Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2024; 12(23): 5366-5373
Published online Aug 16, 2024. doi: 10.12998/wjcc.v12.i23.5366
Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome
Ze-Ning Shi, Xin Zhang, Chun-Yuan Du, Bing Zhao, Shu-Gang Liu
Ze-Ning Shi, Shu-Gang Liu, Department of Pediatrics, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
Xin Zhang, Bing Zhao, Department of Anesthesiology, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
Chun-Yuan Du, Department of Gynecology and Obstetrics, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
Author contributions: Shi ZN, Zhang X, and Du CY were the guarantors of the integrity of the entire study; Zhang X and Zhao B performed the study concept and design; Shi ZN and Liu SG performed the literature study; Shi ZN and Zhang Xin pro conducted the study; Shi ZN and Zhang X conducted the statistical analysis; Shi ZN and Zhang X wrote the manuscript; All authors have access to the data and played a role in writing this manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the Hospital affiliated to the Military Medical University (Approval No. 2024007).
Informed consent statement: As this study was retrospective, informed consent of patients was not required.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Data sharing statement: Data for this study were obtained from the corresponding authors.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin Zhang, PhD, Research Fellow, Department of Anesthesiology, Army Military Medical University Officer School Affiliated Hospital, No. 346 Shenglibei Street, Shijiazhuang 050000, Hebei Province, China. zhangxing202309@163.com
Received: March 22, 2024
Revised: May 25, 2024
Accepted: June 12, 2024
Published online: August 16, 2024
Processing time: 104 Days and 22.9 Hours
Abstract
BACKGROUND

Neonatal respiratory distress syndrome (NRDS) is one of the most common diseases in neonatal intensive care units, with an incidence rate of about 7% among infants. Additionally, it is a leading cause of neonatal death in hospitals in China. The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant

AIM

To explore the effect of pulmonary surfactant (PS) combined with noninvasive positive pressure ventilation on keratin-14 (KRT-14) and endothelin-1 (ET-1) levels in peripheral blood and the effectiveness in treating NRDS.

METHODS

Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included. Of these, 64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation. The expression of KRT-14 and ET-1 in the two groups was compared. The deaths, complications, and PaO2, PaCO2, and PaO2/FiO2 blood gas indexes in the two groups were compared. Receiver operating characteristic curve (ROC) analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.

RESULTS

The observation group had a significantly higher effectiveness rate than the control group. There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions, such as bronchial dysplasia, cyanosis, and shortness of breath. After treatment, the levels of PaO2 and PaO2/FiO2 in both groups were significantly higher than before treatment, while the level of PaCO2 was significantly lower. After treatment, the observation group had significantly higher levels of PaO2 and PaO2/FiO2 than the control group, while PaCO2 was notably lower in the observation group. After treatment, the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels. The observation group had a reduction of KRT-14 and ET-1 levels than the control group. ROC curve analysis showed that the area under the curve (AUC) of KRT-14 was 0.791, and the AUC of ET-1 was 0.816.

CONCLUSION

Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy. KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.

Keywords: Pulmonary surfactant, Non-invasive positive pressure ventilation, Neonatal respiratory distress syndrome, Keratin-14, Endothelin-1

Core Tip: The purpose of this study was to explore the effect of pulmonary surfactant (PS) combined with noninvasive positive pressure ventilation on the levels of keratin-14 (KRT-14) and endothelin-1 (ET-1) in peripheral blood and the effectiveness for treating neonatal respiratory distress syndrome (NRDS). KRT-14 and ET-1 expression in the two groups was compared. The therapeutic effectiveness, occurrence of death and complications, and the blood gas indexes PaO2, PaCO2 and PaO2/FiO2 in the two groups were compared. Receiver operating characteristic curve analysis was used to determine the diagnostic value of KRT-14 and ET-1 for the effectiveness of NRDS therapy. PS combined with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy. KRT-14 and ET-1 levels may have potential as diagnostic indicators of therapy.