Nasal CPAP for very preterm infants at birth: Does it improve outcome? A randomised controlled trial

对于极早产儿出生时进行鼻 CPAP：它能改善结局吗？

• 批准号: nhmrc : 148002
• 负责人: Dr Chad Andersen
• 金额: $ 30.71万
• 依托单位国家: 澳大利亚
• 项目类别: NHMRC Project Grants
• 财政年份: 2001
• 资助国家: 澳大利亚
• 起止时间: 2001-01-01 至 2004-12-31
• 项目状态: 已结题
• 来源: https://researchdata.edu.au/nasal-cpap-preterm-controlled-trial/97901
• 关键词: Nasal; CPAP; very; preterm; infants

Neonatal respiratory distress syndrome (RDS) is the major cause of morbidity and mortality in preterm infants. Many of these infants need ventilatory support to keep them alive. In 1996 and 1997, 10,471 infants in Australia and New Zealand needed ventilatory support for a total of 72,544 days. This treatment is a great physical burden for the infants and an enormous emotional stress for their parents. Each day of treatment costs about A$2000 so their hospital treatment costs about $72 million a year. Of infants born less than 29 weeks' gestational age, about 40% of the survivors subsequently developed chronic lung disease (CLD). This condition is defined as prolonged dependence on supplementary oxygen therapy. CLD is associated with further costs and increased lung problems and readmissions to hospital in the first year of life. Thus, CLD is an expensive and time-consuming condition that has a high social cost. This project will determine whether treating these very premature babies from birth simply by applying oxygen under a low continuous positive pressure (CPAP) into their nose rather than the present treatment of placing a tube in the windpipe (known as intubation) and ventilation will reduce the incidence and severity of neonatal respiratory distress syndrome and subsequent chronic lung disease. The project will involve 600 babies from different, high quality neonatal intensive care units. Babies who are born at less than 29 weeks' gestation and who show signs of breathing at birth will be randomly allocated to be treated with either nasal CPAP or intubation and ventilation. This project will determine whether CPAP treatment at birth improves survival and reduces the severity of the RDS and subsequent CLD, or has no long term beneficial effect. If the trial is successful, this will be one of the most useful new treatments in neonatal medicine because it is simple to use, easier for the babies, and cheaper than ventilation.

新生儿呼吸窘迫综合征（RDS）是早产儿发病和死亡的主要原因。这些婴儿中的许多人需要急救支持来维持生命。1996年和1997年，澳大利亚和新西兰有10，471名婴儿需要照料，共计72，544天。这种治疗对婴儿来说是巨大的身体负担，对父母来说是巨大的情感压力。每天的治疗费用约为2000澳元，因此他们每年的医院治疗费用约为7200万澳元。在胎龄小于29周的婴儿中，约40%的幸存者随后发展为慢性肺病（CLD）。这种情况被定义为长期依赖补充氧气治疗。CLD与生命第一年的进一步成本和增加的肺部问题和再入院有关。因此，CLD是一种昂贵且耗时的疾病，具有很高的社会成本。该项目将确定是否从出生起就通过在低持续正压（CPAP）下向鼻内供氧而不是目前的气管插管（称为插管）和通气治疗来治疗这些非常早产的婴儿，将减少新生儿呼吸窘迫综合征和随后的慢性肺部疾病的发病率和严重程度。该项目将涉及来自不同的高质量新生儿重症监护病房的600名婴儿。出生时妊娠少于29周且出生时显示呼吸体征的婴儿将随机分配接受鼻CPAP或插管和通气治疗。该项目将确定出生时CPAP治疗是否能提高生存率并降低RDS和随后CLD的严重程度，或者没有长期的有益影响。如果试验成功，这将是新生儿医学中最有用的新疗法之一，因为它使用简单，对婴儿来说更容易，而且比通气更便宜。