How to improve CPAP failure prediction in preterm infants with RDS: a pilot study
| Autor: | Maurizio Radicioni, Alberto Leonardi, Vittorio Bini, Victoria Elisa Rinaldi, Lucia Lanciotti, Pier Giorgio Camerini |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Diaphragmatic breathing Pilot Projects Doppler imaging 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Fraction of inspired oxygen Internal medicine medicine Humans 030212 general & internal medicine Continuous positive airway pressure Prospective Studies Oxygen saturation (medicine) Respiratory Distress Syndrome Newborn Respiratory distress Continuous Positive Airway Pressure business.industry Infant Newborn Pediatrics Perinatology and Child Health Breathing Cardiology Gestation business Infant Premature |
| Zdroj: | European journal of pediatrics. 180(3) |
| ISSN: | 1432-1076 |
| Popis: | We aimed to test the diagnostic accuracy in predicting continuous positive airway pressure (CPAP) failure in premature infants with respiratory distress syndrome (RDS) by integrating oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF ratio) with the measurement of peak velocity of the right diaphragmatic excursions (RD-PV), during the inspiration (I-Peak) and expiratory (E-Peak) phases, performed by pulsed-wave Tissue Doppler imaging. This is a prospective, observational pilot study conducted over a 2-year period. Neonates at ≤ 32 weeks gestation supported by early CPAP were eligible. Natural surfactant was delivered via a minimally invasive technique. We performed serial measurements of SF ratio and RD-PV during the early post-natal hours to test the accuracy in predicting surfactant administration as well as invasive ventilation support within 72 h from birth because of the RDS worsening. Of 56 preterm infants enrolled, 34 (61%) failed CPAP support. SF ratio showed a significant inverse relationship with both Silverman-Andersen score at birth (rho = − 0.417; P = .001) and RD-PV [E-Peak] (rho = − 0.361; P = .007). We achieved a high accuracy in predicting CPAP failure (AUC = 95%; 95% CI, 89–100%) by integrating gender, SF ratio, and RD-PV [E-Peak] at the restricted, multivariate analysis. Conclusions: SF ratio and RD-PV, as measured by pulsed-wave Tissue Doppler, may help physicians to improve their confidence in optimizing therapeutic options in preterm infants with RDS. |
| Databáze: | OpenAIRE |
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