Особенности течения и тактики интенсивной терапии респираторного дистресса у недоношенных новорожденных: ОРИГИНАЛЬНЫЕ СТАТЬИ

Юрий Станиславович  Александрович; Джамиля Алибулатовна  Темирова; Дмитрий Олегович  Иванов; Дмитрий Анатольевич  Лебедев

doi:10.56871/PED.2025.38.67.002

Respiratory distress in preterm newborns: clinical featers and intensive care tactics

ORIGINAL STUDIES

Yurii S. Aleksandrovich Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
Jamilya A. Temirova Maternity Hospital No. 10, Saint Petersburg, Russia
Dmitry O. Ivanov Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
Dmitry A. Lebedev Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia

Keywords:

респираторный дистресс новорожденные недоношенные респираторная поддержка respiratory distress newborns premature infants respiratory support

Abstract

Background. Respiratory disorders or respiratory distress are the most common cause of hospitalization of a newborn in the intensive care unit, and this is typical for both full-term and premature infants.

Aim — to determine the priorities of intensive care tactics for respiratory distress in premature newborns of different gestational age by studying the clinical and laboratory features of its course.

Materials and methods. A retrospective observational multicenter study was performed on 155 newborns, who were divided into two conditional groups depending on the gestational age. Group I included 120 premature newborns with a gestational age of up to 34 weeks, and group II included 35 late premature infants (gestational age — 34–36 (6/7) weeks).

Results. Group I showed lower Apgar scores both one minute and 5 minutes after birth. The median score on the Silverman–Andersen scale in the group I was 5 points, which was statistically significantly higher than in the group II (4 points). The severity of multiple organ dysfunction on the nSOFA (Neonatal Sequential Organ Failure Assessment) scale was higher in patients of the I group (3 vs 2; p=0.006). The median duration of mechanical ventilation in the I group of patients was significantly higher (263 vs 63 hours; p=0.006). Arterial hypotension was registered in the first 24 hours of life in 19 (12.2%) premature infants: 18 (15%) patients in the group I and 1 (2.8%) child — in the group II, the differences were statistically significant (p=0.04). Median volume of volumetric load in the first day of life in the group I was 89, and in the group II — 70 ml/kg in day, which was statistically significant. No statistically significant differences were obtained in terms of the level of hourly diuresis and hydrobalance. Diuresis was 3.6–3.1 ml/kg in hour and was within the permissible values. Inotropic-vasopressor support was provided to 45 (29%) premature infants: 40 (33.3%) patients in group I and 5 (14.3%) in group II. The differences were statistically significant (p=0.02). In group I, the median of the vasotropy-inotropic index was 11.2 [5; 12.5], in group II — 8.6 [5; 10], the differences are statistically significant (p=0.03).

Conclusion. Early premature infants are a more vulnerable group of newborns who have a severe course of respiratory distress, which requires longer respiratory and more intensive hemodynamic support.

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