The Clinical Analysis Of Acute Neonatal Respiratory Failure

Background and ObjectivesNeonatal acute respiratory failure is a serious clinical problem associated with high mortality,morbidity and cost.The treatment of acute respiratory failure(ARF) needs mechanical ventilation,high-level care and medical technology.In most domestic hospitals,the incidence of ARF is 5.0%.52.3%of the neonates admitted by the Neoatal Intensive Care Unit(NICU) die of ARF.Mechanical ventilation is the most important treatment.Traditional mechanical ventilation improves ventilation by so high tidal volume and inspiratory pressure that the incidence of ventilator induced lung injury(VILI) is high.Because of the development of research work on mechanical ventilation,Lung protective ventilation strategy(LPVS),or the stragety of permissive hypercapnia(PHC) and open lung(OLC),was introduced.The achievement ratio of salvage is also elevated.In our research,we reviewed 67 cases of neonatal ARF hospitalized in NICU of Qi Lu Hospital of Shandong University between January 2007 and January 2008.We made a retrospective analysis about the fundamental information,etiological factors,incidence,case fatality,clinical managements and prognosis.The purpose is to get the message about the pathogenetic regulations and the situation of management in our NICU,and to summarize clinical experience.This information is essential for determining resource needs and furthermore for improving the medical level of our center.Methods We made a retrospective analysis of 67 cases of neonatal ARF hospitalized in NICU of Qi Lu Hospital between January 2007 and January 2008.The diagnostic criteria of ARF was defined by National Neonatal academic committee in Sep 1986 in Hangzhou.NICU admission was determined according to the admission criteria from NICU of Johns Hopkins Children's Center in 2000-2001.Patient informations were collected,which included fundamental characteristics(gestational age,birth weight,gender,antenatal history,history of delivery and resuscitation,eg.),primary disease diagnosis,selected NICU procedures and outcomes.All statistical analyses were performed using SPSS 13.0 software when all the datas were collected.Results1.ARF infants fundamental characteristics:The incidence of ARF in our NICU was 8.6%.59.7%of ARF infants came from countryside.The minimum gestational age was 25 weeks.The maximum gestational age was 41 weeks.The mean gestational age was 34.2±3.2 weeks and 71.6%were preterm.The minimum birth weight was 1000 grams.The maximum birth weight was 4100 grams.The Mean birth weight(BW) was 2374±848 grams and 58.2%of them were lesser than 2500 grams,11.9%were lesser than 1500 grams.Male/Female ratio of ARF infants was 2.4:1(47:20).The overall cesarean section rate was 59.7%.Premature rupture of membrane rate was 43.3%.Placental abruption rate was 4.5%.Multiple birth rate was 34.3%and 4.5%with congenital anomalies.13.4%of ARF infants had Apgar Scores＜7 at 1 minute.Mean age of mothers with ARF infants was 29±5years and 49.3%of them received no prenatal care before delivery.Gestational hypertension and diabetes were the most common diseases in the pregnant women who had infant subsequently developed ARF.Other common diseases independent of pregnancy were thyrotoxicosis(4.5%) and hysteromyoma(3.0%).2.Primary disease of ARF infants:In the leading diseases that caused ARF was respiratory distress syndrome of newborn(NRDS,32.8%),followed by pneumonia(22.4%),hypoxic-ischemic encephalopathy(HIE,13.4%),transient tachypnea(10.4%),neonatal septicemia(7.5%),meconium aspiration syndrome (MAS,7.5%) and other diseases(agenesis of lung,intracranial hemorrhage, congenital herat disease,necrotizing enterocolitis,6.0%).3.Clinical management:30.3%of infants less than 34 weeks received antenatal steroids.17.9%received pulmonary surfactant(PS) treatment in delivery room or NICU.Nasal continuous positive airway pressure(NCPAP) and synchronized intermittent mandatory ventilation(SIMV) were applied to 68.7% and 22.4%of ARF infants.Mean ventilation time was 74 hours in survivors.4.Prognosis:51(76.1%) cases were cured and 5(7.5%) cases improved.11 cases(included 5 cases quitted) died.The mortality was 16.4%.The average length of stay in hospital in surrival infants was 15.3±7.0 days.Patients less than 34 weeks gestational age need longer hospital stay(22.3±0.8days)than those who were older than 34 weeks gestational age(P＜0.05).5.Primary diseases of dead cases:NRDS(72.7%),congenital anomalies(18.3%), neonatal septicemia(9.0%).Conclusions1.The incidence of ARF in our NICU was 8.6%.The majority of ARF infants were male,premature and LBW.2.Disease of respiratory system was the major cause of ARF in our NICU.The major cause of ARF was NRDS.3.Pulmonary surfactant replacement therapy was given to only 17.9%of all ARF infants;For the ventilation strategy,NCPAP remained to be major ventilation mode,which played a tremendous role in curing ARF infants,and complication due to trachea cannula and mechanical ventilation were avoided4.The in-hospital mortality of ARF was 16.4%.Primary diseases of dead cases were NRDS,congenital anomalies and neonatal septicemia.