Klievakina O. Optimization of respiratory support in full-term newborns with hypoxic-ischemic encephalopathy

The thesis work is based on the results of the personal observations over the status of newborns with HIE at the treatment stages, as well as data from the personal analysis of clinical, instrumental and laboratory - biochemical results of the patients’ study. A prospective, incidence, randomized study involving 60 (100 %) full-term infants born between 38 and 42 weeks of gestation was conducted. All patients were treated in the neonatal intensive care unit for HIE of the II and III degrees (according to the Sarnat scale modified by A. Hill, J.J. Volpe (1994) and the presence of respiratory distresses requiring artificial lung ventilation (ALV). The main group included 30 (50.00 %) patients who underwent early tracheal extubation 72 hours after the birth and were transferred to non-invasive nasal intermittent positive pressure ventilation (NIPPV), using long or short nasal prongs. The comparison group consisted of 30 (50.00 %) newborns who underwent traditional ALV in P - SIMV mode through an endotracheal tube until recovery of consciousness level, absence of seizures and settling of a regular pattern of spontaneous breathing. Case monitoring of neurological status in newborns was performed according to the modified Thompson scale (1997). The results of the comparison of both groups were evaluated during the hospitalization of children in the department; 72 hours after birth; on the 4th day after birth; one day after transferring a child to spontaneous breathing. During the first 72 hours after birth, children in both groups underwent invasive auxiliary flow-controlled lung ventilation with respiratory passages pressure control (P - SIMV). The main and comparison groups did not differ statistically in gestational age, body weight, age of newborns and gender structure. For the first time, the use of early non-invasive lung ventilation of full-term newborns with moderate and severe hypoxic-ischemic encephalopathy, which is the latest in the practice of intensive care. The effect of non-invasive MV on the level of CNS impairment markers and the level of markers indicative of a ventilator-associated disorder in newborns with HIE under the influence of non-invasive MV was studied for the first time. Based on the obtained data, the approach to choosing the respiratory support of full-term newborns with hypoxic-ischemic encephalopathy of various degrees of severity has been improved. The advantages and effectiveness of the proposed technique are shown, which is likely to reduce the total number of disorders associated with ALV, consequently reducing the stay of children in hospital beds.