Using of sustained lung inflation method in newborn suffering with RDS during their stabilization in delivery room

Abstract

Using of sustained lung inflation (SLI) during newborn stabilization in delivery room, as a new strategy of therapy in newborn with RDS. The aim: to study the efficiency of sustained lung inflation (SLI) during stabilization in delivery room in the very preterm in infants suffering from respiratory distress syndrome (RDS). Material and methods: 122 infants born 23.01.2012 to 07.09.2014 in Zhytomir Oblast Perinatal Center. The infants were 28,2 ± 1.9 weeks old, weighed 1097 [540 - 1500] g., and had the clinical signs of RDS. Two group of infant were observed: a group of newborn (n = 68, index group), was provided of sustained lung inflation (SLI) during stabilization in delivery room and control group (n = 54), without using sustained lung inflation (SLI) during stabilization. All the newborns were administered surfactant replacement therapy with the help of Curosurf® by the technique of minimally invasive surfactant treatment (MIST) on the background of “lungs involvement”. The both methods were compared and tested for death, IVH, PVL, BPD, pneumothorax frequency. The investigation is done within the framework of comparison with historical control. Results: no complications were observed during using of sustained lung inflation in delivery room in the very preterm in infants suffering from respiratory distress syndrome. The infants tolerated the administration well. The investigation revealed no increase in duration of oxygen therapy in the infants of index group versa those of control group. The comparison of using SLI in delivery room and not using SLI in delivery revealed difference in duration of primary ventilator support, so the need of mechanical ventilation in index group were less versa control group: 50.0% newborn needed only CPAP therapy versa 38.9% newborn (р = 0,29). The research detected tendency to more less of duration of CPAP therapy in index group (p = 0.07). The investigation revealed no statistical discrepancy in the developmental frequency of severe BPD in the number of the infants who undergoing SLI in delivery room and in the number of newborn with standard method of stabilization in delivery room: 11.8% vs. 9.3%, accordingly (p=0,88), in severe IVH: 7.4% vs. 7.4.%, accordingly (p=0,73), incidence of periventricular leukomalacia: 4.4% versa 1,9%, accordingly (р = 0,79), in the incidence of air leak syndrome: 1.5% versa 1.9%, accordingly (р = 0,59). The observation revealed no statistical discrepancy in death or BPD frequency in the infants (weighed from 500 till 999 g) of the index group versa those of the control group (accordingly 58.6% versa 42.9%, (р = 0,42); in severe IVH and BPD: 13.8% vs. 9.5.%, accordingly (p=0,98) and 17.2% vs. 9.5.%, accordingly (p=0,72). Using of sustained lung inflation (SLI) during newborn stabilization in delivery room, which needed surfactant-replacement therapy, doesn’t have any positive effect compare with newborn in standard treatment: using PPV (positive pressure ventilation). Further investigations to study the clinical efficacy of sustained lung inflation (SLI) during newborn stabilization in delivery room are needed especially in newborn less 28 weeks gestation age.