Incidence And Outcome Of CPAP Failure In Preterm Infant

Objective:Retrospective analysis of the clinical data of early CPAP treatment for neonatal respiratory distress syndrome?RDS?,so as to explore the high risk factors of CPAP failure and their effects on outcome.Materials and Methods:The clinical data?303 cases?of CPAP treatment for preterm infants with RDS from January 2015 to June 2017 in Qingdao University Hospital were retrospectively analyzed.Among them,170 were males and 133 were females.These premature infants were divided into three groups according to gestational age,including 25-27+6 weeks group,28-31+6 weeks group,and 32-36+6 weeks group.According to whether intubation was required within 72 hours after birth,the premature infants were divided into CPAP-success group?no need for tracheal intubation?and CPAP-failure group?tracheal intubation required?.We analyzed the risk factors of CPAP failure in three gestational age groups,and explored the effects of CPAP failure on severe complications of premature infants?pneumothorax,bronchopulmonary dysplasia,severe intracranial hemorrhage and retinopathy?.Results:CPAP treatment was given to 303 preterm infants within half an hour after birth,and the failure rates of CPAP were calculated:38.9%?14/36?in 25-27⁺66 weeks group,36.9%?62/168?in 28-31⁺66 weeks group and 26.2%?26/99?in 32-36⁺66 weeks group.The smaller the gestational age,the higher the failure rate of CPAP.The rates of pneumothorax,bronchopulmonary dysplasia,and intracranial hemorrhage were significantly higher in the CPAP-failure group than the values in the CPAP-success group at 25-27⁺66 weeks and28-31⁺66 weeks(CPAP-success group vs.CPAP-failure group at 25-27⁺66 weeks:0%vs.28.57%,72.73%vs.100%,13.63%vs.50%;CPAP-success group vs.CPAP-failure group at 28-31⁺⁶weeks:0%vs.6.45%,25.47%vs.58.84%,8.49%vs.19.35%)?P<0.05?.The CPAP-failure group need longer hospital stays and ventilator time.In 25-27⁺66 weeks group,the hospital stays in CPAP-failure group and CPAP-success group were88.29±20.09d vs.71.45±19.42d,P=0.011,the ventilator time 37.93±16.79d vs.23.86±15.70d,P=0.016.In 28-31⁺⁶weeks group,the hospital stays in CPAP-failure group and CPAP-success group were 56.53±18.36d vs.47.62±17.24d,P=0.002,the ventilator time 13.16±10.31d vs.9.16±10.65d,P=0.000.In 25-27⁺66 weeks group,the proportions of cesarean section and gestational hypertension increased in CPAP-failure group?P=0.018?.The birth weight was smaller,the grade of chest radiography was higher,the fraction of inspired oxygen was higher within 2 hours after birth,and the Apgar score at 5minutes was lower in CPAP-failure group?P<0.05?.Chest radiography grade,gestational hypertension,gestational diabetes,and premature rupture of fetal membranes were independent risk factors for CPAP failure in 28-31+6 weeks group?P=0.000,OR=25.769;P=0.018,OR=7.631?.;P=0.009,OR=8.442;P=0.001,OR=36.658).Chest radiography grade and gestational diabetes were independent risk factors for CPAP failure in 32-36⁺⁶weeks group?Chest radiographs OR 25.769,P=0.000;gestational hypertension OR=7.631,P=0.018;gestational hypertension OR 8.442,P=0.009;premature rupture of membranes OR 36.658,P=0.001?.Chest grading,gestational diabetes mellitus is an independent risk factor for failure of CPAP in gestational age in 32-36 6 weeks preterm infants?gestational diabetes OR 13.789,P=0.009;gestational diabetes OR 0.038,P=0.050?.Conclusion:1.The smaller the gestational age of premature infants,the higher the failure rate of CPAP treatment.2.Compared with the CPAP-success group,the CPAP-failure group had a significantly higher incidence of bronchopulonary dysplasia,intracranial hemorrhage,and pneumothorax for preterm infants younger than 32 weeks.3.The CPAP-failure group required longer hospital stays and ventilator time.The risk factors of CPAP failure were different for premature infants with different gestational ages.Chest radiography grade,birth weight,and perinatal factors such as gestational diabetes,gestational hypertension,premature rupture of fetal membranes were correlated with CPAP failure in preterm infants.Timely prediction of high-risk factors for CPAP failure,and early intervention can help prevent serious complications.