Clinical application of optimization strategy of early respiratory support in the management of respiratory distress syndrome-high-risk premature infants

Abstract

Objective To study the clinical application of optimization strategy of early respiratory support in the management of respiratory distress syndrome(RDS)-high-risk premature infants, such as early continuous positive airway pressure (CPAP) + selective pulmonary surfactant (PS), and its clinical significances. Methods From June 2011 to May 2016, a total of 95 cases of RDS-high-risk premature infants with spontaneously breathing were enrolled in Central Hospital of Karamay City, whose gestational age were ≤ 32 weeks or birth weight were < 1 200 g . According to different early respiratory support treatment strategies, they were divided into two groups. From December 2013 to May 2016, a total of 57 cases of RDS-high-risk premature infants were enrolled as the study group and they were studied by prospective analytical studies method, during this period the optimized early respiratory support treatment strategy (early CPAP + selectivity PS-based strategy) was applied for early intervention. From June 2011 to November 2013, the clinical data of 38 cases of RDS-high-risk premature infants were selected as the control group and they were studied by retrospective analytical method, during that period the early prophylactic PS was recommended as early respiratory support strategy. Rate of prophylactic PS usage, rate of total PS usage, intubation rate in the first five days after birth, mechanical ventilation (MV) rate in the first five days after birth, incidence of RDS, mortality of RDS , incidence of bronchopulmonary dysplasia (BPD) between two groups were analyzed by statistical method. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Central Hospital of Karamay City. Informed consent was obtained from the parents of each participating neonate. Results ①There were no statistical differences beween two groups in the gestational age, birth weigth, ratio of gender, the severity of respiratory embarrassment, negative rate of gastric foam test, rate of uterine-incision delivery and high-order birth rate (P>0.05). ②In study group, rate of prophylactic PS usage, rate of total PS usage, intubation rate in the first five days after birth were much lower than those in control group, and the differences were statistically significant (χ2=27.880, 11.515, 13.068; P 0.05). Conclusions RDS-high-risk premature infants treated by optimized strategies based on early CPAP + selective PS can significantly reduce the rate of prophylactic PS usage, rate of total PS usage, and intubation rate in the first five days after birth, while it does not increase the incidence of adverse events, such as the mortality of RDS-high-risk premature infants and the incidence of BPD. Curative effect of optimization strategy of early CPAP + selective PS is good for the treatment RDS-high-risk premature infants in this study. As the sample size in this study is small, whether it is worthy of wide clinical application in primary hospitals, multi-center and large-sample randomized controlled trial (RCT) will be needed to confirm. Key words: Respiratory distress syndrome, newborn; Infant, premature, diseases; Treatment strategy; Continuous positive airway pressure; Pulmonary surfactants