Value of INSURE technology in respiratory support of very low and extremely low birth weight infants-analysis of 83 cases

Abstract

Objective To investigate the clinical value of INSURE technology in very low and extremely low birth weight infants requiring respiratory support.Methods From June 2010 to August 2012,83 cases of very low and extremely low birth weight infants who had difficulty in breathing and required respiratory support were admitted into First Hospital of Tsinghua University and divided into two groups:INSURE group (n=41) and mechanical ventilation (MV) group (n=42).Infants in INSURE group accepted intubate-pulmonary surfactant-extubate to continuous positive airway pressure and those in MV group accepted intubation with or without pulmonary surfactant treatment,and mechanical ventilation without extubation.Arterial blood gases at 1 h and 12 h after treatment were compared between the two groups by t test.The incidence of respiratory distress syndrome,ventilator associated pneumonia,air leaking,chronic lung disease,intracranial hemorrhage,retinopathy,leukoencephalomalacia disease were compared with Chi-square test.Hospitalization costs,duration of ventilation,oxygen inhalation and hospital stay were compared by rank-sum test.Results (1) PO2 in INSURE group after one hour of treatment were (78.7 ±11.5) mm Hg(1 mm Hg=0.133 kPa),which were higher than those before treatment [(50.1 ±10.8) mm Hg,t=9.737,P＜0.05]; while PCO2 was lower[(48.3±8.9) mm Hg vs (54.9±11.5) mm Hg,t=-3.428,P＜0.05].PO2 in MV group after one hour of treatment were (80.2±10.0) mm Hg,which were higher than those before treatment [(51.3±9.8) mm Hg,t=10.093,P＜0.05]; while PCO2 was lower[(45.6±9.5) mm Hg vs (57.1±12.8) mm Hg,t=-4.526,P＜0.05].(2) There were no difference in PO2 and PCO2 between the two groups after one hour of treatment (P＞0.05).After 12 hours of treatment,no differences were found in PO2[(89.4±11.5) mm Hgvs (90.2±10.8) mm Hg,t=0.093] and PCO2[(44.2±5.9) mm Hg vs (39.1± 7.3) mm Hg,t=0.126] between INSURE group and MV group (P＞0.05 respectively).(3) The incidence of ventilator associated pneumonia,air leaking,intracranial hemorrhage and chronic lung disease in INSURE group were 7.3％ (3/41),4.9％ (2/41),4.9％ (2/41) and 4.9％ (2/41),which were lower than those in MV group [34.1％ (14/42),x2=27.470; 16.7％ (7/42),x2=8.651;19.0％ (8/42),x2 =8.814; 11.9％ (5/42),x2 =4.275](P＜0.05 respectively).Duration of ventilation,oxygen inhalation,neonatal intensive care unit stay in INSURE group were 5 d (3-7 d),8 d (5-11 d) and 16 d (11-25 d),which were all shorter than those of MV group [8 d (4-12 d),Z=-1.947; 12 d (8-22 d),Z=-2.013; 21 d (12-35 d),Z=-1.782](P＜0.05 respectively).Conclusions INSURE technology could be used in very low and extremely low birth weight infants because of less invasiveness,fewer complications,safety and low-cost. Key words: Infant, very low birth weight; Infant, extremely low birth weight; Pulmonary surfactants; Continuous positive airway pressure