Influencing Factors in Selecting Initial Respiratory Support Strategies in Neonatal Respiratory Distress Syndrome and Early Outcomes of Different Support Strategies in High Altitude Areas

Abstract

Background At present, there are a variety of mechanical ventilation mode of breathing for premature infants with respiratory distress syndrome (NRDS) , but the application of these techniques in Tibetan Plateau are limited because of the low air pressure and oxygen content and etc. The NRDS initial breathing support measures can only be performed with INSURE technique (tracheal intubation—injection of pulmonary surfactant—nasal continuous positive airway pressure ventilation after extubation) and invasive mechanical ventilation (MV) . It is currently unclear what factors influence the selection of the NRDS initial breathing support therapy in premature infants in Tibetan Plateau. Objective To explore the factors in selection of supporting NRDS initial breathing strategies in high altitude area and evaluate the early clinical outcomes of different supporting strategies. Methods The clinical data of 183 premature infants diagnosed with NRDS and their mother's general data in Paediatri neonatal ward of Lhasa People's Hospital from June 2018 to June 2020 were analyzed retrospectively. According to the accepted initial respiratory support mode, they were divided into INSURE group (n=122) and MV group (n=61) . Multifactorial Logistic regression analysis was used to explore influencing factors in selection of NRDS initial breathing support treatment. Results The gestational age, birth weight, 1 min, 5 min and 10 min Apgar scores in MV group were lower than those in INSURE group and the proportion of prenatal application of glucocorticoids was higher than that in INSURE group (P<0.05) . The difference was statistically significant after comparing the composition of premature infants of different gestational ages between INSURE group and MV group (P<0.05) . The difference was statistically significant as well after comparing the composition of NRDS 5 min Apgar score between INSURE group and MV group (P<0.05) . The mortality and incidence of pulmonary hemorrhage in MV group were higher than those in INSURE group (P<0.05) . Among the surviving infants, the incidence of bronchopulmonary dysplasia (BPD) in MV group was higher than that in INSURE group〔43.2% (16/37) vs 16.1% (18/112) 〕 (P<0.05) . Multifactoral Logistic regression analysis showed that gestational age, Apgar score at 5 minutes after birth and whether to use prenatal glucocorticoid were influencing factors in selecting MV for premature infants with NRDS (P<0.05) . Conclusion In Tibet Plateau, the gestational age at birth, Apgar at 5 minutes after birth and whether to use glucocorticoids before delivery are closely related in the selection of the NRDS initial breathing support strategy.

Keywords

• respiratory distress syndrome, newborn|respiration, artificial|continuous positive airway pressure|altitude|prognosis|root cause analysis