Respiratory failure in extremely premature babies: anatomical and physiological features, risk factors, and clinical variants of the course in the early neonatal period

DOI: https://doi.org/10.29296/25877305-2021-04-04
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Issue: 
4
Year: 
2021

O. Zavyalov(1, 2); Professor I. Ignatko(2, 4), Corresponding Member of the Academy of Medical
Sciences, MD; Professor I. Pasechnik(1), MD; Professor B. Babaev(3), MD; A. Dementyev(2, 3), Candidate of
Medical Sciences; Zh. Chabaidze(3), Candidate of Medical Sciences (1)Central State Medical Academy,
Presidential Administration of Russia, Moscow (2)S.S. Yudin City Clinical Hospital, Moscow (3)Russian
Medical Academy of Continuing Professional Education, Ministry of Health of Russia, Moscow (4)I.M. Sechenov
First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

The paper deals with the embryology, anatomy, and physiology of the respiratory system, which are considered in the context of clinical significance for the practical activities of neonatal anesthesiologists and resuscitators. It gives the definition, classification, and degree of respiratory failure (RF). The pathogenetic predictors and perinatal risk factors for the progression of and the features of the clinical picture of RF have been studied in extremely premature babies. The paper shows the neonatal diagnostic criteria for and the clinical assessment of the severity of respiratory distress syndrome. It discusses the most common clinical and etiological variants of RF: newborn respiratory distress syndrome and congenital pneumonia, which are characteristic for extremely premature babies in the early neonatal period.
Keywords: 
neonatology
congenital pneumonia
respiratory failure
premature newborns
early neonatal period
newborn respiratory distress syndrome
neonatal intensive care unit

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References: 
  1. Bronholegochnaja displazija. Monografija. Pod red. D.Ju.Ovsjannikova, N.A. Geppe, A.B.Malahova, D.N. Degtjareva. M.: Izd-vo: «Rossijskij Universitet druzhby narodov», 2020; 175 s. [Bronchopulmonary dysplasia. Monograph. Ed. by. D.Yu. Ovsyannikov, N.A. Geppe, A.B. Malakhova, D.N. Degtyareva. M.: «Peoples Friendship University of Russia», 2020; p 175. (in Russ.)].
  2. Ovsjannikov D.Ju., Kravchuk D.A. Nikolaeva D.Ju. Klinicheskaja patofiziologija organov dyhanija nedonoshennyh detej. Neonatologija: novosti, mnenija, obuchenie. 2018; 6 (3): 74–98 [Ovsyannikov D.Yu., Kravchuk D.A., Nikolaeva D.Yu. Clinical pathophysiology of the respiratory system in preterm infants. Neonatology: news, opinions, training. 2018; 6 (3): 74–98 (in Russ.)]. DOI: 10.24411/2308-2402-2018-13003
  3. Dement'eva G.M. Pul'monologicheskie problemy v neonatologii. Pul'monologija. 2002; 1: 6–12 [Dementyeva G.M. Pulmological problems in neonatology. Pulmonology. 2002; 1: 6–12 (in Russ.)].
  4. Gomella T.L., Eyal F.G., Fayez B.-M. Neonatology. Management, Procedures, On-Call Problems, Diseses, and Druds. 8tn ed. McGraw Hill Lange,
  5. Rukovodstvo po perinatologii: v 2 t. Red. D.O. Ivanov. SPb.: Inform–Navigator, 2019 [Guide to perinatology in 2 vol. Ed. D.O. Ivanov. SPb: Inform–Navigator, 2019 (in Russ.)]..
  6. Fox G., Hoque N., Watts T. Oxford Handbook of Neonatology. 2nd ed. Oxford University Press, 2017; p. 553.
  7. Examination of the newborn: an evidence – based guide. Ed. by A. Lomax. 2nd ed. Wiley Blackwell, p. 247.
  8. Mihajlov A.V., Ivanov D.O. Plod i novorozhdennyj kak patsienty. SPb: ID «Petropolis», 2015; 1272 s. [Mikhailov A.V., Ivanov D.O. The Fetus and Neonates as the Patients. St.Petersburg: PH «Petropolis», 2015; 1272 p. [(in Russ.)].
  9. Kapitan T.V. Propedevtika detskih boleznej s uhodom za det'mi: uchebnik dlja vuzov. 6-e izd., ispr. i dop. M.: MEDpress–inform, 2019; 896 s. [Kapitan T.V. Propedeutics of childhood illnesses with childcare: a textbook. M.: MEDpress–inform, 2019; 896 p. (in Russ.)].
  10. Respiratornaja meditsina: rukovodstvo: v 3 t. Pod red. A.G. Chuchalina. 2-e izd., pererab. i dop. M.: Litterra, 2017; T. 1; 460 s. [Respiratory medicine: manual: in 3 volumes. Ed. A.G. Chuchlina. 2nd ed., M.: Litterra, 2017; Vol. 1; 460 p. (in Russ.)].
  11. Intensivnaja terapija v pediatrii. Pod red. V.A.Mihel'sona. M.: GEOTAR-Media, 2008; 552 s. [Intensive care in pediatrics. Ed. by V.A. Mikhelson. M.: GEOTAR-Media, 2008; 552 p. (in Russ.)].
  12. Anesteziologija i intensivnaja terapija v pediatrii: uchebnik. Pod red. V.A. Mihel'sona, V.A. Grebennikova.3-e izd., pererab. i dop. M.: MEDpress-inform, 2009; 512 s. [Anesthesiology and intensive care in pediatrics: textbook. Ed. V.A. Michelson, V.A. Grebennikova. 3rd ed., revised and add. M.: MEDpress-inform, 2009; 512 p. (in Russ.)].
  13. Detskaja anesteziologija. Pod red. A.D. Keja, Ch.D. Foksa, D.H. Diasa. Per. s angl. pod red. S.M. Stepanenko. M.: GEOTAR-Media, 2018; 648 s. [Essentials of Pediatric Anesthesiology. Ed. by A.D. Kaye, C.J. Fox, J.H. Diaz. M.: GEOTAR-Media, 2018; 648 s. (in Russ.)].
  14. Polin R.A., Yoder M.C. Workbook in practical neonatology, 6th ed. Elsevier, Inc, 2020; p. 360.
  15. Intensivnaja terapija i anestezija u detej. Prakticheskoe rukovodstvo. Per. s angl. Izd-vo: «Severodvinskaja tipografija», 2017; 464 s. [Intensive care and anesthesia in children. A practical guide. Transl. from engl. Publishing house: «Severodvinsk printing house», 2017; 464 p. (in Russ.)].
  16. Detskaja pul'monologija: natsional'noe rukovodstvo. Pod red. B.M. Blohina. M.: GEOTAR-Media, 2021; 960 s. [Pediatric Pulmonology: National Guide. Ed. B.M. Blokhin. M.: GEOTAR-Media, 2021; 960 p. (in Russ.)].
  17. Anesteziologija, reanimatologija i intensivnaja terapija v pediatrii. Ucheb. posob. Pod red. V.V. Lazareva, V.A. Grebennikova. M.: Aksiom grafiks junion, 2020; 400 s. [Anestesiology, reanimatology and intensive care in pediatrics: textbook. Ed. by V.V. Lazarev, V.A. Grebennicov. M.: Axiom Grifix Union, 2020; 400 p. (in Russ.)].
  18. Uest Dzh. Patofiziologija organov dyhanija. Per. s angl. pod red. A.I. Sinopal'nikova. M.: BINOM, 2008; 232 s. [West J. Pathophysiology of the respiratory system. Transl. from engl. Ed. by A.I.Sinopalnikov. M.: BINOM, 2008; 232 p. (in Russ.)].
  19. Patofiziologija: uchebnik: v 2 t. Pod red. V.V. Novitskogo, O.I. Urazovoj. 5-e izd., pererab. i dop. M.: GEOTAR-Media, 2018; T.2; 592 s. [Pathophysiology: textbook: in 2 volumes. Ed. V.V. Novitsky, O.I.Urazova. 5th ed., rev. and add. M.: GEOTAR-Media, 2018; Vol. II; 592 p. (in Russ.)].
  20. Rasstrojstva dyhanija u detej. Per. s angl. Pod red. Dzh.A.Gregori. M.: Meditsina, 1984; 232 s. [Respiratory Disordes in Children. Transl. from engl. Ed. J.A. Gregory. M.: Medicine, 1984; 232 p.. (in Russ.)].
  21. Sumin S.A., Shapovalov K.G. i dr. Anesteziologija – reanimatologija. Uchebnik dlja podgotovki kadrov vysshej kvalifikatsii. V 2 t. T.II. M.: OOO «Izdatel'stvo «Meditsinskoe informatsionnoe agentstvo», 2018; 744 s. [Sumin S.A., Shapovalov K.G. et al. Anesthesiology – resuscitation: A textbook for training highly qualified personnel: in 2 volumes. v. II. M.: Medical information Agency, 2018; 744 p. (in Russ.)].
  22. Intensivnaja terapija: natsional'noe rukovodstvo. V 2 t. Pod red. I.B. Zabolotskih, D.N. Protsenko. 2-e izd., pererab. i dop. M.: GEOTAR-Media, 2020; T.2; 1056 s. [Intensive care: national leadership. 2 t. Ed. I.B. Zabolotskikh, D.N. Protsenko. 2nd ed., revised. and add. M.: GEOTAR-Media, 2020; V.2; 1056 p. (in Russ.)]. DOI: 10.33029/9704-5018-5-ICNG-2020-1-1056
  23. Lucky J., Gautham K.S. et al. Clinical Guidelines in Neonatology. New York: Mc Graw Hill, 2019; 648 p.
  24. Neotlozhnaja pediatrija: natsional'noe rukovodstvo. Pod red. B.M. Blohina. M.: GEOTAR-Media, 2017; 832 s. [Emergency Pediatrics: National Guide. Ed. B.M. Blokhin. M. GEOTAR-Media, 2017; 832 p. (in Russ.)].
  25. Kumar V., Abbas A.K., Fausto N., i dr. Osnovy patologii zabolevanij po Robbinsu i Kotranu. Per s angl. Pod red. E.A. Kogan. V 3 t. T.1. M.: Logosfera, 624 s. [Kumar V., Abbas A.K., Fausto N., et al. Transl. from engl. Ed. E.A. Kogan. In 3 vol. Vol.1. M.: logosfera, 2014. 624 p. (in Russ.)].
  26. Pediatrija: uchebnik dlja meditsinskih vuzov. Pod red. N.P. Shabalova. 7-e izd. ispr. i dop. SPb: SpetsLit, 2019; 943 s. [Pediatrics: textbook for medical universities. Ed. N.P. Shabalov. 7th ed. revision and add. St.Petersburg: SpetsLit, 2019; 943 p. [(in Russ.)].
  27. Intensivnaja terapija: natsional'noe rukovodstvo. V 2 t. Pod red. I.B. Zabolotskih, D.N. Protsenko. 2-e izd., pererab. i dop. M.: GEOTAR-Media, 2020; T.1; 1152 s. [Intensive care: national leadership. 2 t. Ed. I.B. Zabolotskikh, D.N. Protsenko. 2nd ed., revised. and add. M.: GEOTAR-Media, 2020; V.1; 1152 p. (in Russ.)].
  28. Aleksandrovich Ju.S., Blinov S.A., Pshenisnov K.V., i dr. Kriterii tjazhesti porazhenija legkih u novorozhdennyh s respiratornym distress-sindromom. Anesteziologija i reanimatologija. 2014; 1: 52–7 [Aleksandrovich Yu.S., Blinov S.A., Pshenisnov K.V. et al. Evaluation of the lung disease severity in infants with respiratory distress syndrome. Anesthesiology and reanimatology. 2014; 1: 52–7 (in Russ).].
  29. Volodin N.N., Degtjarev D.N., Kotik I.E. i dr. Kliniko-rentgenologicheskie osobennosti sindroma dyhatel'nyh rasstrojstv i pnevmonij u gluboko nedonoshennyh detej. Voprosy ginekologii, akusherstva i perinatologii. 2003; 2 (5–6): 16–20 [Volodin N.N., Degtyarev D.N., Kotik I.E. et al. Clinical and x-ray features of respiratory distress syndrome and pneumonias in extremely premature infants. Gynaecology, Obstetrics and Perinatal Medicine. 2003; 2 (5–6): 16–20 (in Russ).].
  30. Fanaroff A.A., Fanaroff J.M. Klaus and Fanaroff’s care of the high-risk neonate. 7th ed. Elsevier, Inc, 2020; p. 527.
  31. Merenstein Gardner’s handbook of neonatal intensive care nursing: an interprofessional approach. Ed. S.L. Gardner, B.S. Carter, M.Enzman-Hines, S. Niermeyer. 9th ed. Elsevier, Inc., 2021; p. 1238.
  32. Klinicheskie rekomendatsii. Neonatologija. Pod red. N.N. Volodina, D.N. Degtjareva, D.S. Krjuchko. M.: GEOTAR-Media, 2019; 320 s. [Clinical guidelines. Neonatology. Ed. N.N. Volodina, D.N. Degtyareva, D.S. Kryuchko. M.: GEOTAR-Media, 2019; 320 p. (in Russ.)].
  33. Izbrannye klinicheskie rekomendatsii po neonatologii. Pod red. E.N. Bajbarinoj, D.N. Degtjareva. M.: GEOTAR-Media, 2016; 240 s. [Selected clinical guidelines for neonatology. Ed. E.N. Baybarina, D.N. Degtyareva. M.: GEOTAR-Media, 2016; 240 p. (in Russ.)].
  34. Il'enko L.I. i dr. Nedonoshennye deti: uchebnoe posobie. M.: RNIMU im. N. I. Pirogova, 2020; 136 s. [Ilyenko L.I. et al. Premature baies: textbook. M.: Pirogov National Research Medical University, 2020; 136 p. (in Russ.)].
  35. Zav'jalov O.V., Chabaidze Zh.L., Dement'ev A.A. i dr. Respiratornyj distress-sindrom novorozhdennyh u gluboko nedonoshennyh detej: epidemiologija, patogenez, klinika i perinatal'nye faktory riska. Vrach. 2020; 31 (8): 24–31 [Zavyalov O., Marenkov V., Dementyev A. et al. Treatment for neonatal respiratory distress syndrome in extremely low-birth weight premature infants: selection of respiratory support. Vrach. 2020; 31 (8): 24–31 (in Russ.)]. DOI: 10.29296/25877305-2020-08-09
  36. Zav'jalov O.V., Marenkov V.V., Dement'ev A.A. i dr. Sindrom dyhatel'nyh rasstrojstv u detej s ekstremal'no nizkoj massoj tela pri rozhdenii: osobennosti provedenija neinvazivnoj respiratornoj terapii v rannem neonatal'nom periode. Voprosy prakticheskoj pediatrii. 2020; 15 (6): 94–102 [Zavyalov O.V., Marenkov V.V., Dementyev A.A. et al. The syndrome of respiratory disorders in children with extremely low birth weight: features of non-invasive respiratory therapy in the early neonatal period. Voprosy prakticheskoi pediatrii = Clinical Practice in Pediatrics. 2020; 15 (6): 94–102 (in Russ.)]. DOI: 10.20953/1817-7646-2020-6-94-102
  37. Zav'jalov O.V. Rol' differentsirovannogo podhoda pri provedenii respiratornoj terapii u detej s ekstremal'no nizkoj massoj tela v rannem neonatal'nom periode. Tez. dokl. nauchno-prakt. konf. molodyh uchenyh. 21–22 dekabrja 2020 g.. M.: TsGMA, 2021; 111 s. [Zavyalov O.V. The role a differentiated approach in respiratory therapy in children with extremely low body in the early neonatal period. Abstracts of the scientific-practical conference of young scientists. December 21–22, 2020. M.: FSBI DPO «TsGMA», 2021; 111 p. (in Russ.)].
  38. Majer R.F., Obladen M. Intensivnaja terapija novorozhdennyh. Dokazatel'stvo i opyt. Per. s nem. M.: MEDpress-inform, 2021; 768 s. [Maier R.F., Obladen M. Neugeborenen – intensivmedizin. Evidenz und Erfahrung. Transl. From German. M.: MEDpress-inform, 2021; 768 s. (in Russ.)].
  39. Ejgenson O.B., Rjumina I.I., Malashina O.A. Narushenija gemodinamiki u novorozhdennyh detej pri sindrome dyhatel'nyh rasstrojstv. Rossijskij vestnik perinatologii i pediatrii. 1993; 38 (4): 6–8 [Eigenson O.B., Ryumina N.I., Malashina O.A. Hemodynamic disorders in newborns with respiratory disorders syndrome. Russian Bulletin of Perinatology and Pediatrics. 1993; 38 (4): 6–8 (in Russ.)].
  40. Perepelitsa S.A., Korotkaja M.V., Pavlenko O.V. i dr. Izmenenija vnutriserdechnoj gemodinamiki u novorozhdennyh s respiratornym distress-sindromom. Anesteziologija i reanimatologija. 2009; 1: 37–40 [Perepelitsa S.A., Korotkaya M.V., Pavlenko O.V. et al. Intracardiac hemodynamic changes in the newborn with respiratory distress syndrome. Anesthesiology and reanimatology. 2009; 1: 37–40 (in Russ.)].
  41. Perepelitsa S.A., Golubev A.M., Moroz V.V. i dr. Prenatal'nyj morfogenez legkih i predposylki dlja razvitija RDS u nedonoshennyh novorozhdennyh. Obschaja reanimatologija. 2010; 6: 53–8 [Perepelitsa S.A., Golubev A.M., Moroz V.V. et al. Prenatal Lung Morphogenesis nd Prerequisites for the Development of Respiratory Distress Syndrome in Premature Neonates. Obshchaya reanimatologiya. 2010; 6: 53–8 (in Russ.)].
  42. Dement'eva G.M., Vel'tischev Ju.E. Profilaktika narushenij adaptatsii i boleznej novorozhdennyh. Lektsija dlja vrachej. 2-e izd. M.: Moskovskij nauchno-issledovatel'skij institut pediatrii i detskoj hirurgii MZ RF, 2011; 75 s. [Dementyeva G.M., Veltischev Yu. E. Prevention of adaptation disorders and diseases of newborns. Lecture for doctors. 2nd ed. M.: Moscow Scientific Research Institute of Pediatrics and Pediatric Surgery, Ministry of Health of the Russian Federation, 2011; 75 p. (in Russ.)].
  43. Fomichev M.V., Mel'ne I.O. Novorozhdennye: terapija tjazhelyh infektsij. M.: Logosfera, 2016; 216 s. [Fomichev M.V., Melne I.O. Newborns: therapy of severe infections. M.: Logosfera, 2016; 216 p. (in Russ.)].
  44. Huven T.A, Polin R.A. Pnevmonija. Neonatologija: novosti, mnenija, obuchenie. 2017; 3: 39–49 [Hooven T.A., Polin R.A. Pneumonia. Neonatology: news, opinions, training. 2017; 3: 39–49 (in Russ).].
  45. Bojtsova E.V., Ovsjannikov D.Ju., Zapevalova E.Ju. i dr. Problemy i diskussionnye voprosy diagnostiki pnevmonij u novorozhdennyh detej. Pediatrija. 2019; 98 (2): 178–85 [Boytsova E.V., Ovsyannikov D.Y., Zapevalova E.Yu. et al. Problems and controversial issues in diagnostics of pneumonia in newborns. Pediatria. 2019; 98 (2): 178–85 (in Russ.)].
  46. Rjumina I.I., Ejgenson O.B., Zhitova E.P. i dr. Osobennosti techenija sindroma dyhatel'nyh rasstrojstv u nedonoshennyh detej razlichnogo gestatsionnogo vozrasta. Rossijskij vestnik perinatologii i pediatrii. 1995; 1: 43–6 [Rumina I.I., Eigenson O.B., Zhitova E.P. et al. Clinical course the respiratory distress syndrome in preterm babies of different gestation age. Russian Bulletin of Perinatology and Pediatrics. 1995; 1: 43–6 (in Russ.)].
  47. Vinogradova I.V., Belova A.N., Ignat'eva E.N. i dr. Dyhatel'nye narushenija u novorozhdennyh s ENMT i ONMT. Vestnik sovremennoj klinicheskoj meditsiny. 2014; 7 (6): 13–7 [Vinogradova I.V., Belova A.N., Ignateva E.N. et al. Respiratory disordes in infants with VLBW and ELBW. Bulletin of Modern Clinical Medicine. 2014; 7 (6): 13–7 (in Russ.)].
  48. Perepelitsa S.A., Golubev A.M., Moroz V.V. Dyhatel'naja nedostatochnost' u nedonoshennyh detej, rozhdennyh ot mnogoplodnoj beremennosti. Obschaja reanimatologija. 2010; 6: 18–24 [Perepelitsa S.A., Golubev A.M., Moroz V.V. Respiratory Failure in Premature Babies Born from Multiple Pregnancy. Obshchaya reanimatologiya. 2010; 6: 18–24 (in Russ.)].
  49. Suljan A.M., Sargsjan A.B., Drampjan T.S. i dr. Kriterii diagnostiki vnutriutrobnoj pnevmonii novorozhdennyh. Pediatrija. Zhurnal im. G.N. Speranskogo. 1994; 4: 34–7 [Sulyan A.M., Sargsyan A.B., Drampyan T.S. et al. Criteria for the diagnosis of intrauterine pneumonia in newborns. Pediatrics. 1994; 4: 34–7 (in Russ.)].
  50. Blohin B.M. Ostraja dyhatel'naja nedostatochnost' u detej. Lechebnoe delo. 2008; 4: 34–44 [Blokhin B.M. Acute respiratory failure in children. Lechebnoe delo. 2008; 4: 34–44 (in Russ.)].