hospital during the first 7 days of their life. We included patients treated between January 2018 and December 2019. All newborns had extremely low body weight (850 ± 149 g); mean gestational age was 28 ± 4 weeks; Apgar score at the first minute of life varied between 3 and 6; Silverman Anderson score (severity of respiratory disorders) was between 3 and 5 s. Standard examination was performed in accordance with current protocols developed by Russian and foreign specialists in neonatal medicine. A specially developed clinical protocol of the study was approved by the local ethics committee. Study participants were divided into 3 groups according to their type of spontaneous respiratory efforts, target level of preductal saturation, and Silverman Anderson score. Patients in Group I received synchronized intermittent mandatory ventilation (SIMV); patients in Group II received ventilation using DuoPAP via nasal prongs (if it was ineffective, we considered SIMV via tube); patients in group III received ventilation using DuoPAP only. In this study, we have identified indications and contraindications for initial and prolonged respiratory therapy with DuoPAP and developed main practical recommendations for effective and safe application of DuoPAP. The efficacy and safety of non-invasive respiratory therapy with DuoPAP via nasal prongs in extremely premature infants with respiratory distress syndrome in the early neonatal period is primarily determined by the newborn’s readiness for active spontaneous and productive respiratory movements, but not only by the compensated parameters of the acid-base state and gas composition of the capillary blood. The assessment of feasibility and limitations of non-invasive respiratory therapy with DuoPAP is an important step towards developing a clinical protocol for respiratory therapy in the early neonatal period in a neonatal intensive care unit; it will help to reduce the use of invasive lung ventilation. Key words: premature newborns, non-invasive respiratory therapy, respiratory distress syndrome, extremely low body weight