A randomised controlled trial of two methods of delivering nasal continuous positive airway pressure after extubation to infants weighing less than 1000 g: binasal (Hudson) versus single nasal prongs

OBJECTIVES: Primary: to determine whether nasal continuous positive airway pressure (CPAP) delivered through binasal prongs results in a greater proportion of extremely low birthweight infants being successfully extubated, after a period of intermittent positive pressure ventilation, than nasal CPAP delivered by a single nasal prong. Secondary: to evaluate the effect of mode of delivery of nasal CPAP after extubation on the need for endotracheal reintubation, weight gain, rates of feeding intolerance, sepsis, suspected sepsis, cranial ultrasound abnormalities, retinopathy of prematurity, chronic lung disease, and the duration of assisted ventilation and care in the tertiary neonatal unit. DESIGN AND SETTING: Randomised, controlled, clinical trial conducted at the neonatal intensive care unit of the Royal Women's Hospital, Melbourne, Australia. PATIENTS: Infants of birth weight less than 1000 g, ventilated, requiring < 50% oxygen and ventilator rate less than or equal to 20/minute, and considered by the clinical management team to be ready for extubation. INTERVENTION: Infants were randomly allocated to receive nasal CPAP delivered through binasal (Hudson) prongs or a single nasal prong. PRIMARY OUTCOME MEASURE: Failure of extubation as defined by the following criteria: (a) apnoea (more than one episode/hour over a six hour period or one episode requiring bag and mask ventilation); (b) absolute increase in oxygen requirement greater than 15% above that required before extubation; (c) respiratory acidosis (pH < 7.25 with PCO(2) > 6.67 kPa). RESULTS: Ten of the 41 (24%) infants randomised to binasal prongs reached predetermined failure criteria compared with 26 of the 46 (57%) infants randomised to a single nasal prong (p = 0.005). Four of 17 (24%) infants of birth weight less than 800 g extubated to binasal prongs reached failure criteria compared with 14 of 16 (88%) extubated to a single nasal prong (p < 0.001). There were no significant differences in any of the secondary outcomes. CONCLUSIONS: For extremely low birthweight infants ventilated using an endotracheal tube, nasal CPAP delivered through binasal (Hudson) prongs is more effective in preventing failure of extubation than that delivered through a single nasal prong.     

Prophylactic nasal continuous positive airways pressure in newborns of 28-31 weeks gestation: multicentre randomised controlled clinical trial

BACKGROUND: The role of nasal continuous positive airways pressure (nCPAP) in the management of respiratory distress syndrome in preterm infants is not completely defined. OBJECTIVE: To evaluate the benefits and risks of prophylactic nCPAP in infants of 28-31 weeks gestation. DESIGN: Multicentre randomised controlled clinical trial. SETTING: Seventeen Italian neonatal intensive care units. PATIENTS: A total of 230 newborns of 28-31 weeks gestation, not intubated in the delivery room and without major malformations, were randomly assigned to prophylactic or rescue nCPAP. INTERVENTIONS: Prophylactic nCPAP was started within 30 minutes of birth, irrespective of oxygen requirement and clinical status. Rescue nCPAP was started when Fio2 requirement was > 0.4, for more than 30 minutes, to maintain transcutaneous oxygen saturation between 93% and 96%. Exogenous surfactant was given when Fio2 requirement was > 0.4 in nCPAP in the presence of radiological signs of respiratory distress syndrome. MAIN OUTCOME MEASURES: Primary end point: need for exogenous surfactant. Secondary end points: need for mechanical ventilation and incidence of air leaks. RESULTS: Surfactant was needed by 22.6% in the prophylaxis group and 21.7% in the rescue group. Mechanical ventilation was required by 12.2% in both the prophylaxis and rescue group. The incidence of air leaks was 2.6% in both groups. More than 80% of both groups had received prenatal steroids. CONCLUSIONS: In newborns of 28-31 weeks gestation, there is no greater benefit in giving prophylactic nCPAP than in starting nCPAP when the oxygen requirement increases to a Fio2 > 0.4.     

A randomised control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants

OBJECTIVE: To compare the effectiveness of the Infant Flow Driver (IFD) with single prong nasal continuous positive airway pressure (nCPAP) in preterm neonates affected by respiratory distress syndrome. DESIGN: Randomised controlled study. PATIENTS: Between September 1997 and March 1999, 36 preterm infants who were eligible for CPAP treatment were randomly selected for either nCPAP or IFD and studied prospectively for changes in oxygen requirement and/or respiratory rate. The requirement for mechanical ventilation, complications of treatment, and effects on mid-term outcome were also evaluated. RESULTS: Use of the IFD had a significantly beneficial effect on both oxygen requirement and respiratory rate (p < 0.0001) when compared with nCPAP. Moreover, O(2) requirement and respiratory rate were significantly decreased by four hours (p < 0.001 and p < 0.03 respectively). The probability of remaining supplementary oxygen free over the first 48 hours of treatment was significantly higher in patients treated with the IFD than with nCPAP (p < 0.02). IFD treated patients had a higher success (weaning) rate (94% v 72 %) and shorter duration of treatment (49.3 (31) v 56 (29.7) hours respectively; mean (SD)), although the difference was not significant. CONCLUSIONS: IFD appears to be a feasible device for managing respiratory distress syndrome in preterm infants, and benefits may be had with regard to oxygen requirement and respiratory rate when compared with nCPAP. The trend towards reduced requirement for mechanical ventilation, shorter clinical recovery time, and shorter duration of treatment requires further evaluation in a multicentre randomised clinical trial.     

加温湿化高流量鼻导管吸氧在32周以下早产儿撤机中的疗效比较

目的 观察26~31+6周呼吸窘迫综合征早产儿撤机后应用加温湿化高流量鼻导管吸氧(HHHFNC)和鼻塞持续气道正压(nCPAP)的疗效。方法 161例早产儿拔管后随机分成两组:治疗组接受HHHFNC治疗(n = 79);对照组接受nCPAP治疗(n = 82)。两组患儿又根据胎龄分为26~28+6周组和29~31+6周组。比较组间治疗失败率、拔管后7 d内再次插管率、并发症发生率和住院期间病死率。结果 治疗组和对照组两组早产儿治疗失败率和再插管率差异无统计学意义。胎龄26~28+6周的早产儿中,治疗组治疗失败率显著高于对照组 (P < 0.05),再次插管率差异无统计学意义;29~31+6周早产儿中,两组治疗失败率和再次插管率差异均无统计学意义。两组患儿并发症发生率和病死率差异亦无统计学意义。结论 对29~31+6周的早产儿撤机时应用HHHFNC能产生与nCPAP相似疗效,而对29周以下早产儿作为一线无创呼吸支持要谨慎。     

Infant Flow Driver or single prong nasal continuous positive airway pressure: short-term physiological effects

The effectiveness of single prong nasal continuous positive airway pressure (CPAP) was compared with the Infant Flow Driver (IFD) in a crossover study in 20 neonates treated with ≤ 30% oxygen by nasal CPAP. They were randomized to the device used at the start of the study. Each infant was studied for four consecutive 2-h periods alternating between single prong nasal CPAP and the IFD. The FiO² from the IFD read 0.02 higher than the same setting on the ventilators used for single prong nasal CPAP. The IFD improved the mean (95% CI) of theFiO₂by 0.05 (0.02–0.08), p = 0:008. Taking into account the systematic error in the FiO² between the devices the real mean improvement in FiO₂ produced by the IFD was 0.03 (-0.005 to 0.06), p = 0:09. There were no significant differences in respiratory rate, heart rate, blood pressure or comfort score of infants during periods of single nasal prong CPAP compared with periods on the IFD.     

Outcome of very low birthweight infants after introducing a new standard regime with the early use of nasal CPAP

In this paper, a retrospective study was performed to find out whether the introduction of early nasal continuous positive airway pressure (nCPAP) as a new standard regime of very low birthweight infants will lead to a decreasing tracheal intubation and ventilation rate, as well as to a lower incidence of bronchopulmonary dysplasia in a tertiary-level perinatal centre. Ninety-three infants (study group) with early nCPAP as the first respiratory support were compared to 63 infants (historical control group) born before the use of early nCPAP. No statistically significant differences were found in the baseline characteristics. The main results of the study include reduced intubation mainly in infants with a birthweight <1,000 g (study group): 58% vs. 81% (p < 0.05). The mean duration of ventilation was 248 h (control group) vs. 128 h (study group) (p < 0.001) and 437 h vs. 198 h in infants <1,000 g (p < 0.001). There was significantly reduced incidence of bronchopulmonary dysplasia from 55% to 18% for all surviving infants (p < 0.001), and for infants <1,000 g, it was 90% vs. 30% (p < 0.001). No significant differences for other outcome criteria were noted, but a significant reduction in the use of central i.v. lines, fluids, drugs, volume expansion, sedation, catecholamines, surfactant, steroids and buffer, as well as antibiotics, was observed (p < 0.05). Therefore, we can conclude that early nCPAP is an easy-to-use and safe procedure for very low birthweight infants to treat respiratory distress.     

鼻塞式同步间歇指令通气和持续气道正压通气在早产儿呼吸窘迫综合征中的应用比较

目的：比较鼻塞式同步间歇指令通气(nSIMV)和鼻塞式持续气道正压通气（nCPAP）在早产儿呼吸窘迫综合征（RDS）中的临床应用效果。方法：50例RDS早产儿,常规使用肺表面活性物质进行替代治疗后,随机分入nSIMV组或nCPAP组,观察治疗后临床症状和血气指标的变化。结果：nSIMV组需气管插管行呼吸机通气比率明显低于nCPAP组（24% vs 60%, P<0.05）;nSIMV组CO2潴留和低氧血症的比率分别为12%和24%,明显低于nCPAP组的40%和36%（P<0.05）。结论：nSIMV能更有效地对RDS早产儿进行呼吸支持治疗。［中国当代儿科杂志,2010,12（7）：524-526］     

Comparison of a high-flow humidified nasal cannula to nasal continuous positive airway pressure in children with acute bronchiolitis: experience in a pediatric intensive care unit

The objective of the current study is to compare the use of a nasal continuous positive airway pressure (nCPAP) to a high-flow humidified nasal cannula (HFNC) in infants with acute bronchiolitis, who were admitted to a pediatric intensive care unit (PICU) during two consecutive seasons. We retrospectively reviewed the medical records of all infants admitted to a PICU at a tertiary care French hospital during the bronchiolitis seasons of 2010/11 and 2011/12. Infants admitted to the PICU, who required noninvasive respiratory support, were included. The first noninvasive respiratory support modality was nCPAP during the 2010/11 season, while HFNC was used during the 2011/2012 season. We compared the length of stay (LOS) in the PICU; the daily measure of PCO₂ and pH; and the mean of the five higher values of heart rate (HR), respiratory rate (RR), FiO_2, and SpO₂ each day, during the first 5 days. Thirty-four children met the inclusion criteria: 19 during the first period (nCPAP group) and 15 during the second period (HFNC group). Parameters such as LOS in PICU and oxygenation were similar in the two groups. Oxygen weaning occurred during the same time for the two groups. There were no differences between the two groups for RR, HR, FiO_2, and CO₂ evolution. HFNC therapy failed in three patients, two of whom required invasive mechanical ventilation, versus one in the nCPAP group. Conclusion: We did not find a difference between HFNC and nCPAP in the management of severe bronchiolitis in our PICU. Larger prospective studies are required to confirm these findings.     

Congenital dacryocystoceles controlled by nCPAP via nasal mask in a neonate

Congenital dacryocystocele is a relatively rare type of nasolacrimal duct obstruction that may induce respiratory distress during the early neonatal period. We encountered a case of bilateral congenital dacryocystoceles with intranasal cysts in a premature infant delivered at 34 weeks of gestation. The patient developed symptoms of respiratory failure immediately after birth, but no ophthalmologic symptoms. Treatment with nasal continuous positive airway pressure via a nasal mask, instead of a nasal prong, effectively relieved the symptoms. Early diagnosis and appropriate treatment are critical for infants with nasal obstruction.     

气泡式与鼻塞式持续气道正压通气在早产儿呼吸窘迫综合征的疗效比较

目的 比较气泡式持续气道正压通气（BNCPAP）与鼻塞式持续气道正压通气（nCPAP）在早产儿呼吸窘迫综合征（NRDS）呼吸支持中的疗效及安全性。方法 回顾性分析使用过BNCPAP（69例）或nCPAP（61例）呼吸支持的130例早产NRDS患儿的临床资料,比较两组的死亡率、呼吸支持时间、是否使用肺表面活性物质（PS）以及治疗失败、支气管肺发育不良（BPD）、早产儿视网膜病（ROP）的发生情况,和上机后血气分析的pH、氧分压、二氧化碳分压的变化情况,并评价其安全性。结果 BNCPAP、nCPAP两组患儿在性别分布、出生胎龄及体重、1 min及5 min Apgar评分及出生方式、NRDS严重程度等方面的差异无统计学意义（P > 0.05）。BNCPAP组无患儿死亡,nCPAP组有1例死亡,但两组病死率的差异无统计学意义（P > 0.05）。BNCPAP组及nCPAP组无创辅助通气的时长、治疗失败率、BPD和ROP的发生率以及需要使用或需要重复使用PS比例的差异均无统计学意义（P > 0.05）。两组患儿上机后8~12 h的pH值变化及氧合指数变化的差异无统计学意义（P > 0.05）,但BNCPAP组患儿的二氧化碳分压下降较nCPAP组患儿多（P < 0.05）。两组患儿气胸及鼻中隔、鼻黏膜损伤发生率的差异无统计学意义（P > 0.05）。结论 BNCPAP和nCPAP在早产儿NRDS呼吸支持中的疗效和安全性相近。     

无创高频与加温湿化高流量鼻导管通气在早产儿呼吸窘迫综合征序贯撤机的临床应用

目的:探讨经鼻无创高频振荡通气(noninvasive high frequency oscillatory ventilation,nHFOV)与加温湿化高流量鼻导管通气(heated humidified high flow nasal cannula,HHHFNC)在极低出生体重早产儿呼吸窘迫综合征(respir...     

Effect on lung function of continuous positive airway pressure administered either by infant flow driver or a single nasal prong

The aim of this study was to assess if continuous positive airways pressure (CPAP) delivered by an infant flow driver (IFD) was a more effective method of improving lung function than delivering CPAP by a single nasal prong. A total of 36 infants (median gestational age 29 weeks, range 25–35 weeks) were studied, 12 who received CPAP via an IFD, 12 who received CPAP via a single nasal prong and 12 without CPAP. CPAP was administered post extubation if apnoeas and bradycardias or a respiratory acidosis developed or electively if the infant was of birth weight <1.0 kg. Lung function was assessed by the supplementary oxygen requirement and measurement of compliance of the respiratory system using an occlusion technique. Assessments were made immediately prior to and after 24 h of CPAP administration and at similar postnatal ages in the non-CPAP group. The infants who did not require CPAP had better lung function (non significant) than the other two groups before they received CPAP. After 24 h, lung function had improved in both CPAP groups to the level of the non CPAP infants. The supplementary oxygen requirements of all three groups decreased over the 24 h period, but this only reached significance in the single nasal prong group (P < 0.05). Four infants supported by the IFD, but none with a single nasal prong, became hyperoxic. Conclusion Continuous positive airways pressure administration via the infant flow driver appears to offer no short-term advantage over a single nasal prong system when used after extubation in preterm infants. Received: 29 June 1999 and in revised form: 23 September / Accepted: 15 October 1999     

经鼻同步间歇指令通气在重度呼吸窘迫综合征早产儿撤机后的应用

目的探讨重度呼吸窘迫综合征(RDS)早产儿撤机后行经鼻同步间歇指令通气(nSIMV)的临床疗效。方法回顾性分析2013年1月至2015年5月新生儿重症监护病房住院的126例RDS早产儿的临床资料。2013年1月至2014年3月住院患儿采用经鼻持续气道正压通气(nCPAP)(61例),而2014年4月至2015年5月住院患儿采用nSIMV(65例)。比较两组治疗后血气分析指标、撤机失败率与原因及并发症的差异。结果通气治疗4h后,nSIMV组pH值、氧分压(PaO_2)、血氧饱和度(SaO_2)和氧合指数(OI)均高于nCPAP组(均P0.05);nSIMV组二氧化碳分压(PaCO_2)低于nCPAP组(P0.05)。nSIMV组和nCPAP组撤机失败率分别是9%(6/65)和30%(18/61)(P0.05),其撤机失败的原因主要有低氧血症(2%vs 5%,P0.05)、高碳酸血症(6%vs 11%,P0.05)和呼吸暂停(2%vs 13%,P0.05)。两组患儿在呼吸机支持时间、全肠道喂养时间、恢复出生体重时间和总住院时间上比较差异无统计学意义(P0.05)。治疗后nSIMV组腹胀发生率明显低于nCPAP组(9%vs 30%,P0.05),但两组喂养不耐受、坏死性小肠结肠炎、脑室内出血、早产儿视网膜病变和支气管肺发育不良的发生率比较差异无统计学意义(P0.05)。结论重度RDS早产儿撤机后采用nSIMV不仅明显改善肺通气功能,降低撤机失败率,且治疗后胃肠道副反应小,不增加并发症的发生,在临床值得推广。     

Long-term outcome of preterm infants treated with nasal continuous positive airway pressure

This study’s aim was to assess neurodevelopmental and growth outcome until the age of 4 years of premature infants placed on early nCPAP, in the setting of the neonatal intensive care unit (NICU) and follow-up program of the Division of Neonatology of the Department of Pediatrics of the University Hospital, Lausanne, Switzerland. All consecutive inborn infants weighing <1500 g or <32 weeks of gestational age admitted to the NICU during two periods of 12 months—7.1996–6.1997 and 7.1998–6.1999—were compared before and after the systematic application of early nCPAP. Of 172 infants admitted to the NICU, 150 (87%) survived. 126 (84%) were tested at 6 months’ corrected age, 121 (81%) at 18 months’ corrected age, and 117 (78%) at the age of 4 years. Detailed perinatal data were collected. Follow-up included neurological examination, developmental testing and measurement of growth parameters. Statistical analyses were performed. Early application of nCPAP and avoidance of mechanical ventilation showed no adverse effects on neurodevelopment and growth. A significantly higher developmental quotient was found in the nCPAP group at 18 months’ corrected age. Several trends were also noted in the nCPAP group with a decrease of intraventricular hemorrhage and in “abnormal neurodevelopment” at 6 months corrected age, a bigger head circumference at all different tested ages and a greater height at 6 and 18 months corrected ages. In conclusion, our study of developmental outcome documents the absence of any harmful effect of early application of nCPAP to treat respiratory failure in very low birthweight infants.     

In vitro comparison of nasal continuous positive airway pressure devices for neonates

OBJECTIVE: To compare the resistance in vitro of different devices used for the delivery of nasal continuous positive airway pressure (NCPAP) in neonates. DESIGN: Flows of 4-8 litres/min were passed through a selection of neonatal NCPAP devices (single prong, Duotube, Argyle prong, Hudson prong, Infant Flow Driver), and the resultant fall in pressure measured using a calibrated pressure transducer. RESULTS: The decrease in pressure (cm H(2)O) for each device (size in parentheses) at a constant flow of 6 litres/min was: Duotube: (2.5), 21; (3.0), 6.2; (3.5), 2.3; single prong: (2.5), 4.4; (3.0), 2.1; (3.5), 1.2; Argyle prong: (XS), 3.6; (S), 1.9; (L), 1.5; Hudson prong: (0), 3.1; (1), 1.8; (2), 0.6; (3), 0.4; (4), 0.3; Infant Flow Driver: (small), 0.3; (medium), -0.3; (large), -0.5. CONCLUSIONS: A large variation in the potential fall in pressure may occur in the clinical setting. Devices with short double prongs had the lowest resistance to flow. These results have implications in the selection of the optimal device/s for clinical application and for future comparisons in randomised trials of NCPAP in neonates.     

经鼻间歇正压通气治疗新生儿呼吸衰竭的随机对照研究

目的比较经鼻间歇正压通气(nIPPV)与经鼻持续气道正压通气（nCPAP）在新生儿呼吸衰竭中的疗效。方法采用RCT研究的方法,选择2008年1 ~12月在第三军医大学大坪医院NICU住院的呼吸衰竭新生儿作为研究对象,按随机数字表法将研究对象随机分为nIPPV组和nCPAP组,分别实施nIPPV 或nCPAP干预,观察患儿动脉血气分析、应用nIPPV和nCPAP时间、并发症和预后等指标,比较nIPPV组和nCPAP组治疗后需气管插管行机械通气的比例及其预后结局。结果研究期间nIPPV组纳入48例,nCPAP组纳入53例。两组在性别构成比、胎龄、年龄、出生体重、出生后5 min Apgar评分、新生儿急性生理学评分和应用肺表面活性物质比例等方面差异无统计学意义（P均>0.05）。两组呼吸衰竭原发病分布差异无统计学意义（P>0.05）。两组治疗前血气分析指标差异均无统计学意义（P均>0.05）,nIPPV组治疗后1 h血气分析pH和PaO2显著高于nCPAP组（P<0.05）。nIPPV组治疗成功率为77.1%(37/48例),nCPAP组为62.3%（33/53例）,nIPPV组显著高于nCPAP组（P<0.05）。nIPPV组和nCPAP组治疗成功的患儿平均应用nIPPV和nCPAP的时间差异无统计学意义（P均>0.05）。nIPPV组的预后结局中治愈和好转出院45/48例（93.8%）, nCPAP组为46/53例（86.8%）,两组差异无统计学意义（P>0.05）。结论与nCPAP相比,nIPPV治疗可显著降低呼吸衰竭新生儿气管插管行机械通气的比例。     

Increased work of breathing associated with nasal prongs.

To see if continuous distending pressure (CPD) given by nasal prongs increases work of breathing, we measured the mechanics of breathing, minute ventilation, and blood gases in nine infants with both nasal prong and face mask CDP. Minute ventilation was 16% larger (P less than .02), work of breathing was 94% higher (P less than .01), and the mean PaO2 was 8 mm Hg lower (P less than .03) with the nasal prongs. There was no difference in pH or PaCO2. We speculate that CDP given by nasal prongs may increase the risk of respiratory failure in the premature infant already compromised with hyaline membrane disease.     

The use of nasal continuous positive airway pressure to treat obstructive sleep apnoea

Aim: To review 66 children with obstructive sleep apnoea (OSA) for whom a trial of nasal continuous positive airway pressure (nCPAP) was proposed. Methods: Baseline sleep studies were performed to assess OSA severity; a trial of nCPAP was performed where moderate to severe OSA, not relieved by adenotonsillectomy, was found. The nCPAP trial was considered either technically successful (ST), if the child accepted the mask for sufficient time to determine nCPAP efficacy, or a technical failure (FT) if otherwise. Patients with an initial FT were offered a period of home acclimatisation to familiarise them with wearing the mask during sleep. ST patients in whom nCPAP was effective were established on long term therapy. Results: Nasal CPAP trials were successful (ST) in 49/66 (74%) patients. Nasal CPAP efficacy could not be determined in the remaining 17 FT patients (26%), generally because of their poor nCPAP tolerance. These patients were subsequently considered for other treatment. A total of 42/49 (86%) ST patients were established on long term nCPAP therapy, 2/49 (4%) derived no benefit from nCPAP, while 5/49 (10%) refused long term nCPAP therapy. Of patients on long term nCPAP, the most frequently reported side effects were skin irritation and nasal dryness; however, these were not serious enough to require any patients to discontinue therapy. A period of home acclimatisation was found to be effective in increasing nCPAP acceptance, with 26% of FT children being subsequently successfully reassessed for nCPAP. Conclusion: The use of nCPAP was feasible in a significant proportion of a paediatric OSA population. Failure was usually because of the child''s intolerance of the nCPAP equipment. Nasal CPAP was an effective treatment in the majority of patients where it could be assessed, and was adopted as a long term therapy in most cases. We have successfully used nCPAP to treat OSA across a wide range of ages. Motivated parents and skilled support staff have proved essential for the success of nCPAP in a paediatric setting.     

The use of nasal continuous positive airway pressure to treat obstructive sleep apnoea.

AIM: To review 66 children with obstructive sleep apnoea (OSA) for whom a trial of nasal continuous positive airway pressure (nCPAP) was proposed. METHODS: Baseline sleep studies were performed to assess OSA severity; a trial of nCPAP was performed where moderate to severe OSA, not relieved by adenotonsillectomy, was found. The nCPAP trial was considered either technically successful (ST), if the child accepted the mask for sufficient time to determine nCPAP efficacy, or a technical failure (FT) if otherwise. Patients with an initial FT were offered a period of home acclimatisation to familiarise them with wearing the mask during sleep. ST patients in whom nCPAP was effective were established on long term therapy. RESULTS: Nasal CPAP trials were successful (ST) in 49/66 (74%) patients. Nasal CPAP efficacy could not be determined in the remaining 17 FT patients (26%), generally because of their poor nCPAP tolerance. These patients were subsequently considered for other treatment. A total of 42/49 (86%) ST patients were established on long term nCPAP therapy, 2/49 (4%) derived no benefit from nCPAP, while 5/49 (10%) refused long term nCPAP therapy. Of patients on long term nCPAP, the most frequently reported side effects were skin irritation and nasal dryness; however, these were not serious enough to require any patients to discontinue therapy. A period of home acclimatisation was found to be effective in increasing nCPAP acceptance, with 26% of FT children being subsequently successfully reassessed for nCPAP. CONCLUSION: The use of nCPAP was feasible in a significant proportion of a paediatric OSA population. Failure was usually because of the child's intolerance of the nCPAP equipment. Nasal CPAP was an effective treatment in the majority of patients where it could be assessed, and was adopted as a long term therapy in most cases. We have successfully used nCPAP to treat OSA across a wide range of ages. Motivated parents and skilled support staff have proved essential for the success of nCPAP in a paediatric setting.     

咖啡因联合无创呼吸支持治疗极低出生体重儿呼吸暂停的疗效观察

目的 比较咖啡因联合加温湿化高流量鼻导管通气（heated humidified high-flow nasal cannula,HHHFNC）与经鼻持续气道正压通气（nasal continuous positive airway pressure,nCPAP）治疗早产儿呼吸暂停的有效性和安全性.方法 将2013年9月至2014年3月在河北省儿童医院NICU住院,诊断为早产儿原发性呼吸暂停的极低出生体重儿80例,按照呼吸支持的模式采用随机数字表法随机分为HHHFNC组（39例）和nCPAP组（41例）,两组患儿均给予咖啡因治疗.比较两组患儿频繁呼吸暂停的发生率、需要气管插管的比例、氧暴露时间、无创辅助通气时间、喂养情况以及不良事件的发生率.结果 两组患儿在性别比、胎龄、日龄、出生体重等方面差异无统计学意义（P＞0.05）;两组患儿频繁呼吸暂停的发生率[15.4％ （6/39） vs 12.2％（5/41）]、需要气管插管的比例[17.9％ （7/39） vs 19.5％（8/41）]、氧暴露时间[（183.1 ±31.2）h vs （175.9 ±32.1）h]、无创辅助通气时间[（163.3 ±25.1）h vs（153.0±26.2）h]等方面差异均无统计学意义（P＞0.05）.HHHFNC组患儿腹胀[7.7％ （3/39） vs24.4％（10/41）]、鼻损伤[2.6％（1/39） vs 19.5％ （8/41）]、头部塑形发生率[0.0％ （0/39） vs 29.3％（12/41）]均低于nCPAP组（P＜0.05）,且HHHFNC组开奶日龄较nCPAP组提前[（67.5 ±19.1）h vs（96.3±18.7）h,P＜0.05],达到足量经口喂养时间缩短[（346.8±28.6）h vs（371.0 ±29.4）h,P＜0.05].结论 HHHFNC联合咖啡因治疗极低出生体重早产儿呼吸暂停和nCPAP组同样有效,且早产儿易耐受,不良反应少,是一种有效的无创呼吸支持模式.