| Objective s:The prevention and treatment of bronchopulmonary dysplasia has always been a research hotspot in neonatal medicine.In particular,the timing and efficacy evaluation of the clinical use of diuretics and dexamethasone are still controversial.In order to explore whether diuretics and dexamethasone can improve the clinical outcomes and prognosis of children with evolving bronchopulmonary dysplasia,we used diuretics and dexamethasone to moderately intervene the children who still received mechanical ventilation or inhaled oxygen volume fraction>0.25 on the 14th day after birth,Objective to provide valuable clinical evidence for early intervention of bronchopulmonary dysplasia.Methods:Preterm infants with gestational age≤32w or birth weight≤1500g admitted to the Neonatal Intensive Care Unit of the First Affiliated Hospital of Kunming Medical University from January 2019 to March 2021 were selected as the research subjects.A total of 55 preterm infants who still needed mechanical ventilation or inhaled oxygen volume fraction>0.25 to maintain blood oxygen saturation≥92%at 2 weeks(14 days)after birth were included in this study.Using prospective randomized controlled study,randomly divided into 2 groups,middle-late intervention group and late intervention group,middle-late intervention group in the 15th day of birth began to accept the diuretic and/or dexamethasone therapy,the late intervention group according to the current clinical routine treatment(if still cannot from oxygen 28 days after he was born is 29 days began to accept the diuretic and/or dexamethasone therapy).The incidence,severity and mortality of BPD at 36 weeks of gestational age were compared between the two groups.The treatment conditions(use of pulmonary surfactant,caffeine treatment,use of antibiotics,total duration of oxygen,total duration of mechanical ventilation,total duration of non-invasive ventilation,etc.)during hospitalization were compared between the two groups.The complications during hospitalization(fungal infection,sepsis,pneumonia,suppurative meningitis,apnea,NRDS,respiratory failure,pulmonary hemorrhage,IVH,PVL,hyperglycemia,gastrointestinal bleeding,ROP and electrolyte disturbance,etc.)were compared between the two groups.The feeding,growth and development of the two groups during hospitalization were compared.The discharge conditions(length of hospital stay,family oxygen therapy demand)were compared between the two groups.The neurological abnormalities(cranial MRI,transfontanelle craniocerebral ultrasound,amplitude integrated EEG)were compared.SPSS26.0 software was used to establish a database for analysis.Measurement data were expressed as(x-±s)or median,and t-test or rank sum test was used for comparison between groups.Enumeration data were presented as rate(%),x 2 test or precise probability method was used for comparison between groups,and P<0.05 was considered statistically significant.Results:1.Comparison of general conditions and perinatal conditions:27 cases were included in the middle and late intervention group,while 28 cases were included in the late intervention group.There was no statistical significance in gender,gestational age and birth weight,maternal prenatal fever,prenatal infection index,prenatal sickness,prenatal hormone,antibiotic and magnesium sulfate use of two groups of children(P>0.05).2.Comparison of morbidity and mortality:There was no statistical significance in the incidence and mortality of BPD at 36 weeks of corrected gestational age between the two groups(P>0.05).The incidence of moderate and severe BPD(II and III grade)in the middle and late intervention group was lower than that in the late intervention group,and the difference was statistically significant(P<0.05).3.Comparison of treatment conditions during hospitalization:there was no statistical significance in the use of alveolar surfactant,antibiotic and caffeine between the two groups(P>0.05).The duration of mechanical ventilation in the middle and late intervention group was shorter than that in the late intervention group,the difference was statistically significant(P<0.05).There was no significant difference in the days of non-invasive ventilation between the two groups(P<0.05).The total days of oxygen use in the middle and late intervention group were shorter than those in the late intervention group,and the difference was statistically significant(P<0.05).The proportion of preterm infants needing dexamethasone in the middle and late intervention group was significantly lower than that in the late intervention group,the difference was statistically significant(P<0.05).4.Comparison of complications during hospitalization:In-hospital complications including fungal infection,septicemia,pneumonia,fester sex meningitis,apnea,NRDS,respiratory failure,pulmonary hemorrhage,pneumothorax,anemia,the IVH,PVL,hyperglycemia,thyroid function decrease,gastrointestinal bleeding,blood coagulation dysfunction,ROP and electrolyte disorders etc.,there were no statistically significant difference in the two groups(P>0.05);5.Comparison of feeding and growth conditions:there was no statistical significance difference in the feeding conditions during hospitalization between the two groups included the age of enteral feeding after birth,the age of feeding intolerance,and the age of total enteral feeding,etc(P>0.05).There was no statistical significant difference between the two groups in the age of birth weight recovery and the incidence of EUGR(P>0.05).6.There was no statistical significant difference between the two groups in neurological imaging abnormalities including cranial MRI,cranial ultrasound through the anterior fontanelle and amplitude integrated EEG(P>0.05).7.Comparison of discharge conditions:the hospital stay in the middle and late intervention group was significantly shorter than that in the late intervention group,the difference was statistically significant(P<0.05);The demand for family oxygen therapy after discharge in the middle and late intervention group was significantly lower than that in the late intervention group,with statistical significance(P<0.05).Conclusion(s):The intervention of fifteenth days of birth was a relatively early and active intervention for children with a maximum probability of developing bronchopulmonary dysplasia.It could promote early withdrawal of mechanical ventilation,early oxygen withdrawal,reduction of home oxygen therapy,shorter length of stay and reduction of incidence rate of moderate to severe(II,Ⅲ)bronchopulmonary dysplasia.No serious adverse reactions occurred in the short term. |
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