Efficacy And Safety Of Inhalation Of Pulmonary Surfactant Using Vibrating Mesh Nebulizers Combined With Nasal Continuous Positive Airway Pressure In The Treatment Of Neonatal Respiratory Distress Syndrome

【Objective】To investigate the efficacy and safety of inhalation of pulmonary surfactant（PS）using vibrating mesh nebulizers combined with nasal continuous positive airway pressure（NCPAP）in the treatment of neonatal respiratory distress syndrome.【Methods】A prospective,randomized,controlled,single-center study was performed on premature infants with NRDS between December 2020 and March 2022 and selected according to random number generated by computer.They were divided into the vibrating mesh atomization technology group and the INSURE technology group after obtaining the consent of the guardian of the children.The patient in the INSURE group were infused with PS through the endotracheal tube under positive airway pressure,and then treated with NCPAP after extubation.The patient in the vibrating mesh atomization technology group inhaled aerosolized PS by vibrating mesh nebulizer while using a noninvasive ventilator.The P/F ratio（Pa O₂/Fi O₂）,p H,Pa CO_2,duration of non-invasive ventilator support,mechanical ventilation via endotracheal tube（MVET）,additional doses of PS,oxygen cure time,and complications and hospital mortality were compared between the two groups.The occurrences of adverse events like Apnea,decreased transcutaneous oxygen saturation（Tc SO₂）,and bradycardia in the two groups were recorded.【Results】1.General situation:65 infants were enrolled including 31 cases the vibrating mesh atomization technology group and 34 cases in the INSURE technology group.There was no significant difference in baseline data between the two groups,indicating that baseline data of the two groups were balanced and comparable.2.Main outcome measures:PaO₂/FiO₂ in both groups were significantly increased compared with those before one hour of PS treatment（102±17 vs.193±23 in vibrating mesh atomization technology group,109±18 vs.166±46 in INSURE technology group,both P<0.05）,pH in both groups were increased compared with those before treatment（7.24±0.06 vs.7.35±0.07 in vibrating mesh atomization technology group,7.26±0.06 vs.7.34±0.05 in INSURE technology group,both P<0.05）,Pa CO₂ decreased（54±7 vs.45±6 in vibrating mesh atomization technology group,55±4 vs.44±7 in INSURE technology group,both P<0.05）.Compared with INSURE techniques,there were significant differences between the two groups in Pa O₂/Fi O₂（P<0.05）,but no significant differences in p H and Pa CO₂（P>0.05 for both）.The time on non-invasive ventilator support in the vibrating mesh atomization group was shorter than in the INSURE group（h:126±19 vs.94±16,P<0.05）,but there was no significant difference in the MVET demand rate、additional doses of PS、oxygen cure time between the two groups[3.2%（1/31）vs.8.8%（3/34）,6.5%（2/31）vs.8.8%（3/34）,d:8.0（7.0,10.0）vs.8.5（6.8,11.0）,both P>0.05].3.Complications and adverse reactions:Intracerebral hemorrhage in vibrating mesh atomization technology group was less than that in the INSURE group[9.7%（3/31）vs.23.5%（8/34）],but no significant differences（P>0.05）.No significant differences in BPD,NEC,sepsis,pneumonia between the two groups[6.5%（2/31）vs.8.8%（3/34）,6.5%（2/31）vs.2.9%（1/34）,9.7%（3/31）vs.14.7%（5/34）,12.9%（4/31）vs.17.6%（6/34）,P>0.05 for all].Apnea,decreased transcutaneous oxygen saturation（Tc SO2）,and bradycardia in vibrating mesh atomization technology group was less than that in the INSURE group[3.2%（1/31）vs.8.8%（3/34）,3.2%（1/31）vs.11.8%（4/34）,0%vs.5.9%（2/34）],but no significant differences（P>0.05）.There were no deaths in both groups.【Conclusion】Compared with the INSURE technique,NCPAP combined with vibrating mesh atomization technology was also effective and safe in the treatment of RDS,which could significantly improve Pa O₂/Fi O₂ and shorten the duration of respiratory support.Thus,it was worthy of clinical popularization and application.