Clinical Experience Of The Best Early Respiratory Management Mode In Preterm Infants With 27～32 Weeks’ Gestational Age

ObjectiveTo improve the early respiratory management, the survival rate and the life quality of premature infants, this paper investigate early respiratory management mode and clinical experience of INTURE technology application, with prospective analysis of early respiratory management mode in preterm infants 27+0-32+6 weeks’ with gestational ages.Method1.This paper prospectively selects 127 premature infants, who were born birth from August 2013 to December 2014, neonatal gestational age with 27+0-32+6 weeks admitted to Shandong Provincial Hospital. And all those premature infants were born in our hospital and put in our hospital NICU within 30 minutes after they birth,36 weeks’correct gestational age as the observation endpoint.All those premature infants were divided into nCPAP group (n=67) and PS group (n=60) according to randomly taken by the different modes of breathing support after hospitalization.nCPAP group was given noninvasive nCPAP assisted breathing therapy immediately(with in 0.5h after birth), observed the spontaneous breath closely, and PS was used selectively. PS group was immediately (with in 0.5h after birth) given preventive tracheal intubation-PS injection-nCPAP auxiliary breathing (INSURE). Intubation ventilator assisted breathing therapy was used, If the symptoms of two groups of children with respiratory distress. The following indexes were compared between the two groups like the recently incidence rate of NRDS, the rate of need for endotracheal intubation for mechanical ventilation(MV), all time of Oxygen inhalation, apnea, ventilator associated pneumonia(VAP), air leak of pulmonary, intracranial hemorrhage, pulmonary hemorrhage, necrotizing enterocolitis of newborn(NEC) incidence rate, and the corrected gestational age of 36 weeks long-term complication, such as the development of Broncho pulmonary dysplasia (BPD), extrauterine growth restriction(EUGR), retinopathy of prematurity (ROP), and The mortality rate.2. It selects 59 premature infants, who were born birth from August 2013 to 2015 April neonatal gestational age 27+0～32+6 weeks, admitted to Shandong Province-owned Hospital. according to apnea of prematurity (AOP) treatment. The group treated by caffeine citrate (n=32), initial loading dose of caffeine citrate was 20mg/kg (equivalent to the caffeine base 10mg/kg), maintenance dose was 5mg/kg (equivalent to the caffeine base 2.5mg/kg) after 24h, intravenous infusion. The group treated by aminophylline (n=27), initial loading dose of dose of aminophylline was 5mg/kg, and maintained by a dose of 2mg/kg, with intra-venous drip q8-12h, intravenous infusion,36 weeks’ correct gestational age as the observation endpoint. Then compare the indexes like the treated efficiency of AOP, termination time of apnea, the corrected gestational age of the stop of nCPAP, the corrected gestational age of the stop of Oxygen inhalation, the rate of mechanical ventilation, intracranial hemorrhage, NEC, the hospitalization time,36 weeks’ correct gestational age weight, death rate, the incidence of Broncho pulmonary dysplasia (BPD), retinopathy of prematurity (ROP).Results1. There were no statistically significant differences in gender, birth weight, gestational age, maternal antenatal glucocorticoid application, pregnancy (including delivery and multiple pregnancy), lmin and 5 min Apgar score among all the groups (P>0.05).2. There were no statistically significant differences in the incidence of NRDS and the fatality rate of premature infants of 36 weeks’correct gestational age between nCPAP group and PS group (P>0.05).3. The PS usage and total hospitalization expenses of the nCPAP group were significantly lower than those in PS group, and the differences were statistically significant (P<0.05).4. There were no statistically significant differences in the usage rate of ventilators, all time of Oxygen inhalation, the usage rate of second dose PS, hospital day and complication like apnea,VAP, lung frequent hemorrhoid, pulmonary hemorrhage, intracranial hemorrhage, NEC,36 weeks’ correct gestational age BPD, EUGR and the incidence rate of ROP between two groups.5. Compared with the aminophylline group, the total effective rate of the caffeine citrate group was higher (87.5% vs 55.6%) in the treatment of apnea, AOP duration time decreased markedly(72.33±8.67 vs 96.60±10.61) and the differences were statistically significant (P<0.05).6. Contrast between caffeine citrate and aminophylline, The 36 weeks’ correct gestational age BPD incidence in caffeine group (0.00% vs 18.52%), EUGR(3.13% vs 22.22%) and ROP (0.00% vs 14.81%) is lower than that in aminophylline group, and the differences were statistically significant (P<0.05).7. The NEC incidence in caffeine group was significantly lower than aminophylline group (0.00% vs 14.81%), the time of using Oxygen inhalation was also significantly lower than aminophylline group (82.35±1.96 vs 158.13±2.89), and the time of using nCPAP was also significantly lower than aminophylline group (53.76±3.82 vs 98.24±2.36), and the differences were statistically significant (P<0.05).8. There were no statistically significant differences (all P>0.05) in the intracranial hemorrhage, and 36 weeks’ corrected gestational age at discharge, between caffeine citrate group and the aminophylline group.Conclusions1. The clinical efficacy of early prophylactic application of PS combined with noninvasive nCPAP respiratory support in treatment of prematurity are equal to noninvasive nCPAP respiration support and selective application of PS, but the aforesaid measures can significantly reduce chances of PS, reduced total hospitalization expenses.2. The curative effect of caffeine citrate is better than aminophylline in treatment of prematurity with 27-32 weeks’ gestational age, and reduced risk of invasive mechanical ventilation, shorten the time, significantly improve preterm infants with oxygen in vital organs of oxygen, thereby decreasing the incidence of BPD、EUGR and ROP of prematurity with 36 weeks’ correct gestational age.