Application Of Nasal Intermittent Positive Pressure Ventilation In Premature Infants With Respiratory Distress Syndrome

ObjectiveTo explore the therapeutic effect and prognosis of nasal intermittent positive pressure ventilation（NIPPV）as the initial treatment on respiratory distress syndrome（RDS）in preterm infants,and then provide references for preterm infants with RDS in clinical treatment.MethodsA retrospective cohort study method was used to collect clinical data of 69cases of premature infants diagnosed as RDS with gestational age between 28-32weeks,birth weight between 1.0-1.8 kg and RDS from July 2020 to August 2021 in Jiangxi maternal and Child Health Hospital.The collected clinical data included 36cases in the treatment group（the initial NIPPV treatment group）and 33 cases in the control group（the initial treatment group of invasive frequent mechanical ventilation）.Record the general clinical data of the preterm infants including gender,admission age,birth weight,delivery method,gestational age,Apgar score,pulmonary surfactant（PS）use time,and compare the treatment effects and prognostic impact of the two groups of preterm infants.Observation indicators:（1）Arterial blood gas analysis indicators:arterial blood gas analysis at the beginning of treatment and 3,24 hours after treatment.The main observation and evaluation indicators include partial pressure of oxygen（Pa O₂）,partial pressure of carbon dioxide（Pa CO₂）and oxygenation index（OI）.（2）Clinical observation and evaluation indicators:total respiratory support time,hospitalization time,treatment outcome（cure,improvement,invalid,death）of the preterm infants.（3）Observation indicators of complications:pneumonia,pulmonary hemorrhage,apnea,pneumothorax,septicemia,abdominal distension that requires fasting,feeding intolerance,gastrointestinal bleeding,abnormal hearing（abnormal hearing in left ear/abnormal hearing in right ear/Binaural hearing abnormalities）,necrotizing enterocolitis（NEC）,retinopathy of prematurity（ROP）,patent ductus arteriosus（PDA）,persistent pulmonary hypertension of the newborn（PPHN）,intracranial hemorrhage（ICH）,bronchopulmonary dysplasia（BPD）.ResultsA total of 36 children in NIPPV group and 33 children in invasive normal frequency mechanical ventilation group were collected.There was no significant difference in general clinical data between the two groups（P>0.05）.（1）Arterial blood gas analysis indexes:there was no significant difference in Pa O₂,Pa CO₂and OI between the two groups at the beginning of treatment and 3,24 hours after treatment（P>0.05）.（2）Clinical observation and evaluation indexes:the total respiratory support time and hospital stay in NIPPV group were significantly shorter than those in invasive normal frequency mechanical ventilation group.The difference between the two groups was statistically significant（P<0.05）.There was no significant difference in the outcome between the two groups,and there was no significant difference in the total effective rate between the two groups（P>0.05）.Three children in NIPPV group were changed to normal frequency mechanical ventilation due to ineffective treatment,three children in invasive normal frequency mechanical ventilation group were changed to invasive high frequency mechanical ventilation due to ineffective treatment,and two children in invasive normal frequency mechanical ventilation group died of gastrointestinal bleeding and pulmonary bleeding.（3）Observation indexes of complications:the incidence of complications during hospitalization between the two groups was compared.There was no significant difference in the incidence of apnea,pneumothorax,sepsis,abdominal distension requiring fasting,feeding intolerance,gastrointestinal bleeding,abnormal hearing,NEC,ROP,PDA,PPHN and ICH between NIPPV group and invasive normal frequency mechanical ventilation group（P>0.05）.The incidence of pneumonia,pulmonary hemorrhageand BPD in NIPPV group were 2.8%（1/36）,0（0/36）,and 2.8%（1/36）respectively.The above indexes in invasive normal frequency mechanical ventilation group were 21.2%（7/33）,18.2%（6/33）and21.2%（7/33）,and there were significant differences in the incidence of pneumonia,pulmonary hemorrhage and PDA complications between the two groups（P<0.05）.ConclusionNIPPV is safe and effective in the treatment of RDS in premature infants.It can shorten the total time of respiratory support and hospital stay,and reduce the complications of children.It is worthy of clinical application.