Clinical efficacy of minimally invasive surfactant therapy combined with nasal intermittent positive pressure ventilation in the treatment of neonatal respiratory distress syndrome.

Abstract

This study aims to evaluate the efficacy of minimally invasive surfactant therapy (MIST) combined with nasal intermittent positive pressure ventilation (NIPPV) in treating neonatal respiratory distress syndrome (NRDS). The intubation-surfactant-extubation (INSURE) + NIPPV group [receiving INSURE combined with NIPPV] and NIPPV + MIST group (receiving NIPPV combined with MIST) were established. Total administration time, duration of noninvasive ventilation, rate of invasive ventilation after noninvasive ventilation failure, pulmonary surfactant (PS) dosage, length of hospital stay, re-administration of PS, blood gas parameters, serological markers, and complication incidence were assessed between both groups. The NIPPV + MIST group demonstrated a shorter total administration time, lower rate of invasive ventilation support, shorter duration of noninvasive ventilation, reduced hospital stay, and fewer cases requiring re-administration of PS than the INSURE + NIPPV group. After 48 h of treatment, compared to the INSURE  + NIPPV group, the NIPPV + MIST group showed higher arterial partial pressure of oxygen, oxygenation index, and interleukin-4 (IL-4) levels, lower partial pressure of carbon dioxide, fraction of inspired oxygen, interferon-gamma (IFN-γ), and IFN-γ/IL-4 ratio, and lower bronchopulmonary dysplasia incidences, vocal cord injury, and laryngeal edema (all P  < .05). No significant differences were found in PS dosage, oxygen desaturation, bradycardia, nasal injury, air leak, intraventricular hemorrhage ≥ Grade II, or necrotizing enterocolitis (P > .05). MIST combined with NIPPV is effective in treating NRDS by improving ventilation and spontaneous breathing, regulating the Th1/Th2 immune balance, inhibiting pulmonary inflammation, reducing lung injury, and minimizing damage from invasive procedures.