ПРЕДИКТОРЫ ПОТРЕБНОСТИ В ИСКУССТВЕННОЙ ВЕНТИЛЯЦИИ ЛЕГКИХ У НЕДОНОШЕННЫХ НОВОРОЖДЕННЫХ ДЕТЕЙ ПОСЛЕ МАЛОИНВАЗИВНОГО ВВЕДЕНИЯ БЕРАКТАНТА

Abstract

The purpose of the study was to predict the ineffectiveness of the first injection of Beractant by a minimally invasive method in the first 6 hours of life and the use of artificial lung ventilation (ALV) in premature newborns with a gestational age (GA) of less than 32 weeks with respiratory distress syndrome (RDS) at the age of 72 hours of life. Materials and methods of the research: a multicenter, retrospective, cohort study was carried out. Nine perinatal centers from different Russia regions took part in the research from July 1, 2019 till June 30, 2020. A total of 102 premature newborns at the GA of less than 32 weeks participated in the survey. The 100 mg/kg Beractant was used in the first and repeated injections of surfactant. The first injection was allowed at the age of not later than 6 hours of life. The authors have studied the methods of injection by a thin catheter represented by the term less invasive surfactant administration (LISA) or through an endotracheal tube using INSURE method, which consists of an intubation-surfactant-extubation sequence. The two comparison groups of patients were formed. Group 1 of 69 children “without ALV”: after the introduction of Beractant the patients had needed non-invasive respiratory support (non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP)). Group 2 of 33 children “with ALV”: needed intubation trachea and invasive ALV during the first 72 hours of life. Results: both groups did not differ statistically significantly in terms of gender, GA, body weight and length at birth, as well as in the APGAR score. The statistically significant differences were found in the duration of the anhydrous interval (Me [Q1; Q3] in children “without ALV” 72.0 [27.0; 95.0] hours versus 15.0 [6.8; 59.2] hours in children “with ALV,” p=0.035) and by the level of C-Reactive Protein (CRP) in the blood: the median (Me) maximum value in children “without ALV” was 8.0 [7.4; 10.0] mg/l versus 19.45 [11.2; 28.7] mg/l in in children “with ALV.” The risk of transfer to ALV in those children who were injected with Beractant using INSURE was 3,625 [1,137; 11,552] times higher than in those who were administered using LISA. Conclusion: the predictors for ALV in the first 72 hours of life in premature newborns with GA of less than 32 weeks are a short anhydrous period and a high level of CRP in the child's blood. The use of the INSURE method in comparison with LISA adds about 3.6 times higher risk of need for the ALV in patients with RDS in the first 72 hours of life (in the selection described in the article).