Efficacy and Safety of Noninvasive High-Frequency Oscillatory Ventilation Combined with Less Invasive Surfactant Administration in the Treatment of Neonatal Respiratory Distress Syndrome

LIN Jianfeng; WU Yuanping; LI Xueping; ZHUANG Zeyin

doi:10.14033/j.cnki.cfmr.2025.36.015

Abstract：Objective:To explore the efficacy and safety of noninvasive high-frequency oscillatory ventilation(NHFOV)combined with less invasive surfactant administration(LISA)in the treatment of neonatal respiratory distress syndrome(RDS).Method:A total of 73 extremely preterm infants with a gestational age of 28～32+6 weeks diagnosed with RDS,admitted to the Pengpai Memorial Hospital from January 2023 to December 2024 were enrolled.The included neonates were divided into the NHFOV group(n=37)and the NIPPV group(n=36)using a random number table method.Within each group,infants were further stratified by gestational age into two subgroups:28～29+6 weeks and 30～32+6 weeks.Eventually,four subgroups were obtained,namely the 28～29+6 weeks gestational age subgroup(n=15)and 30～32+6 weeks gestational age subgroup(n=22)in the NHFOV group,as well as the 28～29+6 weeks gestational age subgroup(n=15)and 30～32+6 weeks gestational age subgroup(n=21)in the NIPPV group.After surfactant(PS)administration via LISA,all subgroups in each gestational age group were treated with different noninvasive ventilation modes(NHFOV and NIPPV,respectively).Blood gas analysis indicators[PaO2,PaCO2,oxygenation index(OI),alveolar-arterial oxygen pressure difference(PA-aO2)]were recorded before treatment and 6 hours after treatment.The duration of noninvasive ventilation,the rate of failed conversion to invasive ventilation were documented.Short-term complications such as air leak syndrome and periventricular-intraventricular hemorrhage(PVH-IVH)were monitored,and the incidence of bronchopulmonary dysplasia(BPD)was evaluated during follow-up until the corrected gestational age of 40 weeks.Result:After 6 hours of treatment with two different ventilation modes combined with LISA,in comparison of arterial blood gas analysis indicators and complications,the NHFOV ventilation group was significantly better than the NIPPV group in terms of the increase amplitude of PaO2,the decrease amplitudes of PaCO2,OI value,and PA-aO2 value,with statistically significant differences(P<0.05).The NHFOV group was superior to the NIPPV group in the continuous time of non-invasive ventilation,the incidence of air leak syndrome,and the conversion rate to invasive ventilation,with statistically significant differences(P<0.05).There were no statistically significant differences in the incidence of PVH-IVH and BPD(P>0.05).After 6 hours of treatment,in comparison of arterial blood gas indicators and complications in the NHFOV group among neonates of different gestational ages,the 28～29+6 weeks gestational age group was significantly better than the 30～32+6 weeks group in terms of the increase amplitude of PaO2,the decrease amplitudes of PaCO2,OI value,and PA-aO2 value,with statistically significant differences(P<0.05).The incidence of air leak syndrome was also significantly lower than that of the 30～32+6 weeks group,with a statistically significant difference(P<0.05).There were no statistically significant differences in the comparison of non-invasive ventilation duration,failure to switch to invasive ventilation,the incidence of PVH-IVH,and BPD among different gestational ages(P>0.05).Conclusion:Both NHFOV and NIPPV are safe and effective noninvasive ventilation modes for the treatment of neonatal RDS.The efficacy of NHFOV may be associated with gestational age differences,with more significant advantages in extremely preterm infants with lower gestational age,which can quickly improve respiratory function and reduce the incidence of air leak syndrome.In clinical practice,individualized treatment regimens should be implemented based on gestational age.