Early Respiratory Management of Respiratory Distress Syndrome in Very Preterm Infants and Bronchopulmonary Dysplasia A Case-Control Study 英文参考文献.docVIP

EarlyRespiratoryManagementofRespiratoryDistress SyndromeinVeryPretermInfantsand BronchopulmonaryDysplasia:ACase-ControlStudy ArjanB.tePas*,EnricoLopriore,MarissaJ.Engbers,FransJ.Walther DivisionofNeonatology,DepartmentofPediatrics,LeidenUniversityMedicalCenter,Leiden,TheNetherlands Background. In the period immediately after birth, preterm infants are highly susceptible to lung injury. Early nasal continuous positiveairwaypressure (ENCPAP)isanattempttoavoidintubation andmayminimize lunginjury. Incontrast, ENCPAP can fail, and at that time surfactant rescue can be less effective. Objective. To compare the pulmonary clinical course and outcome of very preterm infants (gestational age 25–32weeks) with respiratory distress syndrome (RDS) who startedwithENCPAPandfailed(ECFgroup),withacontrolgroupofinfantsmatchedforgestationalage,whoweredirectly intubated in the delivery room (DRI group). Primary outcome consisted of death during admission or bronchopulmonary dysplasia(BPD).Results.25infantswereincludedintheECFgroupand50controlinfantsmatchedforgestationalagewere includedintheDRIgroup.MeangestationalageandbirthweightintheECFgroupwere29.7weeksand1,393gandinthe DRI group 29.1weeks and 1,261g (p=NS). The incidence of BPD was significantly lower in the ECF group than in the DRI group(4%vs.35%;P,0.004;OR12.6(95%CI1.6–101)).Neonatalmortalitywassimilarinbothgroups(4%).Theincidenceof neonatal morbidities such as severe cerebral injury, patent ductus arteriosus, necrotizing enterocolitis and retinopathy of prematurity, was not significantly different between the two groups. Conclusion. A trial of ENCPAP at birth may reduce the incidence of BPD and does not seem to be detrimental in very preterm infants. Randomized controlled trials are needed to test whether early respiratory management of preterm infants with RDS plays an important role in the development of BPD. Citation: tePasAB,LoprioreE,EngbersMJ,WaltherFJ(2007)EarlyRespiratoryManagementofRespiratoryDistressSyndromeinVer