The Research On Correlation Between Neonatal Respiratory Distress Syndrome And It’s Clinical Parameters And The Study On Body Description Of Lung Function After It Treatment

Research background and purpose:Neonatal respiratory distress syndrome(NRDS),one of the common critical diseases in neonatal intensive care unit(NICU),is a serious threat to the life safety of newborns.With the development of medical science,recent studies have shown that some clinical parameters such as peripheral blood neutrophil-lymphocyte ratio(NLR),platelet parameters,blood lactic acid(LAC),coagulation function and other changes have a certain correlation with neonatal diseases such as bronchopulmonary dysplasia(BPD),neonatal sepsis,neonatal intracranial hemorrhage and so on.However,there are relatively few studies on the correlation between NRDS and NRDS.Relevant studies have shown that NRDS newborns can indeed improve the disease status of the children to a certain extent after undergoing positive pressure ventilation and oxygen therapy,but also aggravate the lung injury of these children and affect the lung mechanics.This will increase the risk of various respiratory complications such as bronchopulmonary dysplasia,repeated respiratory tract infection,asthma,chronic obstructive pulmonary disease and other diseases in the later stage,which is extremely unfavorable to the recovery of the prognosis in the later stage.It is very necessary to promote long-term lung function examination for neonatal patients with NRDS to provide clinical guidance for determining the nature and severity of respiratory diseases and early intervention after treatment.In summary,the purpose of this study is to explore the correlation between relevant clinical parameters(NLR,platelet parameters,blood lactic acid,coagulation function)and NRDS,to grasp the lung function characteristics of newborn after NRDS treatment and to obtain body description data,to provide certain clinical guidance for the prevention,diagnosis and treatment of NRDS,and to help improve the prognosis and quality of life of premature infants.Materials and Methods:Part Ⅰ:Neonatal respiratory distress syndrome and the correlation of clinical parametersIn this study,preterm neonates(gestational age<37 weeks,birth age<1 day)who were admitted to the Department of Neonatology of Mianyang Central Hospital from January 1,2020 to December 31,2022 meeting the natriol criteria were selected.Their clinical data were collected,and NRDS were diagnosed according to the 5th edition of the criteria of Practical Neonatology.They were divided into observation group(NRDS group)and control group(non-NRDS group)according to whether NRDS were diagnosed.SPSS27.0 software was used for statistical analysis of the data,and the highrisk factors and complications of neonatal respiratory distress syndrome were understood according to the statistical results.Clinical parameters such as peripheral blood neutrophil-lymphocyte ratio(NLR),platelet parameters(platelet count PLT,platelet distribution width PDW,mean platelet volume MPV,platelet mass index PMI,large platelet ratio p-LCr),blood lactic acid(LAC),and coagulation function(prothrombin time P)were dynamically observed in the NRDS groupT,activated partial thrombin time APTT,fibrinogen FIB,thrombin time TT)characteristics,to explore the correlation between the above clinical parameters and NRDS.Part Ⅱ:The study of body image lung function after treatment of neonatal respiratory distress syndromeIn the first part of the study,preterm neonates who met the natrification criteria were selected from January 1,2020 to December 31,2022 in the Department of Neonatology of Mianyang Central Hospital(gestational age<37 weeks,birth weight was P10-P90 for gestational age,body characterization and lung function were completed when the gestational age was adjusted for 34-38 weeks and the condition was stable).Body description lung function data(RR,VT/kg,FEF25,FEF50,FEF75,TPTEF/TE,VPTEF/VE,FRC,Refff)were collected,NRDS were diagnosed according to the 5th edition of "Practical Neonatology",and were divided into observation group(NRDS group)and control group(non-NRDS group)according to whether NRDS was diagnosed.The two groups were stratified according to gestational age:Early preterm infants(28W≤GA<32W),middle preterm infants(32W≤GA<34W),and late preterm infants(34W≤GA<37W).The observation group(NRDS group)was then divided according to the oxygenation index P/F=PaO2(arterial oxygen partial pressure)/FiO2(inhaled oxygen concentration),which reflects the oxygenation of the body:200mmHg<PaO2/FiO2≤300mmHg is mild NRDS,100mmHg<PaO2/FiO2≤200mmHg is moderate NRDS,PaO2/FiO2≤100mmHg is severe NRDS.SPSS27.0 software was used for statistical analysis of the data,and according to the statistical results,the characteristics of neonatal lung function in NRDS were understood.Results:Part I:A total of 645 premature infants qualified for inclusion,including 187 in the NRDS group and 458 in the non-NRDS group.The statistical results show that:(1)In the NRDS group,compared with the non-NRDS group,in terms of general conditions,perinatal and maternal pregnancy conditions,and treatment conditions,There were statistically significant differences in gestational age,birth weight,sex(male),Apgar score(1 min,5 min,10 min),delivery mode(cesarean section),gestational diabetes,postpartum use of pulmonary surfactant(PS),respiratory support,respiratory support time,antibiotic use time and hospital stay(P<0.05).(2)Compared with the non-NRDS group,there were statistically significant differences in complications such as neonatal pneumonia,neonatal pulmonary hemorrhage,bronchopulmonary dysplasia,neonatal anemia,myocardial damage,retinopathy,coagulation dysfunction,neonatal cerebral hemorrhage,unclosed ductus arteriosus,atrial septal defect or patent foramina ovale(P<0.05).(3)Dynamic comparison of platelet parameters between NRDS group and nonNRDS group:PLT and PMI of NRDS group were lower than those of non-NRDS group on day 1,day 3-5 and day 7-10 afterbirth,with statistical significance(P<0.05).MPV and P-LCR in NRDS group were higher than those in non-NRDS group on day 1,day 3-5 and day 7-10 afterbirth,with statistical significance(P<0.05).PDW of the first day,3-5 days and 7-10 days after birth in the NRDS group was higher than that in the non-NRDS group,with no statistical significance(P>0.05).The PCT of the NRDS group was lower than that of the non-NRDS group on the 1st and 3rd to 5th days after birth,with statistical significance(P<0.05),but the PCT of the NRDS group was higher than that of the nonNRDS group on the 7th to 10th day,with no significant difference.(4)Dynamic comparison of NLR/lactate/coagulation parameters of children in NRDS group and non-NRDS group:The NLR of the NRDS group was higher than that of the non-NRDS group on day 1,day 3-5 and day 7-10 after birth,and there was no significant difference in NLR between the two groups on day 1,while the difference between the two groups on day 3-5 and day 7-10 was statistically significant(P<0.05).The LAC of NRDS group was higher than that of non-NRDS group on day 1,3-5 and 7-10 after birth,and the difference of LAC on day 1 between the two groups was statistically significant(P<0.05),while the difference of LAC on day 3-5 and 7-10 was not statistically significant.PT and APTT in NRDS group were higher than those in nonNRDS group on day 1 and 3-5 postnatal days,and the differences were statistically significant(P<0.05),but there were no significant differences in FIB and TT between the two groups on day 1 and 3-5 postnatal days.(5)Multivariate analysis of NRDS in premature infants:In the multivariate Logistic regression model,gestational age at birth,gestational diabetes,and PCT at day 1 were statistically significant(P<0.05),indicating that gestational age at birth,gestational diabetes,and PCT at day 1 were independent risk factors for NRDS.Part II:A total of 209 patients were eligible for inclusion,including 64 in the NRDS group and 145 in the non-NRDS group.There were 65 early preterm infants,65 mid-term preterm infants and 79 late preterm infants in the two groups.P values of gestational age at birth,birth weight,gestational age to correct lung function test,weight at test and body length at test were all greater than 0.05 among preterm infants of different gestational ages,indicating that the differences in general conditions among all groups were not statistically significant and the baseline was comparable.(1)Early preterm infants had non-NRDS group(N=24),mild NRDS group(N=31),moderate NRDS group(N=7)and severe NRDS group(N=3).The statistical results showed that:VT/kg,RR,FEF25,FEF50 and FRC were not significantly different between NRDS group and non-NRDS group.From the non-NRDS group to the severe NRDS group,FEF75 of the four groups showed a decreasing trend,and the differences between the non-NRDS group and the moderate NRDS group,the severe NRDS group and the mild NRDS group and the severe NRDS group were statistically significant(P<0.05).TPTEF/TE and VPTEF/VE in NRDS group were lower than those in nonNRDS group,and the differences were statistically significant(P<0.05).The Reff of NRDS group was higher than that of non-NRDS group,and the difference between the two groups was statistically significant(P<0.05).(2)There were preterm infants in the non-NRDS group(N=56),mild NRDS group(N=5)and moderate NRDS group(N=4).The statistical results showed that:The P values of VT/kg,RR,TPTEF/TE,FEF25,FEF50,FEF75,FRC and Reff were all greater than 0.05,indicating that there was no significant difference between NRDS group and non-NRDS group.VPTEF/VE of NRDS group was lower than that of nonNRDS group,and P value of both groups was<0.05,indicating that the difference was statistically significant(P<0.05).(3)Late preterm infants had non-NRDS group(N=65),mild NRDS group(N=3),moderate NRDS group(N=7)and severe NRDS group(N=4).The statistical results showed that:VT/kg,FEF25,FEF50,TPTEF/TE,VPTEF/VE,FRC and Reff were not statistically significant between NRDS group and non-NRDS group.The difference of RR between the NRDS group and the non-NRDS group was statistically significant(P<0.05),and the RR of the four groups increased successively from the non-NRDS group to the severe NRDS group.From the non-NRDS group to the severe NRDS group,FEF75 of the four groups showed a decreasing trend,and there were statistically significant differences in FEF75 among the severe NRDS group,the mild NRDS group and the non-NRDS group(P<0.05).Conclusions:1.The risk factors of neonatal respiratory distress syndrome were gestational age,birth weight,male,cesarean section,Apgar score,gestational diabetes,and PCT at day 1,among which gestational age,gestational diabetes and PCT at day 1 were independent risk factors for NRDS.2.In the early stage of neonatal respiratory distress syndrome,thrombocytopenia,elevated lactic acid and abnormal coagulation function occur.3.Small airway obstruction will occur after treatment of NRDS neonates.The degree of small airway obstruction is related to the severity of the disease.The more serious the disease is,the more obvious small airway obstruction will be.