Analysis Of Failure Factors For Preterm Infants With Respiratory Distress Syndrome Treated With Non-invasive Respiratory Support

Objective:To investigate the factors for preterm infants with RDS who failed to be treated with non-invasive respiratory support(nCPAP or NIPPV)in the NICU of the 2nd Affliliated Hospital of Kunming Medical University in the past 2 years.The clinical data were retrospectively analyzed to provide research evidence for clinical application of reasonable respiratory support mode.Methods:77 cases of RDS preterm infants(28 weeks gestational age<37 weeks)who were hospitalized in the neonatal department of the second affiliated hospital of Kunming Medical University from December 2016 to January 2019 were enrolled as subjects and their clinical data were retrospectively analyzed.According to the therapeutic effect,the collected subjects were divided into the successful group of non-invasive respiratory support and the failed group of non-invasive respiratory support.General information,high-risk factors of pregnant mothers,detection indexes at admission,treatment status,late complications and outcomes of the two groups were compared.Results:Compared with the non-invasive respiratory support success group,the non-invasive respiratory support failure group have higher male to female ratio(78.0%vs.52.8%),lower gestational age(30.75±2.15 weeks vs 31.71±1.99 weeks),lower birth weight(1431.83±274.46g vs 1661.39±411.44).g)and lower 1 minute Apgar scores(6.38±1.84 points vs 7.14±1.06 points)(P all<0.05);Mother who give birth to RDS preterm infants in non-invasive respiratory support failure group have higher age(32.12±5.77 years than 29.39±5.37 years),higher proportion of cesarean section(63.4%vs 33.3%)and a higher proportion of GDM(31.7%vs 11.1%)than non-invasive respiratory support success group(P all<0.05);In the blood gas analysis on admission,non-invasive respiratory support failure group have significantly lower PH,PaO2 and PaO2/FiO2(respectively 7.09±0.13 ratio 7.18±0.17,64.60 ±24.80mmHg ratio 79.08 ± 28.72mmHg,130.71 ± 34.57 ratio 198.17±68.72)(P all<0.05),and PaCO2(62.58±18.44mmHg to 53.56±14.21mmHg)was significantly higher than non-invasive support success group(P<0.05).Logistic regression analysis showed that male(OR=1.07,95%CI=1.04-1.10),cesarean section(OR=1.15,95%CI=1.07-1.25),PaCO2>50mmHg(OR=1.03,95%CI=1.01-1.06)and Pa02/FiO2<195(OR=0.41,95%CI=0.17-0.99)are independent risk factors for InSure method combined with non-invasive respiratory support failure.Conclusion:1.Factors that may fail when RDS preterm infants with the following clinical features and medical history receive noninvasive respiratory support:(1)male,gestational age,low birth weight,low Apgar score in 1 minute,cesarean section;(2)Pregnant mothers are older and have gestational diabetes during pregnancy;(3)PH,Pa02,Pa02/Fi02 decreased significantly and PaC02 increased significantly at admission;BUN increased significantly at admission.2.Male,cesarean section,PaCO2>50mmHg and Pa02/Fi02<195 are independent risk factors for failure of premature infants with non-invasive respiratory support for NRDS.