| Objective: To investigate the feasibility and safety of pulmonary surfactant(PS) combined with three different noninvasive ventilation strategies including nasal intermittent positive pressure ventilation(NIPPV), humidified high flow nasal cannula(HHFNC) and nasal continuous positive airway pressure(NCPAP) for the treatment of Neonatal Respiratory Distress Syndrome(NRDS).Methods:Between January and October, 2014, seventy seven preterm infants(<34 weeks of gestational age) with NRDS were enrolled in Neonatal intensive care unit of Han Dan Central Hospital and randomly assigned to three groups: NIPPV group(24 infants), HHFNC group(26 infants) and NCPAP group(27 infants). After PS was given, the infants in each group received NIPPV, HHFNC or NCPAP respectively. Pa CO2, Pa O2, Pa O2/Fi O2 and a/APO2 were measured at 0 hour, 12 hours, 24 hours and 48 hours after respiratory support. Other data were also collected, including duration of oxygen therapy, duration of noninvasive ventilation, the number of apnea events, need for reintubation and re-medication, conversion from noninvasive to invasive ventilation, complications, timing of breastfeeding initiation, length of hospital stay, and medical expenses.Statistical analyses were performed using SPSS version 13.0. Continuous variables were expressed as means with SDs and compared using t test between groups,while repeated-measures ANOVA was used in comparison within groups. Categorical variables were compared using Pearson chi-square test. A two-sided P value less than 0.05 was considered to be statistically significant.Results:1.There was no statistically significant difference in baseline charact- eristics of three groups of infants, including gestational age, birth weight, sex and delivery mode(P>0.05).2 After administration of PS and respiratory support, 12 h, 24 h and 48 h later, Pa O2 improved significantly in three groups while Pa CO2 decreased. But there was no statistically significant difference in Pa O2 and Pa CO2 among the three groups(P>0.05). At each timepoint within the groups, there were significant differences in Pa O2/Fi O2, a/APO2(P<0.05). Compared with HHFNC group and NCPAP group, NIPPV group were significantly improved, and there were significant differences among the three groups(P<0.05).3 Compared with NCPAP group, duration of oxygen therapy, duration of noninvasive ventilation and the number of apnea events were reduced in both NIPPV group and HHFNC group. There were no significant difference in re-medication among the three groups(P>0.05). Conversions to invasive ventilation in NIPPV group were less than NCPAP group and HHFNC group. The breastfeeding initiation in NCPAP group was later than the other two groups. The length of hospital stay and medical expenses were decreased in NIPPV group and HHFNC group, compared with NCPAP group(P<0.05).4 There was no statistically significant difference in nasal injury, resp- iratory infection and intracranial hemorrhage among the three groups(P>0.05). Compared with the other two groups, there were more infants with abdominal distension and gas leakage in NCPAP group(P<0.05).Conclusion:1 Three noninvasive ventilation strategies in combination with PS are effective for treatment of preterm infants with NRDS in correcting hypoxemia and improve pulmonary oxygenation quickly.2 NIPPV could significantly improve pulmonary oxygenation in a short time, relieve clinical symptoms, shorten the duration of noninvasive ventilation and oxygen therapy, and it is advantageous for the infants with faint spontaneous breathing.3 NIPPV, HHFNC could facilitate early breastfeeding initiation, which are beneficial for the recovery of gastrointestinal function for infants, and could decrease the complications associated with long time parenteral nutrition.4 HHFNC is easy to operate, infants could have a comfortable position, with less side effects and less medical costs, therefore, HHFNC is advent- ageous for popularization. |
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