الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Since its introduction in the sixties, mechanical ventilation has become a lifesaving practice that improved the outcome of neonates with respiratory failure. Inspite of being a revolutionary therapy, mechanical ventilation is not without complications; either related to the pressure of mechanical breaths, the duration of mechanical ventilation or to the number of re-intubation attempts.
Aerosols have been used to treat critically ill newborn infants despite the paucity of clinical data because of concern of ethical issues in this age range. This is supported by the fact that infants receive considerably more aerosolized drug per kilogram of body weight than do adults.
Nebulized normal saline has historically been used either as a placebo typically in studies examining bronchodilator medications and sputum expectorants or used as a carrier to medications. Some studies have found it to be of benefit in relieving respiratory distress signs in infants with respiratory infections and helping decreasing the rate of admission from emergency department.
Our study aims at evaluating the effect of normal saline nebulization in preventing extubation failure freshly extubated neonates admitted to Neonatal intensive care units (NICUs) of Children hospital, Ain-Shams university from October 2021 to April 2022.
Neonates were randomly allocated post extubation into one of 2 groups of 30 subjects each (ratio 1:1), one group received standard care + normal saline nebulization (case group) for 72 hours at least and the other received standard care only (control group). Progress was assessed by LUS scoring (0-18) at time of extubation (at enrollment) and 72 hours later. The higher the score, the worse the prognosis.
RDS was the most common disease causing intubation, median of intubation age was 1 day. 26 out of 30 patients in control group vs all 30 patients in case group were put on post extubation NIV. Median of duration on NIV in both groups was 3 days. NIPPV was the most used mode.
The length of NICU stay was longer in case group yet the outcome of the two groups was not significantly different.
Both case and control groups achieved significant improvement in LUS scores after 72 hours compared to at enrollment but with no significant difference between them.
There was no significant difference in reintubation rate in both study groups
The higher the LUS score, the more time the patient needed on NIV ventilatory support and in NICU.
The LUS although is known to have an excellent role in predicting reintubation but during our study the LUS scores were not significantly higher in patients who underwent reintubation. This might be due to the low median of scores in our study
from the current study, we concluded that normal saline nebulization cause some improvement in LUS scores yet it does not help decrease reintubation rate or length of NICU stay.
LUS score of (6) was the cutoff point at enrollment to predict NIV duration of more than 3 days with sensitivity of 68.29% and specificity of 73.68 % while it was (3) 72 hours later to predict NIV duration of more than 3 days with sensitivity of 80.65 % and specificity of 58.33 %. On the other hand, LUS score of (4) at 72 hours after extubation was a cutoff point to predict length of NICU stay of more than 15 days with sensitivity of 65.38% and specificity of 76.46 %.
LUS is an excellent and safe tool in assessing lung condition in neonates and helps greatly in predicting the clinical outcomes so we strongly encourage implementing it on a wider scare in intensive care units