FEATURES OF RESPIRATORY FAILURE IN PREMATURE INFANTS WITH NEONATAL SEPSIS

Abstract

Neonatal sepsis remains the main cause of morbidity and mortality in neonatal intensive care units. In particular, the share of sepsis in the structure of neonatal respiratory failure reaches 35.3%. At the same time, the search for sensitive indicators of the critical course of the acute respiratory distress syndrome against the background of the septic process remains relevant. Objective. To study the peculiarities of the course of respiratory failure in the dynamics of treatment of premature babies with neonatal sepsis, depending on the gestational age. Material and methods. To achieve this goal, in the conditions of the Neonatal Intensive Care Unit of the Regional Municipal Non-Commercial Enterprise "Chernivtsi Regional Children's Clinical Hospital" during 2021–2022 a comprehensive prospective study was conducted of 60 prematurely born patients with neonatal sepsis, which progressed with the phenomena of respiratory failure. Group I included 36 newborns (with gestational age up to and including 32 weeks), according to group II – 24 infants (gestational age > 32 weeks). Research results. Oxygen dependence was most clearly reflected by lower SpO2 indicators and, accordingly, the need to increase FiO2, which was explained by the immaturity of the respiratory system in children with a critically low gestational age. In ¾ of the newborns of the II clinical group, respiratory index exceeded 200 mmHg, and in the I clinical group this sign occurred only in every second patient: AR - 30.1%, RR – 1.9 (95% CI: 1.5–2.5), OR – 3.5 (95% CI: 1.9–6.5). It was established that with a critically short gestation period against the background of worse adaptation to extrauterine living conditions, clinical signs of respiratory distress, lower respiratory index and higher hypercarbia are more pronounced in babies with relatively comparable parameters of respiratory support. Conclusion. Clinical and paraclinical features of respiratory failure against the background of neonatal sepsis in prematurely born children consist of deeper disturbances of the gas composition of the blood, torpidity to measures of respiratory protection in newborns with a critically short gestation period, which is explained by the combined pathogenetic influence of the immaturity of the respiratory system and the aggressive influence of infectious and inflammatory process.