Background:Pulmonary disease is still the main reason cause diseases and mortality for preterm babies. Objectives:This study aims to evaluate of the clinical efficacy of high-frequency oscillatory ventilation in the treatment of preterm infants who have seriously respiratory distress syndrome required mechanical ventilation. Subjects and method:A prospective clinical trail was conducted at Neonatal Unit of Tu Du Hospital from 1st December 2005 to 30th November 2006. Intervention: Patients were randomized to high-frequency oscillatory ventilation (20 patients) or conventional mechanical ventilation-CMV (59 patients). High-frequency oscillatory ventilation(HFOV) was used in high lung volume strategy. Results:The two groups of patients were similar in demographic distribution of birth weight, gestational age, gender, surfactant after birth. Patients on HFOV were ventilator \ufffd?dependent (2.14 \xb1 1.76 vs 3.48 \xb1 2.70 day. p=0.004) and respiratory pressure support (4.01 \xb1 2.23 vs 6.55 \xb1 day. p =0.02) for a shorter time than patients on CMV. Conclusion: First intention HFOV with high volume strategy shortened the time of ventilation and pressure support in preterm infants with seriously respiratory distress syndrome. In the future, it will be necessary to have the tremendous research for the efficacy of HFOV in order to decrease the ratio of bronchopulmonary dysplasia of infants who have seriously respiratory distress syndrome required mechanical ventilation.
Respiratory Distress Syndrome ; Newborn/ therapy ; Infant ; Premature

Child ; Humans ; Infant, Newborn ; Consensus ; Respiratory Distress Syndrome/therapy* ; Respiratory Distress Syndrome, Newborn ; Respiration, Artificial ; Intensive Care Units, Pediatric

The objective of this study was to determine how the neonatal mortality rate has changed since surfactant (S) therapy was introduced in our Neonatal Intensive Care Unit (NICU), and to evaluate the efficacy of surfactant therapy in respiratory distress syndrome (RDS) patients. Incidences of risk babies such as outborns, prematurity, low birth weight infants and RDS, and neonatal mortality rates were compared between 'pre' (control, 1988 to 1991, n=4,861) and 'post' S period (study, 1993 to 1996, n=5,430). In RDS patients of 'post' S period, neonatal mortality rate was compared between S-treated and non-treated patients, and chest X-ray and ventilatory parameters were compared between pre- and post-72 hr of surfactant treatment. Surfactant therapy showed short term effects, judging by the decrease of early neonatal deaths and improvement of chest X-ray and ventilatory parameters in RDS patients. The overall neonatal mortality rate had a tendency to decrease in spite of increased incidences of risk babies in 'post' S period but it was less than expected. The reasons were thought to be that we had a high proportion of risk babies, and there was some bias in patient selection for surfactant therapy and its use. In conclusion, with the active prevention of risk baby delivery and appropriate use of surfactant, better results could be expected.
Female ; Human ; Incidence ; Infant Mortality ; Infant, Newborn ; Male ; Pulmonary Surfactants/therapeutic use* ; Respiratory Distress Syndrome/mortality* ; Respiratory Distress Syndrome/epidemiology ; Respiratory Distress Syndrome/drug therapy* ; Risk Factors

Acute Disease ; Fatal Outcome ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Respiratory Distress Syndrome, Newborn ; diagnosis ; therapy

OBJECTIVETo assess the efficacy of nasal intermittent positive pressure ventilation (NIPPV) in treatment of respiratory distress syndrome (RDS) in premature infants.

METHODSAccording to the requirements of Cochrane systematic review, a thorough literature search was performed among PubMed (1977-2008), Embase (1989-2008), OVID, Cochrane (2008), Chinese Digital Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database (CBMdisc). Quality assessments of clinical trials were carried out. Randomized controlled trials (RCTs) with NIPPV and RDS were enrolled, and Revman 4.2 software was used for meta-analysis. The trials were analyzed using relative risk (RR) for dichotomous data, weighted mean difference (WMD) were used for continuous data, both kind of data were expressed by 95% confidence intervals (95% CI). For homogenous data (P> or =0.10), fixed effects model was calculated, for heterogeneity data (P<0.10), random effects model was calculated.

RESULTSFive RCTs involving 284 premature infants diagnosed as respiratory distress syndrome (RDS) were included. Three studies comparing NIPPV with nasal continuous positive airway pressure (NCPAP) in the postextubation period, the extubation failure rate was 8.34% vs 40.79% in NIPPV group and NCPAP group, the NIPPV group had significantly lower extubation failure rates [RR 0.21 (95% CI: 0.10-0.45; P<0.001)]. Two of the above-mentioned three studies analyzed bronchopulmonary dysplasia (BPD) rates, the incidence of BPD was 39.34% vs 54.39% in NIPPV group and NCPAP group, the NIPPV group had a trend towards lower BPD rates, but this did not reach statistical significance [RR 0.73 (95% CI: 0.49-1.07; P=0.11)]. NIPPV was used as primary mode in two studies, one compared with conventional ventilation (CV), which detected that the NIPPV group had significantly lower BPD rates (10% vs. 33.33%, P=0.04); the other compared with NCPAP, which also showed that NIPPV group had significantly lower BPD rates (2.33% vs. 17.07%, P=0.03).

CONCLUSIONThe primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS, and was associated with a decreased incidence of BPD. In the postextubation period, NIPPV is more effective in preventing failure of extubation than NCPAP.

Humans ; Infant, Newborn ; Infant, Premature ; Intermittent Positive-Pressure Ventilation ; Respiratory Distress Syndrome, Newborn ; therapy

OBJECTIVETo investigate the efficacy of volume-targeted ventilation (VTV) for the treatment of neonatal respiratory distress syndrome (NRDS).

METHODSFifty-two neonates with NRDS between August 2013 and August 2015 were randomly divided into two groups: VTV and pressure-controlled ventilation (PCV) (n=26 each ). A/C+Vc+ ventilation model was applied in the VTV group, and A/C+PCV ventilation model was applied in the PCV group. Arterial blood gas analysis was performed at 6, 24, and 48 hours after ventilation. The following parameters were observed: time of invasive ventilation, duration of oxygen therapy, mortality, and the incidence rates of hypocapnia, pneumothorax, ventilator-associated pneumonia (VAP), grade III-IV periventricular-intraventricular hemorrhage (PVH-IVH), periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP).

RESULTSCompared with the PCV group, the VTV group had a significantly shorter time of invasive ventilation (P<0.05) and significantly lower incidence rates of hypocapnia, VAP, and PVL (P<0.05); however, there were no significant differences in the duration of oxygen therapy, mortality, and incidence rates of pneumothorax, grade III-IV PVH-IVH, BPD, and ROP.

CONCLUSIONSVTV has a better efficacy than PCV in the treatment of NRDS, and is worthy of clinical promotion and application.

Female ; Humans ; Infant, Newborn ; Male ; Respiration, Artificial ; adverse effects ; methods ; Respiratory Distress Syndrome, Newborn ; therapy

High-Frequency Ventilation ; methods ; Humans ; Infant, Newborn ; Male ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn ; therapy

OBJECTIVE: To systematically evaluate the efficacy and safety of high-flow nasal cannula (HFNC) therapy versus nasal continuous positive airway pressure (nCPAP) in the treatment of respiratory distress syndrome (RDS) in neonates. METHODS: PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine disc, Wanfang Database, CNKI, and Weipu Database were searched for the randomized controlled trials (RCTs) of HFNC versus nCPAP in the treatment of neonatal RDS published up to April 1, 2020. RevMan5.3 software was used to perform a Meta analysis of the eligible RCTs. RESULTS: A total of 12 RCTs were included, with 2 861 neonates in total, among whom 2 698 neonates (94.30%) had a gestational age of ≥28 weeks and 163 (5.70%) had a gestational age of <28 weeks. For primary respiratory support, the HFNC group had a significantly higher rate of treatment failure than the nCPAP group (RR=1.86, 95%CI: 1.53-2.25, P<0.001), but there were no significant differences between the two groups in the rate of invasive mechanical ventilation (P=0.40) and the rate of use of pulmonary surfactant (P=0.77). For post-extubation respiratory support, there were no significant differences between the two groups in the treatment failure rate, reintubation rate, and total oxygen supply time (P>0.05). For primary respiratory support and post-extubation respiratory support, the HFNC group had a significantly lower incidence rate of nasal injury than the nCPAP group (P<0.001), and there were no significant differences between the two groups in the mortality rate and incidence rates of the complications such as air leak syndrome, bronchopulmonary dysplasia, and necrotizing enterocolitis (P>0.05). CONCLUSIONS Based on the current clinical evidence, HFNC has a higher failure rate than nCPAP when used as primary respiratory support for neonates with RDS, and therefore it is not recommended to use HFNC as the primary respiratory support for neonates with RDS. In RDS neonates with a gestational age of ≥28 weeks, HFNC can be used as post-extubation respiratory support in the weaning phase.
Cannula ; China ; Continuous Positive Airway Pressure ; Humans ; Infant, Newborn ; Infant, Premature ; Respiratory Distress Syndrome, Newborn/therapy*

OBJECTIVETo observe the effects of neurally adjusted ventilatory assist (NAVA) on the patient-ventilator synchrony, gas exchange, and ventilatory parameters in preterm infants with respiratory distress syndrome (RDS) during mechanical ventilation.

METHODSTen preterm infants with RDS received mechanical ventilation in NAVA mode for 60 minutes and in synchronized intermittent mandatory ventilation (SIMV) mode for 60 minutes, and the two modes were given in a random order. The vital signs, patient-ventilator synchrony, blood gas values, and ventilatory parameters were compared between the two ventilation modes.

RESULTSInspiratory trigger delay was significantly shorter with NAVA than with SIMV (P<0.05). There were no significant differences in arterial pH, PaCO2, PaO2 and PaO2/FiO2 between the two modes. The spontaneous respiratory rate, peak inspiratory pressure (PIP), electrical activity of the diaphragm and work of breathing were significantly lower in NAVA than in SIMV (P<0.05).

CONCLUSIONSCompared with SIMV, NAVA appears to improve patient-ventilator synchrony, decrease PIP, and reduce diaphragmatic muscle load and work of breathing in preterm infants with RDS during mechanical ventilation.

Diaphragm ; physiology ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Respiration, Artificial ; methods ; Respiratory Center ; physiology ; Respiratory Distress Syndrome, Newborn ; therapy

Background: Respiratory distress is one among the leading reasons cause mortality for infants especially for preterm babies or light weight babies. Surfactant therapy in premature infants can decrease mortality, duration of respiratory treatment, pulmonary air leaks and chronic lung disease. Objective: This study aims to assess the effect of surfactant therapy in premature infants with respiratory distress syndrome at Intensive Care Unit of Children Hospital N\xb0.2. Subjects and method:A cases study about premature infants less than 24 hours after birth with respiratory distress syndrome (RDS) admitted to intensive care unit and treated with surfactant from January 2007 to July 2007 at the Children Hospital No 2. There were 30 cases recruited. The data was collected and analyzed by EpiInfo software 2002.Results: Most of them improved in respiration status after using surfactant (96.7%); no case of air leak was seen; 3 bronchopulmonary dysplasia cases and 4 deaths due to nosocomial infection were seen. Conclusion: Surfactant therapy was effective in premature infants with RDS. In the case of having economic advantages, surfactant may be indicated for preventive treatment on the premature and light weigh infants without respiratory distress syndrome on clinical aspect.
Respiratory Distress Syndrome ; Newborn/ therapy ; Pulmonary Surfactant-Associated Proteins ; Infant ; Premature