Clinical analysis of 168 neonates with respiratory distress syndrome treated by Calsurf and different mechanical ventilation modes

Objective To summarize our experience of Calsurf and mechanical ventilation (MV) to rescue 168 neonates with respiratory distress syndrome (RDS). Methods The study involved RDS patients who were admitted to Neonatal intensive care unit (NICU) of Hebei Provincial Children's Hospital and received Calsurf and MV treatment from Sep. ,2006 to Feb 29,2008. The data were retrospectively collected from these cases in a standard form,which included general clinical characteristics,mechanical ventilation modes,complications,outcome,and so on. To evaluate the effect of Calsurf,blood gas and ventilator settings were recorded at 0,1,12,72 hours of Calsurf treatment. Results Mean (SD) gestational age (GA) of infants studied was 32.3±3.7weeks and 88.7% were preterm (GA 37 weeks). Mean birth weight (BW) was 1730±750 grams and 87.5% of them had BW 2500 grams. The male/female ratio was 4.6(138/30). At 0,1,12 and 72 hours of Calsurf treatment,FiO2 of RDS patients was 0.51±0.11,0.32±0.1,0.28±0.08 and 0.26±0.09,respectively. Significant decline in FiO2 and increase in PiO2/FiO2 and a/APO2 were observed at different time points,especially between 0 and 1 hour (P 0.05),but there was no statistical difference. Different ventilation modes were applied to these patients. In 14.9%(25/168) of these infants,surfactant was administered during a brief intubation followed by immediate extubation (INtubation SURfactant Extubation,INSURE). Surfactant therapy was successfully given only during NCPAP without intubated ventilation in these infants. High Frequency Oscillation Ventilation (HFOV) 7.7%(13/168); SIPPV+VG was the most widely-used ventilation mode 60.11.% (101/168).and 4.8%(8/168) received inhaled nitric oxide treatment. Ventilation associated pneumonia and pneumothorax were still two major complications. The mortality of the study population was 10.7% including hospital death (4.8%) and withdrawal treatment (5.9%) after parents' decision. Conclusion Calsurf can quickly improve oxygenation status of RDS patients. More and more clinicians are applying preventive pulmonary ventilation.