| Summary: | 碩士 === 長庚大學 === 臨床醫學研究所 === 106 === Purpose:
Respiratory distress syndrome (RDS) is one of the most common respiratory problems encountered in the neonatal intensive care unit (NICU). It is also the leading cause of mortality and morbidity in preterm infants. To establish non-invasive respiratory support (NRS) such as nasal continuous positive airway pressure (NCPAP) and non-invasive positive pressure ventilation (NIPPV) will improve the respiratory distress in a short time. However, the complication and nasal trauma of NCPAP and NIPPV have been emphasizing iatrogenic damage effects. Recently, heated humidified high-flow nasal cannula (HHHFNC) have been introduced and applied as nasal respiratory support in infants with less nasal trauma and higher comfort. The aim of this study is to compare the efficiency between HHHFNC and NCPAP for preterm infants gestational age less than 37 weeks and birthweight at equal and greater than 1,500 g with symptoms of respiratory distress. To investigate the treatment effect of HHHFNC applied as primary treatment for preterm infants with RDS.
Methods:
This is a single-center, prospective, randomized case-controlled trial in the NICU during January 2015 to December 2017. Early nasal respiratory support was initiated in the NICU in any preterm infants who shows symptoms of respiratory distress. All eligible participants will randomize assigned to HHHFNC or NCPAP group (ratio 1:2). Preterm infants who was born in our hospital and will enrolled to this study. Inclusion criteria included GA ＜ 37 weeks and BBW ≧ 1,500 g; exclusion criteria included congenital malformation, severe intraventricular hemorrhage. The primary outcome is the percentage of infants who failed nasal respiratory support and need of NIPPV support; secondary outcome is the morbidity, mortality, length of hospital stay, length of ICU days, length of mechanical ventilation days and nasal trauma score.
Result:
A total of 54 RDS preterm infants were enrolled to this study and randomized to receive either HHHFNC group (n= 18) or NCPAP group (n = 36) (Fig. 1) during January 2015 to December 2017. There was no difference between HHHFNC group and NCPAP group in failure of NRS for primary respiratory support (28% vs. 53%, p = 0.081). The most common reason for treatment failure in the two groups was progressive respiratory distress, with no significant between-group difference in the reason for treatment failure. For days of NRS, there was no significant difference in all kind of NRS mode. The incidence of neonatal morbidities were comparable in both groups. Length of hospital admission (17 vs. 19, p = 0.424), length of ICU stay (5 vs. 6, p = 0.224).
Conclusion:
In summary, there was no difference of failure of primary treatment of NRS, and secondary outcomes were all comparable in our study. HHHFNC appears to have similar efficacy and safety to NCPAP in primary treatment in preterm infants with RDS. Preterm infants with respiratory distress who required respiratory support may use HHHFNC instead of use NCPAP for less nasal trauma and higher comfort.
Keyword: heated humidified high-flow nasal cannula nasal; nasal continuous positive airway pressure; non-invasive respiratory support; preterm infant; respiratory distress syndrome.
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