Predictors of Success Rate in Different Initial Respiratory Supports in Very Low Birthweight Infants with Respiratory Distress.

Minoo Fallahi,Seyyed Abolfazl Afje,Mitra Radfar,Ahmad Reza Shamshiri,Naeeme Taslimi Taleghani,Majid Jafari,Fatemeh Esmaili

doi:10.34172/aim.2020.96

Abstract

Ideal respiratory support for very low birth weight infants (VLBW) can be selected based on demographic and clinical status at birth. In this prospective cohort study, we included 163 VLBW neonates treated with either invasive or non-invasive respiratory support in their first 72 hours of life in the neonatal intensive care unit of Mahdiyeh hospital, Tehran, Iran. We used descriptive statistics to describe the data, and multiple logistic regression to determine the factors associated with the success rate of different strategies and the choice of strategy for primary respiratory support. All analyses were done using SPSS version 20 and STATA version 12 at a significance level of 0.05. The success rates of initial respiratory supports with nasal continuous positive airway pressure (NCPAP), noninvasive positive pressure ventilation (NIPPV), and INSURE (intubation surfactant extubation) were 63.20%, 42.10% and 61.90%, respectively. The results of multiple logistic regression analysis showed patent arterial duct (PDA) (yes vs. no: OR = 0.42) had a significant effect on initial respiratory support success (P<0.05). Also, gestational age (>28 vs. ≤28 weeks: OR = 0.26) and 5-min APGAR (≤6 vs. >6: OR = 9.69) had a significant effect on the choice of initial respiratory support in VLBW infants (P<0.05). The neonatal clinical condition may be a predictor of success for initial respiratory support at birth. Since the arterial duct may be open during the first hours of life, more study is needed to verify if early closure of the arterial duct may help increase the success rate of non-invasive respiratory support.

Highlights

Neonatal respiratory distress syndrome (RDS) is the most common respiratory disease in infants, which can lead to respiratory failure due to lack of alveolar surfactants, and is one of the major causes of their death
All neonates under 1000 grams needing nasal continuous positive airway pressure (NCPAP) with positive end-expiratory pressure (PEEP) of about 4–6 cmH2O were transferred to NICU, unless there was no spontaneous breathing or the patient suffered from gasping, which would necessitate intubation
Better understanding of the physiology of RDS and the importance of preserving functional residual capacity (FRC) in its treatment have resulted in studies comparing early CPAP strategies and early surfactant therapies

Summary

Introduction

Neonatal respiratory distress syndrome (RDS) is the most common respiratory disease in infants, which can lead to respiratory failure due to lack of alveolar surfactants, and is one of the major causes of their death. The results of multiple logistic regression analysis showed patent arterial duct (PDA) (yes vs no: OR = 0.42) had a significant effect on initial respiratory support success (P < 0.05). Since the arterial duct may be open during the first hours of life, more study is needed to verify if early closure of the arterial duct may help increase the success rate of non-invasive respiratory support.

Methods

Results

Conclusion