Effect of Sustained Lung Inflation during CPAP in Preterm Neonates with Respiratory Distress Syndrome
Rabab Mohammed Abdelwahab;
Abstract
SUMMARY
T
he aim of our work was to study the biochemical and clinical effects of sustained lung inflation applied to preterm newborns with respiratory distress syndrome while on nasopharyngeal CPAP.
This study was conducted on 100 preterm neonates 28 – 34 weeks of gestation admitted immediately or shortly after birth to the neonatal intensive care unit of Gynecology and Obstetrics Hospital at Ain Shams University.
The studied neonates were subdivided into three groups as the following:
Group A:
Comprised 33 preterm infants (15 females and 18 males) with a mean gestational age (31.76± 1.62) and birth weight (1.50 ± 0.32) Kg. These preterm infants developed RDS that was diagnosed on the basis of clinical and radiological findings put on CPAP and assigned to receive a total of 15 sustained lung inflations during the first 4 days of life.
Group B:
Comprised 33 preterm infants (14 females and 19 males) with a mean gestational age (32.12 ± 1.92) and birth weight (1.54 ± 0.47) Kg. These preterm infants developed RDS, put on CPAP and did not receive sustained lung inflations.
Group C:
Comprised 34 preterm infants (16 females and 18 males) with a mean gestational age (31.50 ± 1.91) and birth weight (1.49 ± 0.42) Kg. These preterm babies were intubated and ventilated during resuscitation in the delivery room or immediately after admission to NICU followed by surfactant administration.
All preterm newborn were subjected to the following:
I) Full perinatal history taking:
-Antenatal history excluding the previously mentioned exclusion criteria and including parity, administration of steroids (full course, partial course or no steroids), maternal (diseases, antibiotics, MgSO4, and chorioamnionitis
-Natal history including mode of delivery, gestational age calculated from the duration of amenorrhea or by ultrasonography, birth weight, and recorded Apgar scores at 1 and 5 minutes.
-Postnatal physical examination notable for:
• Assessment of gestational age using Ballard score.
• General condition, neurological, abdominal and cardiac examination with special attention to chest examination.
II) Investigations:
1- ABG at enrollment and every 12 hours.
2- Oxygen indices:
Oxygenation index (OI), arterial -alveolar oxygen tension ratio (a/A ratio) and alveolar arterial oxygen gradient (A-a)-DO2:
3- Sepsis indices clinically and laboratory:
Complete blood picture (CBC), C-reactive protein and blood culture (at the time of admission).
4- Serum concentrations of cytokines:
IL-6, IL-8, IL-1β - TNF-α and elastase will be measured at enrollment and at 96 hours in group A and group B, but only at 96 hours of life in group C.
5- Volumetric indices of the lung:
By classic radiograph at enrollment and at 96 hours of age.
6- Functional echocardiography after 24 hours of life, third, fifth days of life and on demand.
7- Transcranial U/S (done at first, third and seventh days of life).
8- Fundus examination was done as screening tool for retinopathy of prematurity.
Our study revealed non significant difference between group A (SLI), group B (CPAP only), and group C (ventilation) as regards sex, gestational age, birth weight, mode of delivery, Apgar score either at 1 or 5 minutes, antenatal steroids or magnesium sulfate and rupture of membrane, in addition to maternal diseases and maternal medications.
The current work observed significantly (better) lung inflation among group B (CPAP only) upon enrollement compared to group A (SLI) and to group C (ventilation), whereas non significant difference was noted at 96 hours of life.
Our study revealed statistically non significant difference between group A (SLI), group B (CPAP only), and group C (ventilation) as regards neonatal medications given in the NICU.
As regards ventilatory severity indices, group C (ventilation) had significantly higher (worse) oxygenation index (OI) and alveolar arterial oxygen tension gradient (A-a) DO2 compared to group A (SLI) and group B (CPAP only) at enrollement and at 96 hours of age.
Whereas it had significantly lower (worse) arterial - alveolar oxygen tension ratio (a/A) upon enrollement only compared to group A (SLI) and group B (CPAP only).
T
he aim of our work was to study the biochemical and clinical effects of sustained lung inflation applied to preterm newborns with respiratory distress syndrome while on nasopharyngeal CPAP.
This study was conducted on 100 preterm neonates 28 – 34 weeks of gestation admitted immediately or shortly after birth to the neonatal intensive care unit of Gynecology and Obstetrics Hospital at Ain Shams University.
The studied neonates were subdivided into three groups as the following:
Group A:
Comprised 33 preterm infants (15 females and 18 males) with a mean gestational age (31.76± 1.62) and birth weight (1.50 ± 0.32) Kg. These preterm infants developed RDS that was diagnosed on the basis of clinical and radiological findings put on CPAP and assigned to receive a total of 15 sustained lung inflations during the first 4 days of life.
Group B:
Comprised 33 preterm infants (14 females and 19 males) with a mean gestational age (32.12 ± 1.92) and birth weight (1.54 ± 0.47) Kg. These preterm infants developed RDS, put on CPAP and did not receive sustained lung inflations.
Group C:
Comprised 34 preterm infants (16 females and 18 males) with a mean gestational age (31.50 ± 1.91) and birth weight (1.49 ± 0.42) Kg. These preterm babies were intubated and ventilated during resuscitation in the delivery room or immediately after admission to NICU followed by surfactant administration.
All preterm newborn were subjected to the following:
I) Full perinatal history taking:
-Antenatal history excluding the previously mentioned exclusion criteria and including parity, administration of steroids (full course, partial course or no steroids), maternal (diseases, antibiotics, MgSO4, and chorioamnionitis
-Natal history including mode of delivery, gestational age calculated from the duration of amenorrhea or by ultrasonography, birth weight, and recorded Apgar scores at 1 and 5 minutes.
-Postnatal physical examination notable for:
• Assessment of gestational age using Ballard score.
• General condition, neurological, abdominal and cardiac examination with special attention to chest examination.
II) Investigations:
1- ABG at enrollment and every 12 hours.
2- Oxygen indices:
Oxygenation index (OI), arterial -alveolar oxygen tension ratio (a/A ratio) and alveolar arterial oxygen gradient (A-a)-DO2:
3- Sepsis indices clinically and laboratory:
Complete blood picture (CBC), C-reactive protein and blood culture (at the time of admission).
4- Serum concentrations of cytokines:
IL-6, IL-8, IL-1β - TNF-α and elastase will be measured at enrollment and at 96 hours in group A and group B, but only at 96 hours of life in group C.
5- Volumetric indices of the lung:
By classic radiograph at enrollment and at 96 hours of age.
6- Functional echocardiography after 24 hours of life, third, fifth days of life and on demand.
7- Transcranial U/S (done at first, third and seventh days of life).
8- Fundus examination was done as screening tool for retinopathy of prematurity.
Our study revealed non significant difference between group A (SLI), group B (CPAP only), and group C (ventilation) as regards sex, gestational age, birth weight, mode of delivery, Apgar score either at 1 or 5 minutes, antenatal steroids or magnesium sulfate and rupture of membrane, in addition to maternal diseases and maternal medications.
The current work observed significantly (better) lung inflation among group B (CPAP only) upon enrollement compared to group A (SLI) and to group C (ventilation), whereas non significant difference was noted at 96 hours of life.
Our study revealed statistically non significant difference between group A (SLI), group B (CPAP only), and group C (ventilation) as regards neonatal medications given in the NICU.
As regards ventilatory severity indices, group C (ventilation) had significantly higher (worse) oxygenation index (OI) and alveolar arterial oxygen tension gradient (A-a) DO2 compared to group A (SLI) and group B (CPAP only) at enrollement and at 96 hours of age.
Whereas it had significantly lower (worse) arterial - alveolar oxygen tension ratio (a/A) upon enrollement only compared to group A (SLI) and group B (CPAP only).
Other data
| Title | Effect of Sustained Lung Inflation during CPAP in Preterm Neonates with Respiratory Distress Syndrome | Other Titles | دراسة تأثير النفخ المطرد للرئة على متلازمة الكرب التنفسى للأطفال المبتسرين أثناء وضعهم على السباب | Authors | Rabab Mohammed Abdelwahab | Issue Date | 2016 |
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