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CNAA / Theses / 2018 / July /

Optimization of respiratory suport in prematures newborn


Author: Crivceanscaia Larisa
Degree:doctor habilitat of medicine
Speciality: 14.00.09 - Pediatrics
Year:2018
Scientific adviser: Ninel Revenco
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 10 July, 2018
Approved by NCAA on the 23 November, 2018

Abstract

Adobe PDF document – 2.70 Mb / in romanian

Thesis

CZU 616.24-008.64-085-053.32+615.816 (043.2)

Adobe PDF document 16.00 Mb / in romanian
324 pages

Keywords

prematures, respiratory distress syndrome caused by surfactant deficiency, in utero transportation, pulmonary mechanical ventilation, T-piece, less invasive surfactant administration, continues positive pressure in the airway, INSURE method, less invasive surfactant administration, high frequency ventilation

Summary

Research area: neonatology.

Study goal: elucidation of the etiopathogeny and clinical symptoms of respiratory distress syndrome caused by surfactant deficiency and optimization of the respiratory support in premature newborns ≤ 34 weeks of gestation in the way to create a model of non-invasive respiratory support.

Objectives: study of risk factors and survival of neonates with respiratory distress syndrome with a surfactant deficiency and gestation age ≤ 34 weeks. Study of the clinical and paraclinical particularities of neonates ≤34 gestational age with respiratory distress syndrome caused by surfactant deficiency. Determination of pulmonary and extrapulmonary complications in respiratory distress syndrome caused by surfactant deficiency in newborn ≤ 34 gestational age, depending on the level of maternity. Comparison between invasive and non-invasive respiratory support in preterm infants ≤ 34 gestational age starting from the delivery room. To underline indications for the applying different models of respiratory support in prematures ≤ 34 gestational age, depending on the level of neonatal care center. Analysis of blood gas results according to the respiratory support method in preterm newborns ≤34 gestational age. Determination of correlations between respiratory support methods at different stages of care for premature neonates ≤ 34 gestational age. Impact of perinatology service regionalization and neonatal transportation on mortality and morbidity of prematures with respiratory distress syndrome caused by surfactant deficiency for prematures ≤ 34 gestational age. Methodology reconceptualisation for applying a respiratory support in prematures ≤ 34 gestational age with elaboration of a new care model for these babies. Novelty and scientific originality. There were identified risck factors and reconceptualised the methodology of respiratory support in premature newborns in the way to improve treatment measures using the new respiratory suport technologies. There was grounded methodology of the non-invasive respiratory support methodology.

Aplicative value of the study.Were underlined indications for respiratory support for premature newborns ≤ 34 gestational weeks according to perinatal care level (I, II, III) in order to improve respiratory support in this group of babies; was created a theoretic and practice support, wich allows to improve diagnostic and treatment measures of the respiratory distress syndrome in premature babies and by this way reduced morbidity and mortality caused by respiratory distress syndrome.

Solved scientific problem:There was elaborated and implemented a methodology of respiratory support for premature newborns less than 34 gestational weeks starting from delivery room, which involves use of T-piece, followed by early CPAP and surfactant administration by gastric tube. Theese measures allows to avoid routine intubation and mechanical ventilation, thus substantially reduces complications, mortality and invalidity of the preterm newborns.

Theoretical importance: Scientific study results are the support of qualitative adecquate medical assistance for newborns less than 34 gestational weeks. There was established an important correlation between respiratory support method and level of perinatal care centre. Were fixed death’s risk factors for newborns less 34 gestational weeks, most important being respiratory distress sindrom caused by surfactant deficiency, followed by small weight at birth, gestational age, resuscitation method and level of medical assistance.

Implementation of scientific results: the results of the study were considered to have scientific value and were included in 2 National Clinical Protocols: "Respiratory distress syndrome caused by surfactant deficiency" and "Ulceronecrotic enterocolitis"; 3 Institutional Clinical Protocols: "Non-invasive surfactant administration in premature neonates - LISA method", "Use of T-piece in delivery room" and "Use of CPAP in preterm newborns"; an "Algorithm for respiratory support of newborns ≤ 34 gestational age" and a monography "Therapeutic strategies in respiratory distress syndrome caused by surfactant deficiency in prematures", which are used in the didactic process of Department of Pediatrics and Neonatology, State University of Medicine and Pharmacy "Nicolae Testemitanu", in practice activity of neonatal intensive care units, delivery room, units for prematures care and pathology of pregnant women