The role of aggressive factors of respiratory support in the formation of bronchopulmonary dysplasia in preterm infants
Bronchopulmonary dysplasia is a chronic poLyetioLogicaL disease of morphologically and functionally immature Lungs, most common in premature infants who require respiratory support and oxygen therapy to relieve acute respiratory failure. The most important risk factors for this disease are aggressive factors of respiratory therapy, which have a direct damaging effect on the structure of the bronchopulmonary system.
Aim of research - to evaluate the role of respiratory therapy factors in the formation of bronchopulmonary dysplasia in preterm infants with very low and extremely low birth weight.
Material and methods. The study included 97 premature newborns with a gestation age <32 weeks, a birth weight <1500 g, with respiratory disorders and requiring respiratory therapy. Depending on the outcome of respiratory pathology, newborns were divided into 2 groups: 1st group - children who formed bronchopulmonary dysplasia (n=50), 2nd group - children who recovered from respiratory pathology (n=47).
Results and discussion. It was found, that the mask and endotracheal ventilation in the delivery room increase the risk of bronchopulmonary dysplasia. Children of 1st group compared with 2nd group, significantly more often required endotracheal [64.0 and 31.9% respectively, p=0.001; OR=3.793 (CI 1.633-8.806)] and mask ventilation [74.0 and 40.4% respectively, p=0.001; OR=4.194 (CI 1.776-9.906)]. It was found, that the use of supplement oxygen in the delivery room was significantly more often noted in the 1st group of newborns in comparison with recovered children [96.0 and 44.7% respectively, p=0.001; OR=29.71 (CI 6.455-136.8)]. The complex of prolonged respiratory therapy, including endotracheal ventilation, non-invasive ventilation and oxygen therapy was required in 56.0% of patients from 1st group and in 25.5% of cases in the 2nd group [p=0.002; OR=3.712 (CI 1.546-8.783)]. The maximum value of mean airway pressure, expiratory tidal volume, fraction of oxygen and total duration of their exposure, were significantly higher in 1st group compared to 2nd group (p=0.001). The use of non-synchronized algorithms of endotracheal respiratory support was significantly more frequently recorded in patients from 1st group compared with children from 2nd group [42.1 and 14.3% respectively, p=0.026; OR=4.367 (CI 1.096-17.370)].
Summary. Aggressive factors of respiratory therapy, contributing to the formation of bronchopulmonary dysplasia in newborns with very low and extremely low birth weight, are: endotracheal and mask ventilation in delivery room, long-term use of endotracheal ventilation in combination with non-invasive ventilation and oxygen therapy, high values of mean airway pressure, tidal volume expiratory and fraction of oxygen, application of non-synchronized algorithms of endotracheal respiratory support.
Keywords:bronchopulmonary dysplasia, respiratory therapy, preterm infants, extremely low body weight, very low body weight, neonatal intensive care unitt
For citation: Mezhinsky S.S., Shilova N.A., Kharlamova N.V., Chasha T.V., Andreev A.V. The role of aggressive factors of respiratory support in the formation of bronchopulmonary dysplasia in preterm infants. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2019; 7 (1): 12-20. doi: 10.24411/2308-2402-2019-11002. (in Russian)