Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitati...Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable(gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.展开更多
目的探讨经鼻无创高频振荡通气(noninvasive high frequency oscillatory ventilation,nHFOV)与加温湿化高流量鼻导管通气(heated humidified high flow nasal cannula,HHHFNC)预防呼吸危重症早产儿拔管失败的临床效果。方法采用多中心...目的探讨经鼻无创高频振荡通气(noninvasive high frequency oscillatory ventilation,nHFOV)与加温湿化高流量鼻导管通气(heated humidified high flow nasal cannula,HHHFNC)预防呼吸危重症早产儿拔管失败的临床效果。方法采用多中心前瞻性临床随机对照研究方法,将2017年8月至2018年2月收住河北省12家三级甲等医院新生儿重症监护病房、应用有创通气已达撤机条件、准备改为无创呼吸的早产儿纳入研究。根据出生胎龄分为<32周和32~36周,再按照随机数字表法将每组纳入对象分为应用nHFOV组和应用HHHFNC组。主要观察指标包括拔管失败率、医院内病死率、支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生率;次要观察指标包括无创通气时间、用氧时间、住院天数,严重或频繁呼吸暂停、坏死性小肠结肠炎、Ⅲ-Ⅳ度脑室内出血、肺气漏、脑室周围白质软化、有血流动力学意义的动脉导管未闭、早产儿视网膜病、鼻损伤发生率,听力筛查未通过率。结果共纳入研究对象338例,其中胎龄<32周147例(nHFOV组74例,HHHFNC组73例),32~36周191例(nHFOV组98例,HHHFNC组93例)。入选病例拔管失败率13.0%(44/338),其中<32周17.0%(25/147),32~36周9.9%(19/191)。医院内病死率为8.6%(29/338),其中<32周10.9%(16/147),32~36周6.8%(13/191)。BPD发生率5.9%(20/338),其中<32周9.5%(14/147),32~36周3.1%(6/191)。<32周:nHFOV组拔管失败率、无创通气时间、用氧时间、住院天数均低于HHHFNC组,拔管后24 h nHFOV组PaCO2、FiO2低于HHHFNC组,差异有统计学意义(P<0.05);两组并发症发生率差异无统计学意义(P>0.05)。32~36周:两组拔管失败率、医院内病死率、无创通气时间、用氧时间、并发症发生率及听力筛查未通过率差异均无统计学意义(P>0.05);nHFOV组住院时间及拔管后48 h FiO2低于HHHFNC组,差异有统计学意义(P<0.05)。结论nHFOV和HHHFNC作为早产儿拔管后呼吸支持模式是有效的,胎龄<32周早�展开更多
文摘Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable(gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.
文摘目的探讨经鼻无创高频振荡通气(noninvasive high frequency oscillatory ventilation,nHFOV)与加温湿化高流量鼻导管通气(heated humidified high flow nasal cannula,HHHFNC)预防呼吸危重症早产儿拔管失败的临床效果。方法采用多中心前瞻性临床随机对照研究方法,将2017年8月至2018年2月收住河北省12家三级甲等医院新生儿重症监护病房、应用有创通气已达撤机条件、准备改为无创呼吸的早产儿纳入研究。根据出生胎龄分为<32周和32~36周,再按照随机数字表法将每组纳入对象分为应用nHFOV组和应用HHHFNC组。主要观察指标包括拔管失败率、医院内病死率、支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生率;次要观察指标包括无创通气时间、用氧时间、住院天数,严重或频繁呼吸暂停、坏死性小肠结肠炎、Ⅲ-Ⅳ度脑室内出血、肺气漏、脑室周围白质软化、有血流动力学意义的动脉导管未闭、早产儿视网膜病、鼻损伤发生率,听力筛查未通过率。结果共纳入研究对象338例,其中胎龄<32周147例(nHFOV组74例,HHHFNC组73例),32~36周191例(nHFOV组98例,HHHFNC组93例)。入选病例拔管失败率13.0%(44/338),其中<32周17.0%(25/147),32~36周9.9%(19/191)。医院内病死率为8.6%(29/338),其中<32周10.9%(16/147),32~36周6.8%(13/191)。BPD发生率5.9%(20/338),其中<32周9.5%(14/147),32~36周3.1%(6/191)。<32周:nHFOV组拔管失败率、无创通气时间、用氧时间、住院天数均低于HHHFNC组,拔管后24 h nHFOV组PaCO2、FiO2低于HHHFNC组,差异有统计学意义(P<0.05);两组并发症发生率差异无统计学意义(P>0.05)。32~36周:两组拔管失败率、医院内病死率、无创通气时间、用氧时间、并发症发生率及听力筛查未通过率差异均无统计学意义(P>0.05);nHFOV组住院时间及拔管后48 h FiO2低于HHHFNC组,差异有统计学意义(P<0.05)。结论nHFOV和HHHFNC作为早产儿拔管后呼吸支持模式是有效的,胎龄<32周早�
