What is the impact of respiratory diseases on neonates?

The aim was to study the efficacy of rescue High Frequency Oscillatory Ventilation (HFOV) in improving the oxygenation and ventilation in neonates with acute respiratory failure after failing Conventional Mechanical Ventilation (CMV). Primary outcome was short term oxygenation, lung recruitment, and ventilation and secondary outcome studied was survival. 675 babies were ventilated and 97 of them received HFOV. HFOV significantly improved oxygenation index, alveolar-arterial oxygen gradient, pH, PCO2, PO2 and caused better lung recruitment within 2 hours. Fifty seven babies (58.77%) survived and the mortality was more in <28 weeks, babies with pulmonary hemorrhage, sepsis and CDH.

Background:Respiratory diseases in newborns are considered major causes of neonatal morbidity and mortality especially in developing countries. Its causes are diverse and require early detection and management. This study aimed for detection of the prevalence and risk factors of respiratory diseases in addition to outcome among neonates admitted in neonatal intensive care unit.Methods:Our study was a prospective observational study that was undertaken at the neonatal intensive care unit of Qena University Hospital, Egypt from July 2017 to July 2018. Demographic and clinical data of newborns and their mothers were evaluated and tabulated.Results:In this period, 312 neonates were admitted to the neonatal intensive care unit, out of them 145 suffered respiratory diseases giving a prevalence of (46.5%), and (55.9%) were males. The mean neonatal age at admission was 4.33 ± 7.19 days and mean gestational age was 34.49 ± 3.31 weeks. The most common detected respiratory diseases were respiratory distress syndrome (RDS; 49.6%), transient tachypnea of newborn (TTN; 22%), neonatal pneumonia (17.2%) and meconium aspiration syndrome (MAS; 6.21%). Premature rupture of membrane (PROM), maternal diabetes and fetal prematurity had the highest risk factors for respiratory diseases occurrence in neonates. Neonatal mortality rate was 26.2%, mainly due to hyaline membrane disease and pneumonia.Conclusion:Respiratory diseases constitute major part of total admission in neonatal intensive care unit especially RDS, TTN, pneumonia and MAS. Prematurity and maternal diabetes were the most important risk factors associated with respiratory diseases. Respiratory distress syndrome carried the highest risk of mortality and TTN carried the highest survival rate.

Respiratory diseases are a major cause of morbidity in neonates, especially preterm infants; a long term complication of prematurity such as bronchopulmonary dysplasia (BPD) is particularly relevant today. The exact role of the Pulmonary Function Test (PFT) in this area is not yet well defined; the PFT in newborns and infants - in contrast to what happens in uncooperative children and adults - are routinely used only in a few centers. The assessment of pulmonary function in newborns and infants, however, is nowadays possible with the same reliability that in cooperative patients with the possibility to extend the assessment of polmonary function from bench to bed. The assessment of pulmonary function must be carried out with non invasive and safe methods, at the bedside, with the possibility of continuous monitoring and providing adequate calculation and management of data. The ability to assess lung function helps to define the mechanisms of respiratory failure, improving the treatment and its effects and is therefore a useful tool in the follow-up of newborn and infant with pulmonary disease.

Premature infants are exposed to increased generation of reactive oxygen species, and on the other hand, they have a deficient antioxidant defense system. Oxidative insult is a salient part of lung injury that begins as acute inflammatory injury in respiratory distress disease and then evolves into chronic and structural scarring leading to bronchopulmonary dysplasia. Oxidative stress is also involved in the pathogenesis of pulmonary hypertension in newborns through the modulation of the vascular tone and the response to pulmonary vasodilators, with consequent decrease in the density of the pulmonary vessels and thickening of the pulmonary arteriolar walls. Oxidative stress has been recognized as both a trigger and an endpoint for several events, including inflammation, hypoxia, hyperoxia, drugs, transfusions, and mechanical ventilation, with impairment of pulmonary function and prolonged lung damage. Redoxomics is the most fascinating new measure to address lung damage due to oxidative stress. The new challenge is to use omics data to discover a set of biomarkers useful in diagnosis, prognosis, and formulating optimal and individualized neonatal care. The aim of this review was to examine the most recent evidence on the relationship between oxidative stress and lung diseases in preterm newborns. What is currently known regarding oxidative stress-related lung injury pathogenesis and the available preventive and therapeutic strategies are also discussed.

Introduction: Pre-term birth is the main determinant of neonatal morbidity and mortality with long-term adverse health consequences. Infants born pre-term compared to term infants experience more difficulty with temperature instability, feeding intolerance, blood glucose regulation, jaundice, apnea, respiratory distress (RDS) and sepsis. Aim: To study the early neonatal morbidities of all pre-term neonates admitted in NICU and to know the immediate outcome during their stay. Also to compare rate of early morbidities and mortality among SGA and AGA pre-term neonates. Material and methods: It’s a prospective observational study carried out in a NICU of a Medical college in South India, for a period of 18 months. Preterm babies (less than 37 weeks gestation using Modified Ballard score) divided into SGA and AGA using growth charts. Total 100 preterm babies included of which SGA and AGA were 50 each. Neonates with TTN (Transient Tachypnea of the Newborn), Birth asphyxia, Neonatal sepsis, Hypoglycemia, Hypothermia, Neonatal hyperbilirubinemia, Respiratory insufficiency, Feed intolerance were included in present study. Results: Hyperbilirubinemia constituted 61% of morbidities, among which 47.5% are AGA neonates and 52.5% are SGA neonates. 24 newborns presented with sepsis, 15 newborns with feed intolerance. 80 newborns had hypoxia at admission. RDS was commonly seen in AGA neonates when compared to SGA neonates. 6 babies among AGA and 8 among SGA had mortality. One baby was discharged AGAinst medical advice. Conclusion: Most common morbidities among the SGA neonates were sepsis, hyperbilirubinemia, feed intolerance, hypoglycemia, Apnea, PDA, hypoxia. AGA neonates had metabolic disorders and RDS.

Inherited diseases caused by dysfunction of pulmonary surfactant metabolism or surfactant dysfunction have recently been considered the underlying causes of neonatal and pediatric respiratory diseases. Respiratory distress syndrome in premature infants is a common respiratory disease in pediatrics. It is caused by underdeveloped lungs in infants and a lack of active substances on the surface of the alveoli, which leads to insufficiency of lung function, which can lead to difficulty breathing, increased heart rate, facial bruising, and more. Neonatal Respiratory Distress Syndrome is a very dangerous disease with a high mortality rate and a great threat to children's lives and health. Therefore, enough attention and treatment should be caused in clinical practice. Natural pulmonary surfactant (PS) has achieved positive effects in the treatment of neonatal respiratory distress syndrome (RDS), reducing neonatal mortality, the application of mechanical ventilation, and the occurrence of late complications. To further explore the role of pulmonary surfactants in the treatment of neonatal respiratory distress syndrome, to analyze the best time to use PS to prevent RDS, this paper has selected premature infants with RDS received by the neonatal department of a hospital in a province from March 2019 to October 2020 to compare the efficacy of pulmonary surfactant (PS) in preterm infants with respiratory distress syndrome (RDS). The experiment has found that the average mechanical ventilation time (5.1 d) and oxygen therapy time (7.3 d) in the early group are shorter than the average mechanical ventilation time (6.4 d) and oxygen therapy time (10.6 d) in the late group. It has been demonstrated that early administration of pulmonary surfactant (PS) therapy is of great help in improving respiratory distress syndrome in premature infants.

The aim of the study was to analyze major radiological signs on chest X-ray images of neonates with respiratory disorders. The analyzed group consisted of 84 neonates; 56 were born prematurely. In total, 386 X-ray photographs of the neonates were taken; of these, 301 were chest radiographs. The following conditions were diagnosed: pneumonia (n = 44), infant respiratory distress syndrome (n = 28), bronchopulmonary dysplasia (n = 9), atelectasis (n = 5), and meconium aspiration syndrome (n = 3). The initial X-ray images of 29 neonates were normal. Reduced aeration of lung tissue was diagnosed in 55 patients, increased lung tissue aeration in 6. A pathologically widened mediastinal shadow was observed in 4 newborns; in 4 cases, evaluation was not possible. The final radiographs were normal in 41 cases. The most common radiological sign in respiratory disorders is the reduction of lung aeration. Chest X-ray examination plays a significant role in the diagnostics of respiratory disorders, which may be caused be factors unrelated to the respiratory system.

Objective To evaluate the value of sonography in diagnosis of neonatal pulmonary diseases and to provide a reliable and simple method for diagnosing neonatal pulmonary diseases.Methods From May 2012 to August 2012,105 newborns who admitted into Bayi Children's Hospital were enrolled into this study,including respiratory distress syndrome 40 cases (three of them with difficulty in withdrawing mechanical ventilation),meconium aspiration syndrome 17 cases,wet of newborn 17 cases and 30 health neonates without diseases.Lung ultrasound was performed at bedside by a single expert physician within the first 24 h of life.All patients with neonatal diseases were diagnosed by clinical manifestations,arterial blood gas analysis and chest X-ray.Results (1) Lung sonography of normal neonates showed hypo-echo (black),smooth and clear hyper-echoic pleural line.A line was hyper echo too.(2) All 40 neonates with respiratory distress syndrome showed consolidation with air bronchograms; abnormal pleural line,disappeared A-lines,pleural effusion and alveolar-interstitial syndrome.Five out of the 40 (12.5％)infants showed pleural effusion.(3) All 18 meconium aspiration syndrome infants showed focal consolidation under pleural membrane,alveolar-interstitial syndrome,atypical changes of abnormal pleural line and disappeared A-line in lesion area with sonography.(4) All infants with wet of newborn (100.0％,17/17) showed double point,with which all wet of newborn could be diagnosed.(5) Differential diagnosis of respiratory distress syndrome with wet of newborn:five infants with severe dyspnea showed white lung in X-ray and were diagnosed as respiratory distress syndrome,while sonography only showed severe edema and one infant showed pleural effusion which was in accordance with wet of newborn,so was their courses of disease.(6) Three cases of respiratory distress syndrome showed dyspnea after withdrawing mechanical ventilation,and sonography showed local atelectasis but normal in X-ray.Conclusions Lung ultrasound has many advantages,such as accurate,reliable,no radiation damage,low-cost and simple; therefore,it is feasible in neonatal ward. Key words: Respiratory distress syndrome, newborn; Meconium aspiration syndrome; Ultrasonography

Article elucidates the neonatal lung physiology in newborns, methods of respiratory support, particularly positive pressure ventilation, and pulmonary changes caused by anesthesia and surgery. Optimal methods of respiratory support in preterm and full-term newborns are considered. It was noted that newborn infants have a high risk of respiratory complications during anesthesia which can be attributed to their respiratory physiology. The balance between volume of closing and functional residual capacity can be easily disrupted during anesthesia and surgery, which immediately leads to respiratory disorders. Therefore the strategy should include «open lung» ventilation conception and avoid high tidal volume and excessive oxygen inspiratory fraction. High-frequency oscillatory ventilation (HFOV) often used in babies with severe respiratory failure does not have the advantages in reducing of the BPD development, other pulmonary fatalities, as well as severe neurological complications in preterm infants comparing with conventional ventilation. Regarding full-term newborns, the timely start of HFOV may be more effective than conventional mechanical ventilation. This review also applies to such issues as use of inhaled nitric oxide, using of cuffed endotracheal tubes, the influence of anesthetics on immature lungs and breathing problems that may occur during anesthesia and surgery.

Background: Acute respiratory distress syndrome is defined as acute diffuse inflammatory lung injury causing increased pulmonary vascular permeability with increased lung weight, loss of aerated lung tissues leading to hypoxemia and bilateral radiographic opacities associated with increased venous admixture, increased physiological dead space and decreased lung compliance. Aim of work: to determine the prevalence rates of respiratory distress syndrome (RDS) in neonates in King Abdulaziz Hospital, Taif city, Saudi Arabia and to find out the most important causes of RDS in preterm babies in Taif city. Methods: a cross-sectional questionnaire based study carried out in Saudi Arabia, Taif city, King Abdulaziz Hospital from January to June 2016 (6 months period) on preterm neonates. Results: 57.1% of newborn were male gender and 42.9% were female, 4.4% of babies were extreme preterm, 86.5% were preterm, 4.4% were late preterm and 4.7% were full term, the prevalence rate of RDS in newborn was 54.7% in the 6 months of this study. Conclusion: RDS is one of the major problems among newborns and a major reason for increased morbidity and mortality among infants. Preterm babies are the main risk factor for development of RDS. Mother’s illnesses, especially hypertension and Diabetes are very strong risk factors for the disease in preterm babies. Cesarean delivery, especially in preterm babies and male gender stays other important risk factors for RDS.