The urgency of the work is due to the fact that despite the sufficient development of nursing technologies, there is no significant reduction in the frequency of BPD, which remains one of the causes of disability in children. Modern theories of the origin of retinopathy of prematurity (RP) and necrotizing enterocolotis (NEC) have identified the need to study the cross-factors of all these diseases.
Objective: to improve the prevention of severe BPD and comorbidities of prematurity based on the analysis of the effectiveness of various methods of respiratory and non-respiratory intensive care for respiratory disorders in newborns with a gestational age of 28-32 weeks.
During the multicenter retrospective-prospective cohort study on the basis of two clinical institutions in Dnipro, 133 premature neonates were examined and analyzed in the period from 2016 to 2020.
Inclusion criteria: gestational age 28-32 weeks, the presence of respiratory disorders at birth that required respiratory support, the informed consent of parents or legal representatives of the child to be included in the study and processing of personal data.
Exclusion criteria: no need for respiratory support, body weight <750 g, intraventricular hemorrhage of IV degree, the presence of congenital malformations that can independently affect the work of breathing.
The groups were formed on the basis of medical records of patients and papers of intensive care, In 1st group based on the current registration of research and treatment results and in 2nd group due to the anamnestic data of medical records. To achieve the goal of the work, further consolidation was carried out in the general cohort, where stratification was performed according to the development of BPD, RP and NEC.
A simplified SpO2/FiO2 ratio was used to assess the severity of respiratory disorders. The SpO2/FiO2 ratio in 1st group was 245 [161.7; 330], and in 2nd group - 274.3 [211.8; 376], which corresponds to the moderate severity of RDS.
Patients with severe and moderate BPD were significantly longer on mechanical ventilation and/or received FiO2>30%, each subsequent day of MV and /or FiO2 > 30% increases the probability of developing BPD by 15% (p = 0.01).
Even when patients were weaned from MV and treated with non-invasive ventilation with pressure control (NIV PC), the chances of detecting moderate / severe BPD increased by 7%, p = 0.01. And use in respiratory support FiO2> 30% increased these risks by 10% (p <0,01).
It was determined that increasing the duration of vasopressor support by 1 day increased the chances of detecting moderate / severe BPD by 22% (p <0.01).
It was determined that among 24 patients of the study, in whom moderate and severe BPD was verified, 13 (60.1%) also had RP, and 18 children (75.0%) were diagnosed with NEC. An in-depth analysis revealed that in 13 patients with BPD (54.2%) both RP and NEC were verified.
Analyzed the development of moderate and severe RP is associated with an increase in the duration of NIV PC 4 times (p = 0.01), MV - 2.3 times (p = 0.33), CPAP - 4.5 times (p = 0.05), using FiO2> 30% - 4 times (p = 0.01), body weight deficit (p = 0.03).
Statistically significant predictors of NEC development were low Apgar score <7 points (p = 0.04), lower infusion volume in the first day of life (p <0.01), late onset of enteral nutrition (p <0.01 ).
Components of intensive care that affect the development of BPD, RP and NEC: duration of MV (p<0.01), NIV PC (p<0.01), CPAP (p<0.01), initial respiratory support (p = 0,02), usage of FiO2> 30% (p <0,01), duration of vasopressor therapy (p <0,01).
Scientific novelty:
For the first time it is substantiated that in premature infants with RDS the level of SpO2/FiO2 in the first day of life is prognostically significant for assessing the risk of developing BPD.
The influence of different methods of respiratory support on the development of severe forms of BPD and RP has been studied, new data on the risks and benefits of NIV PC regimen as a method of weaning from mechanical ventilation have been obtained.
For the first time, cross-risks of comorbidities of prematurity associated with nutritional support have been identified.
The practical significance of the results: a scale for predicting the development of comorbidities of prematurity based on intensive care procedures has been proposed.
Key words: premature infants, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, comorbidities, respiratory support
