Study On The Influencing Factors Of Initial Treatment Of Neonatal Respiratory Distress Syndrome With Nasal Continuous Positive Airway Pressure

Background and objectivesNeonatal respiratory distress syndrome is a clinical syndrome in which dyspnea and progressive exacerbation occur early in life due to lack of pulmonary surfactant.RDS is one of the common respiratory diseases in newborns and is still the leading cause of death in preterm infants.George Gregory firstly used continuous positive airway pressure in the treatment of RDS in the 1970 s.This was an innovative treatment that significantly improved the survival rate of RDS children.Nasal continuous airway positive pressure,also known as spontaneous breathing with continuous positive airway pressure,refers to the provision of gas higher than atmospheric pressure throughout the respiratory cycle for children with spontaneous breathing through nasal oxygen supply.It is the most commonly used noninvasive ventilation method for newborns.It has been found that short-term application of nCPAP is helpful for alveolar recruitment and prevention of alveolar collapse,meanwhile long-term application of nCPAP is helpful for lung growth.At present,nCPAP is considered to be the basic respiratory support mode for the treatment of respiratory distress syndrome.NCPAP as the initial respiratory support mode for the treatment of RDS has many influencing factors,but factors leading to the failure of nCPAP-assisted ventilation in the early postnatal period are still unknown.There are few relevant research reports at home and abroad.This article included 1015 RDS cases hospitalized in the neonatal department of the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2018,collecting perinatal conditions,postnatal respiratory support patterns,and pulmonary surfactant use,hospitalization time and cost,complications,prognosis etc.Then 848 cases with initial respiratory support mode of nCPAP,and using nCPAP at least 24 hours were divided into two groups according to the ending of nCPAP respiratory support at 72 hours after birth: nCPAP-successful group,nCPAP-failed group,to analyze the factors that affect the effect of nCPAP in the treatment of RDS,the incidence of complications and whether there are differences in mortality between the two groups,so as to guide the clinical diagnosis and treatment of RDS,improve the prognosis and reduce the family and social burden.MethodsThis article included 1015 RDS cases hospitalized in the neonatal department of the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2018,collecting perinatal conditions,postnatal respiratory support patterns,and pulmonary surfactant use,hospitalization time and cost,complications,prognosis etc.Then 848 cases with initial respiratory support mode of nCPAP,and using nCPAP at least 24 hours were divided into two groups according to the ending of nCPAP respiratory support at 72 hours after birth: nCPAP-successful group,nCPAP-failed group,to analyze the factors that affect the effect of nCPAP in the treatment of RDS.Statistical analysis was performed using SPSS 21.0 software.Results1.Analysis of clinical characteristics of children with RDS1.1 Number of cases of RDS:In 2016,2017 and 2018,the proportion of children with RDS in the same period was 12.7%,11.5%,and 10.3%,respectively,showing a downward trend year by year,the difference was statistically significant(P=0.014).1.2 General situation of children with RDS: RDS mainly happen to premature and low birth weight infants,of which 80.6% of children with RDS with gestational age less than 34 weeks and 90.6% of children with RDS with birth weight less than 2500 g.The younger the gestational age is,the lower the 1 minute Apgar score is,the difference was statistically significant(P < 0.001).1.3 Prenatal application of hormones:There was no upward trend in the prenatal application of hormones in the mothers,and the difference was not statistically significant(P=0.843).1.4 Post-hospital treatment: In 2016,2017 and 2018,the initial respiratory support mode was 9.4%,16.4% and 18.1% of RDS in conventional mechanical ventilation;the rate was increasing year by year,and the difference was statistically significant(P=0.002).There was no significant change in the proportion of PS treatment,and the difference was not statistically significant(P=0.388).The smaller the gestational age is,the proportion and frequency of PS treatment is higher after birth,the difference was statistically significant(P < 0.001).1.5 Complications and prognosis: 92 children(9.1%)had retinopathy of prematurity,49 cases(4.8%)had necrotizing enterocolitis,and 138 cases(13.6%)had bronchopulmonary dysplasia,7 children(0.7%)had pneumothorax.The incidence of retinopathy of premature and necrotizing enterocolitis increased year by year,and the difference was statistically significant(P=0.009,P=0.038).2.Analysis of influencing factors of postoperative nCPAP for initial respiratory support mode treatment of RDS2.1 There were 848 RDS cases with initial respiratory support of nCPAP in 2016,2017 and 2018.The proportion of children with RDS who had successful nCPAP assisted ventilation within 72 hours after birth was 81.7%.The lower the birth weight is,the lower the success rate of nCPAP-assisted ventilation is,and the success rate of nCPAP-assisted ventilation in children with RDS whose birth weight below 1000 g was 69.9%.2.2 Complications and prognosis: Compared with the nCPAP-successful group,the incidence of BPD and pneumothorax in the nCPAP-failed group increased,the difference was statistically significant(P <0.05);the death or unhealed rate in the nCPAP-failed group increased,the difference was statistically significant(P <0.05).The average hospitalization time and hospitalization cost of the nCPAP-failed group were higher than those of the nCPAP-successful group,and the difference was statistically significant(P <0.05).2.3 Logistic regression analysis showed that compared with the nCPAP-successful group,the nCPAP-failed group had lower caffeine caffeine use rate,higher CRP value within 48 hours after birth,heavier chest X-ray findings,the incidence of patent ductus arteriosus was higher,Hct was lower at 72 hours after birth,and the initial blood gas analysis showed a significant increase in carbon dioxide partial pressure and a significant decrease in BE.The incidence of intrauterine distress was high,and the difference was statistically significant(P <0.05).Conclusion1.Children with RDS who did not use caffeine after birth,CRP>5mg/dl in 48 hours after birth,chest X-ray heavier,PDA,decreased hematocrit,and significant increase in carbon dioxide partial pressure and decrease BE in primary blood gas analysis,fetal distress are risk factors for nCPAP failure.2.Failure of nCPAP-assisted ventilation in the early postnatal period will increase the incidence of BPD and pneumothorax complications,increase the rate of death,prolong hospitalization,and increase hospitalization cost.