Background Hypoxemic respiratory failure （HRF） is one of the most common causes for neonatal infants requiring aggressive respiratory support. Inhaled nitric oxide （iNO） has been established routinely as an adjunc...Background Hypoxemic respiratory failure （HRF） is one of the most common causes for neonatal infants requiring aggressive respiratory support. Inhaled nitric oxide （iNO） has been established routinely as an adjunct to conventional respiratory support in developed countries. The aim of this study was to investigate effects of iNO in neonates with HRF in resource limited condition with no or limited use of surfactant, high frequency oscillatory ventilation （HFOV） and extracorporeal membrane oxygenation.Methods A non-randomized, open, controlled study of efficacy of iNO was conducted over 18 months. Eligible term and near-term neonates from 28 hospitals with HRF （oxygenation index ＞15） were enrolled prospectively into two groups as either iNO or control. Oxygenation improvement and mortality as primary endpoint were determined in relation with dosing and timing of iNO, severity of underlying diseases, complications and burden. Intention-to-treat principle was adopted for outcome assessment. Response to iNO at 10 or 20 parts per million （ppm） was determined by oxygenation in reference to the control （between-group） and the baseline （within-group）.Results Compared to 93 controls, initial dose of iNO at 10 ppm in 107 treated infants significantly improved oxygenation from first hour （P=0.046）, with more partial- and non-responders improved oxygenation with subsequent 20ppm NO （P=0.018）. This effect persisted on days 1 and 3, and resulted in relatively lower mortalities （11.2% vs. 15%）whereas fewer were treated with surfactant （10% vs. 27%）,HFOV （＜5%） or postnatal corticosteroids （＜10%） in both groups. The overall outcomes at 28 days of postnatal life in the iNO-treated was not related to perinatal asphyxia,underlying diseases, severity of hypoxemia, or complications,but to the early use of iNO. The cost of hospital stay was not significantly different in both groups.Conclusions With relatively limited use of surfactant and/or HFOV in neonatal HRF, significantly 展开更多
Background Acute hypoxemic respiratory failure （AHRF） often develops acute respiratory distress syndrome （ARDS）, and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% resp...Background Acute hypoxemic respiratory failure （AHRF） often develops acute respiratory distress syndrome （ARDS）, and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively. This study aimed at prospectively investigating incidence, causes, mortality and its risk factors, and any relationship to initial tidal volume （VT） levels of mechanical ventilation, in children 〈5 years of age with AHRF and ARDS. Methods In 12 consecutive months in 23 pediatric intensive care units （PICU）, AHRF and ARDS were identified in those requiring 〉12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge. ARDS was diagnosed according to the American-European Consensus definitions. The mortality and ventilation free days （VFD） were measured as the primary outcome, and major complications, initial disease severity, and burden were measured as the secondary outcome. Results In 13 491 PICU admissions, there were 439 AHRF, of which 345 （78.6%） developed ARDS, resulting in incidences of 3.3% and 2.6%, and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia （62.9%） and sepsis （33.7%） as major underlying diseases respectively. No association was found in VT levels during the first 7 days with mortality, nor for V-r at levels 〈6, 6-8, 8-10, and 〉10 ml/kg in the first 3 days with mortality or length of VFD. By binary Logistic regression analyses, higher pediatric risk of mortality score III, higher initial oxygenation index, and age 〈1 year were associated with higher mortality or shorter VFD in AHRF. Conclusions The incidence and mortalities of AHRF and ARDS in children 〈5 years were similar to or lower than the previously reported rates （in age up to 15 years）, associated with initial disease severity and other confounders, but causal relationship for the initial VT levels as the independent factor to the major outcome w展开更多
Background We conducted a prospective, multicenter investigation of incidence, management and outcome of neonatal acute respiratory disorders （NARD）, and evaluated related perinatal risk factors and efficacy of resp...Background We conducted a prospective, multicenter investigation of incidence, management and outcome of neonatal acute respiratory disorders （NARD）, and evaluated related perinatal risk factors and efficacy of respiratory therapies in neonatal intensive care units （NICUs） in a Chinese neonatal network.Methods Data were prospectively collected in 2004-2005 from infants with NARD defined as presence of respiratory distress and oxygen requirement during the first 3 days of life.Results A total of 2677 NARD was classified （20.5% of NICU admissions）. There were 711 （5.44%） with respiratory distress syndrome （RDS）, 589 （4.51%） pulmonary infection, 409 （3.13%） meconium aspiration syndrome, 658 （5.03%）aspiration of amniotic fluid and 239 （1.83%） transient tachypnoea. Meconium aspiration syndrome had the highest rate with fetal distress, transient tachypnoea from cesarean section, and RDS with maternal disorders. Assisted mechanical ventilation was applied in 53.4% of NARD, and in above five disorders with 84.7%, 52.3%, 39.8%, 24.5%, and 53.6%,respectively. Corresponding mortality in these disorders was 31.4%, 13.6%, 17.8%, 4.1% and 5.0%, respectively.Surfactant was provided to 33.9% of RDS. In all RDS infants, the survival rate was 78.8% if receiving surfactant, and 63.4% if not （P 〈0.001）.Conclusions This study provided NICU admission-based incidence and mortality of NARD, reflecting efficiency of advanced respiratory therapies, which should be a reference for current development of respiratory support in NICU at provincial and sub-provincial levels, justifying efforts in upgrading standard of care in emerging regions through a collaborative manner.展开更多
文摘Background Hypoxemic respiratory failure （HRF） is one of the most common causes for neonatal infants requiring aggressive respiratory support. Inhaled nitric oxide （iNO） has been established routinely as an adjunct to conventional respiratory support in developed countries. The aim of this study was to investigate effects of iNO in neonates with HRF in resource limited condition with no or limited use of surfactant, high frequency oscillatory ventilation （HFOV） and extracorporeal membrane oxygenation.Methods A non-randomized, open, controlled study of efficacy of iNO was conducted over 18 months. Eligible term and near-term neonates from 28 hospitals with HRF （oxygenation index ＞15） were enrolled prospectively into two groups as either iNO or control. Oxygenation improvement and mortality as primary endpoint were determined in relation with dosing and timing of iNO, severity of underlying diseases, complications and burden. Intention-to-treat principle was adopted for outcome assessment. Response to iNO at 10 or 20 parts per million （ppm） was determined by oxygenation in reference to the control （between-group） and the baseline （within-group）.Results Compared to 93 controls, initial dose of iNO at 10 ppm in 107 treated infants significantly improved oxygenation from first hour （P=0.046）, with more partial- and non-responders improved oxygenation with subsequent 20ppm NO （P=0.018）. This effect persisted on days 1 and 3, and resulted in relatively lower mortalities （11.2% vs. 15%）whereas fewer were treated with surfactant （10% vs. 27%）,HFOV （＜5%） or postnatal corticosteroids （＜10%） in both groups. The overall outcomes at 28 days of postnatal life in the iNO-treated was not related to perinatal asphyxia,underlying diseases, severity of hypoxemia, or complications,but to the early use of iNO. The cost of hospital stay was not significantly different in both groups.Conclusions With relatively limited use of surfactant and/or HFOV in neonatal HRF, significantly
文摘Background Acute hypoxemic respiratory failure （AHRF） often develops acute respiratory distress syndrome （ARDS）, and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively. This study aimed at prospectively investigating incidence, causes, mortality and its risk factors, and any relationship to initial tidal volume （VT） levels of mechanical ventilation, in children 〈5 years of age with AHRF and ARDS. Methods In 12 consecutive months in 23 pediatric intensive care units （PICU）, AHRF and ARDS were identified in those requiring 〉12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge. ARDS was diagnosed according to the American-European Consensus definitions. The mortality and ventilation free days （VFD） were measured as the primary outcome, and major complications, initial disease severity, and burden were measured as the secondary outcome. Results In 13 491 PICU admissions, there were 439 AHRF, of which 345 （78.6%） developed ARDS, resulting in incidences of 3.3% and 2.6%, and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia （62.9%） and sepsis （33.7%） as major underlying diseases respectively. No association was found in VT levels during the first 7 days with mortality, nor for V-r at levels 〈6, 6-8, 8-10, and 〉10 ml/kg in the first 3 days with mortality or length of VFD. By binary Logistic regression analyses, higher pediatric risk of mortality score III, higher initial oxygenation index, and age 〈1 year were associated with higher mortality or shorter VFD in AHRF. Conclusions The incidence and mortalities of AHRF and ARDS in children 〈5 years were similar to or lower than the previously reported rates （in age up to 15 years）, associated with initial disease severity and other confounders, but causal relationship for the initial VT levels as the independent factor to the major outcome w
文摘Background We conducted a prospective, multicenter investigation of incidence, management and outcome of neonatal acute respiratory disorders （NARD）, and evaluated related perinatal risk factors and efficacy of respiratory therapies in neonatal intensive care units （NICUs） in a Chinese neonatal network.Methods Data were prospectively collected in 2004-2005 from infants with NARD defined as presence of respiratory distress and oxygen requirement during the first 3 days of life.Results A total of 2677 NARD was classified （20.5% of NICU admissions）. There were 711 （5.44%） with respiratory distress syndrome （RDS）, 589 （4.51%） pulmonary infection, 409 （3.13%） meconium aspiration syndrome, 658 （5.03%）aspiration of amniotic fluid and 239 （1.83%） transient tachypnoea. Meconium aspiration syndrome had the highest rate with fetal distress, transient tachypnoea from cesarean section, and RDS with maternal disorders. Assisted mechanical ventilation was applied in 53.4% of NARD, and in above five disorders with 84.7%, 52.3%, 39.8%, 24.5%, and 53.6%,respectively. Corresponding mortality in these disorders was 31.4%, 13.6%, 17.8%, 4.1% and 5.0%, respectively.Surfactant was provided to 33.9% of RDS. In all RDS infants, the survival rate was 78.8% if receiving surfactant, and 63.4% if not （P 〈0.001）.Conclusions This study provided NICU admission-based incidence and mortality of NARD, reflecting efficiency of advanced respiratory therapies, which should be a reference for current development of respiratory support in NICU at provincial and sub-provincial levels, justifying efforts in upgrading standard of care in emerging regions through a collaborative manner.
