Cause Of Respiratory Distress Research Articles

Respiratory emergencies in adult horses

SummaryAlthough respiratory distress is encountered infrequently in equine practice, it can be serious and potentially fatal, requiring immediate and decisive intervention. History and physical examination can often give sufficient clues to identify the cause of respiratory distress and initiate emergency treatment. Ultrasonography can also be invaluable when assessing distress caused by lower respiratory tract issues. Upper respiratory tract obstruction, tension pneumothorax and occasionally pulmonary oedema can be rapidly fatal and require immediate intervention by emergency tracheotomy, thoracocentesis and evacuation of pleural air or administration of furosemide and oxygen, if available. Acute severe asthma and substantial pleural effusion are often not an immediate threat to life but nonetheless require fast intervention including administration of bronchodilators and corticosteroids or pleurocentesis, respectively.

Thoracic fluid content (TFC) using electrical cardiometry versus lung ultrasound in the diagnosis of transient tachypnea of newborn

This study aimed to evaluate TFC by EC versus lung ultrasound (LUS) findings for diagnosing and follow-up of TTN in late preterm and term neonates. This prospective observational study was conducted on 80 neonates with gestational age ≥ 34 weeks. TTN group included 40 neonates diagnosed with TTN, and no lung disease (NLD) group included 40 neonates without respiratory distress. LUS and EC were performed within the first 24 h of life and repeated after 72 h. There was a statistically significant increase in TFC in TTN group on D1 [48.48 ± 4.86 (1 KOhm−1)] compared to NLD group [32.95 ± 4.59 (1 KOhm−1)], and then significant decrease in TFC in D3 [34.90 ± 4.42 (1 KOhm−1)] compared to D1 in the TTN group. There was a significant positive correlation between both TFC and LUS with Downes’ score, TTN score, and duration of oxygen therapy in the TTN group. Conclusion: Both LUS and TFC by EC provide good bedside tools that could help to diagnose and monitor TTN. TFC showed a good correlation with LUS score and degree of respiratory distress.What is Known:• Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns.• TTN is a diagnosis of exclusion, there are no specific clinical parameters or biomarker has been identified for TTN.What is New:• Thoracic fluid content (TFC) by electrical cardiometry is a new parameter to evaluate lung fluid volume and could help to diagnose and monitor TTN and correlates with lung ultrasound score.

Surfactant Therapy in Meconium Aspiration Syndrome: A Case Report

Background: Meconium aspiration syndrome (MAS) is one of many causes of respiratory distress in newborns. Data regarding MAS in Indonesia is still very limited, but a study revealed MAS is related to a high mortality rate. The latest study revealed surfactant therapy is related to better clinical outcomes in MAS cases. This study aimed to present a case of a baby with meconium aspiration syndrome given bolus surfactant therapy.
 Case presentation: A day-old baby was referred to our emergency department with respiratory distress, delivered by cito caesarean section due to cephalopelvic disproportion with premature rupture of membranes. The baby didn’t cry immediately; bluish skin and green amniotic fluid were found. The baby was already intubated from the referring hospital, and the physical examination revealed rales on both lungs with severe work of breath. Chest radiography revealed patchy opacities in the right lung hemisphere, suggesting MAS. Echocardiography revealed a small patent ductus arteriosus, and head ultrasonography revealed mild brain oedema. The baby received bolus bovine surfactant therapy at 16 hours of age, delivered through an endotracheal tube. Clinical improvement was observed, and supplementary oxygen was reduced gradually. The baby was able to maintain good oxygenation without supplemental oxygen by day 12th and was able to breastfeed and drink from the bottle. He was discharged with good condition.
 Conclusion: Surfactant therapy can become a safe and effective treatment modality in MAS. Further study is still needed regarding time, method, and types of surfactants used in MAS management.

Association of iron deficiency anemia with acute bronchiolitis in children below 2 years of age

Background: Bronchiolitis is the leading cause of respiratory distress in small children and one of the main causes of hospitalization in children <2 years of age. Anemia is also identified as a risk factor for lower respiratory tract infection. Iron deficiency is considered the most common cause of anemia in developing countries. As anemia is highly prevalent in children of our country, this study was undertaken to evaluate whether iron deficiency anemia is associated with acute bronchiolitis. Method: This Cross-Sectional Analytical study was carried out in the Department of Paediatrics, Sir Salimullah Medical College Mitford Hospital (SSMCMH), Dhaka, during the period of December 2021 to November 2022 after obtaining ethical approval to explore the association between iron deficiency anemia and bronchiolitis. Hemoglobin level, RBC indices, TWBC count, serum iron, TIBC level, Transferrin saturation, and PBF were investigated and compared in all children with bronchiolitis and control. For this purpose, a total number of 71 patients were enrolled in the study and among them, 35 children with bronchiolitis were considered as cases, and 36 healthy children without bronchiolitis were considered as control, who were matched with age. After taking written informed consent from parents/legal guardians, a detailed history and thorough clinical examination and laboratory investigations were carried out on each child. Data were recorded in separate case record form and analyzed by SPSS version 23.0. Results: The mean age was found 12.1±6.7 months in cases and 14.1±6.9 months in controls. Male participants (47, 66.2%) were the predominant group in the study and female participants were (24, 33.8%). Exclusive breastfeeding was found in 10 (28.6%) cases and 25 (71.4%) controls. There was a statistically significant difference in Hb (gm/dl), MCV (fl), S.Iron (µg/dl), Transferrin Saturation (%) and RDW-CV (%) between cases and controls (p<0.05). Among 35 cases, 25 (67.6%) had Iron Deficiency Anemia and statistical difference between the case and control was significant (p=0.001) with an odds ratio of 5.0. Conclusion: Iron deficiency anemia has a significant association with bronchiolitis. A larger and more extensive study was recommended.

Neonatal Respiratory Distress in a Poor Resource Setting: From Epidemiology to Outcome

Background: Neonatal respiratory distress one of the main causes of neonatal morbidity and mortality. It is a diagnostic and therapeutic emergency whose etiology is dominated by respiratory pathologies.
 Objective: To study the epidemiological, clinical, diagnostic, therapeutic, and outcomes aspects of neonatal respiratory distress in order to help reduce its impact on neonatal morbidity and mortality.
 Methods: A retrospective descriptive cross-sectional study covering the period from 1st January 2017 to 31 December 2018 was conducted in the Neonatology Unit of the Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle of Ouagadougou, Burkina Faso (West Africa). The clinical records of newborns admitted for respiratory distress (n=305) were included in the study. Results: Over the two-year period, the frequency of neonatal respiratory distress was 39.1% (305/780). Factors of respiratory distress were early neonatal period (80%), male sex (60.7%), full-term birth (82.3%), and normal birth weight (66.3%). The Silverman and Andersen score was mild (20.4%), moderate (68.5%), and severe (11.1%). The main causes of respiratory distress were neonatal septicemic infection (59.3%) and perinatal asphyxia (30.5%). Treatment mainly includes cardiopulmonary resuscitation, maintenance of fluid and electrolyte balance, and oxygen therapy. There were 83 deaths, giving a case-fatality rate of 27.2%. Major causes of death were sepsis (13.1%) and perinatal asphyxia (9.8%).
 Conclusion: Neonatal respiratory distress is common in our neonatal unit. In order to reduce neonatal morbidity and mortality linked to this condition, action must be taken to combat neonatal sepsis, perinatal asphyxia, and preterm birth.

Causes and outcome of infants admitted with respiratory distress in a tertiary care neonatal unit: A five year review

Background: Respiratory distress is a common cause for admission of infants to a neonatal unit. The aim of this study was to analyze the causes of respiratory distress leading to admission in a neonatal unit.
 Method: This is a 5 year retrospective review of neonates admitted initially with diagnosis of respiratory distress in the neonatal unit of a tertiary care hospital from November 2017 to October 2022. Cases were identified and analyzed using electronic database maintained in the neonatal unit and were cross checked with electronic discharge summaries where necessary.
 Results: Respiratory distress was found to be the most common cause for admission to the neonatal unit almost comprising of 46% of total admissions. The commonest cause for respiratory distress on admission was found to be transient tachypnoea of newborn (TTN) in term infants and surfactant deficiency respiratory distress syndrome (RDS) in preterm infants. As compared to babies with TTN, who were all discharged home, 18.4% of those with RDS did not survive. The overall mortality of infants presenting initially as respiratory distress was 9.1%. Other common causes for respiratory distress on admission were sepsis, birth asphyxia, shock, congenital heart disease, seizure and polycythemia.
 Conclusion: Respiratory distress is a common cause for admission to a neonatal unit in both term and preterm infants. Although TTN in term and RDS in preterm are common causes for respiratory distress in newborns, the underlying cause for respiratory distress is diverse and not just limited to the lungs and heart.

Empyema thoracic in a neonate co-infected with SARS-CoV-2 and staphylococcus arouse successfully treated with fibrinolysis: a brief report

BackgroundEmpyema as a rare cause of respiratory distress in neonatal period has not yet been reported after Corona virus disease 2019 (COVID-19) and even rarely in the context of bacterial infections is age group.Case PresentationThe first neonate of quadruplets, resulting from Cesarean-Section of a 30-year-old mother without a history of previous illness, born at 34 weeks of gestation with a birth weight of 1600 gram. All four newborns were hospitalized; while the first one underwent nasal continuous positive airway pressure (N-CPAP) with a positive end-expiratory pressure of 6 and fractional inspired oxygen of 0.6, due to respiratory distress, noting a respiratory score of five out of 12.She was resuscitated one hour later due to bradycardia and underwent ventilator support. She received a single dose of pulmonary surfactant, intravenous paracetamol, and phenobarbital due to respiratory distress syndrome, Pectus Ductus Arteriosus, and unilateral clonic movements, respectively. In the lack of positive blood culture, she extubated two days later and breast-feeding was started. On day eight, she underwent high flow nasal cannula. On day 12, she suddenly developed respiratory distress, mottling, and abdominal distension, leading to N-CPAP and re-evaluation. The nasopharyngeal sampling for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) real time Polymerase chain reaction and the blood culture for staphylococcus aurous became positive. A large volume pleural effusion including septa and loculation in right hemi-thorax on chest computerized tomography scan and ultrasound was seen, necessitating to thoracotomy, which was not possible due to her general condition. Remdesivir was started and antibiotics changed to a more broad-spectrum coverage. Chest tube was inserted and Alteplase was injected for three consecutive days with beneficial effects. She had no problem for six-month follow up.ConclusionThis was a case of empyema thoracic in the context of SARS-CoV-2 and Staphylococcus arouses co-infection. In our experience, it can be treated by chest drainage and fibrinolysis in neonatal period.

Effect of Nasal Continuous Airway Pressure With and Without Surfactant Administration for the Treatment of Respiratory Distress Syndrome in Preterm Neonates.

Background Neonatal respiratory distress syndrome is a common cause of respiratory distress in newborns, often resulting from a lack of surfactant production or premature lung breakdown. The objective of this study was to compare the effect of nasal continuous airway pressure with and without surfactant administration for the treatment of respiratory distress syndrome in preterm neonates. Methodology A comparative analytical study was conducted on 100 neonates (group A continuous positive airway pressure (CPAP) with surfactant = 50 vs. group B CPAP only= 50 ). The group was allocated to the patient according to sequence. In group A, the neonates were given surfactant by the INSURE (intubation, surfactant, extubation) technique via an endotracheal tube with a single dose of 100 mg/kg/dose within the first hours of life followed by CPAP. In group B, the neonates were given only CPAP after birth. At follow-up after 24 hours, pH, pCO2, pO2, positive end-expiratory pressure (PEEP), and FiO2 were documented. All information was recorded on a predesigned questionnaire and results were subjected to statistical analysis to determine the significance of observed differences. Collected data were entered and analyzed using SPSS version 22 (IBM Corp., Armonk, NY, USA). Both groups were compared for mean pH, pCO2, pO2, PEEP, and FiO2 using an independent-sample t-test and effectiveness using a chi-square test. A significant difference was considered when the p-value was ≤0.05. Results Group A had a mean age of 4.84 ± 0.95 hours, while group B had a mean age of 5.5 ± 1.26 hours (p = 0.04). Gender distribution was similar in both groups, with 46.0% males and 54.0% females in group A, and 48.0% males and 52.0% females in group B (p = 0.841). Regarding post-treatment blood gas analysis, group A had a mean pH of 7.30 ± 0.05, and group B had a mean pH of 7.302 ± 0.07. While there was no significant difference in pO2 levels (p = 0.38), there was a substantial difference in pCO2 levels, with group A at 38.26 ± 4.35 and group B at 35.45 ± 4.36 (p = 0.02).CPAP parameters also showed a statistically significant difference in PEEP pCO2, with group A at 4.5 ± 0.73 and group B at 4.16 ± 0.37 (p = 0.004). After treatment, group A exhibited significant improvements in blood gas analysis and CPAP parameters compared to group B. Conclusions The study revealed that both CPAP with and without surfactant treatment effectively treat respiratory distress syndrome in preterm infants, with both being safe, effective, secure, and reducing side effects. However, CPAP treatment without surfactant is a non-invasive and cost-effective option.

PHRENIC NERVE PALSY: A RARE CAUSE OF RESPIRATORY DISTRESS IN NEWBORN

Phrenic nerve palsy is a rare cause of respiratory distress in newborns, and often under-diagnosed, It is often accompanied by brachial plexus palsy. The possibility of spontaneous recovery should be considered before choosing surgery. This rare cause of respiratory distress of the newborn can be easily overlooked among the many common etiologies of respiratory distress of the newborn if this entity is not kept in mind and a thorough workup is not performed.We report a newborn who was admitted to the neonatal unit with respiratory distress and paresis of the right upper limb. He had a dystocia labor. Chest x-ray and ultrasound showed an elevation of the right diaphragmatic dome. The diagnosis was phrenic nerve palsy associated with brachial plexus palsy secondary to birth trauma. The newborn was treated with continuous positive airway pressure (CPAP) ventilation without surgical intervention.The outcome was favorable with spontaneous recovery at the age of 2 months.The management of this association is not yet codified.Further investigations will be necessary to develop more definitive guidelines for the treatment of this condition.

PREVALENCE AND CHARACTERISTICS OF INFANTS WITH RESPIRATORY DISTRESS SYNDROME IN THE NEONATUS INTENSIVE CARE UNIT OF SANGLAH HOSPITAL IN 2020

Respiratory distress syndrome (RDS) is a cause of respiratory distress in baby that occurs several hours after newborns and can cause respiratory arrest and even death. This study aims to provide an overview of the prevalence and characteristics of infants with RDS in neonatal intensive care unit of Sanglah Hospital in 2020. This study used a cross-sectional descriptive approach with retrospective data. The study sample was infants aged 0-28 days with RDS in the neonatal intensive care unit of Sanglah Hospital who were recorded in complete medical records from January 1, 2020 to December 31, 2020. The prevalence of infants with RDS in the neonatal intensive care unit of Sanglah Hospital in 2020 was 10.9%. All of them were singleton pregnancies with a magnitude of 0 days (63.9%), female (52.8%), and second children (50%). Most of the mothers had done prenatal care (91.7%), without a history of disease (75%), primipara (50%), and ruptured membranes <24 hours (75%). Babies born with very premature gestational age (61.1%), by cesarean section (55.6%), low birth weight (30.6%), and APGAR score 7-10 (75%). A total of 36.1% of infants used a breathing apparatus in CPAP and received first-line antibiotics (94.4%). Infants with RDS have a high variability of characteristics including the general characteristics of the history of pregnancy and childbirth. The recommendation for other researchers are expect to conduct further analytical studies in the future.

Early Outcome of Neonates Admitted with Meconium Aspiration Syndrome.

Meconium aspiration syndrome is one of the commonest cause of respiratory distress in neonates. The incidence is still high in developing world. This study aims to study the clinical characteristics and early outcome of neonates admitted for meconium aspiration syndrome. This was a cross-sectional descriptive study done among neonates admitted to the neonatal Intensive Care Unit with a diagnosis of Meconium Aspiration syndrome. Relevant epidemiological, clinical and laboratory data were obtained. The early outcome of those neonate was studied. Out of 140 neonates with a mean birth weight of 2865 + 543 grams,73.6% were male, of which 76.4% were referred cases while 23.6% were inborn. Of them 69.3% had history of thin type of meconium while 30.7% had thick type of meconium during delivery. Of all mothers, 74.3% were primigravida, 4.3% had intrapartum fever of unknown source,11.4% suffered from urinary tract infection while 2.8% had hypertension. Premature rupture of membrane had occurred among 7.9% and oligohydramnios was found in 10%. Half of them (50.7%) had spontaneous vaginal delivery, 44.3% had caesarian section, while 4.8% had assisted delivery. Around one third of the neonates (37.1%) were given supplemental oxygen via nasal prongs, 25.7% via head box, 27.1% via continuous positive airway pressure and 10% intubated. Around half of the neonates (42.1%) had no complications. Complication noted were sepsis, birth asphyxia, seizures and polycythemia in 35%, 14.3%, 5.7% and 2.9% respectively. Mortality occurred among 5.0% of them. Meconium aspiration syndrome is one of the commonest cause of respiratory distress in a neonate which is associated with common maternal risk factors especially in primigravida which included Urinary tract infection, hypertension and oligohydramnios.

Right-sided spontaneous, massive hemothorax in a 27-week pregnant lady: a case report

Spontaneous, massive hemothorax due to pulmonary varix is an uncommon, yet catastrophic cause of respiratory distress during pregnancy and postpartum. Presentation is often confused with pulmonary embolism, the treatment of which, worsens the condition. Diagnosis is challenging because of the elusive abnormalities on radiographic and bronchoscopic examination. Currently, there are no treatment guidelines for pulmonary varix. A 23-year-old pregnant lady in her second trimester, with intra-uterine fetal demise, presented to our emergency with dyspnoea, fever, and right-sided chest pain for three days. Chest X-ray and therapeutic thoracocentesis revealed massive right-sided hemothorax and computed tomography suggested pulmonary varix as the cause which was managed with emergency chest tube drainage. Massive, spontaneous hemothorax due to pulmonary varix in pregnancy is a rare occurrence, but it requires timely, multidisciplinary assessment and management for the betterment of the mother and the fetus.

Interpreting cardiac biomarkers in small animal practice

Background: Cardiac troponin‐I (cTnI) and N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) are two cardiac biomarkers readily available on the market. These two biomarkers are useful diagnostic tools used in the right setting: differentiating cardiac and non‐cardiac causes of respiratory distress and providing prognosis prediction. However, these tests have their limitations and their results should be interpreted with these limitations in mind.Aim of the article: This article reviews the available evidence around the physiology of cTnI and NT‐proBNP – the commercially available assays – and discusses their indications, limitations and result interpretation for each biomarker. The emerging biomarker, microRNA, is also briefly discussed.

The Role of Zinc in Acute Bronchiolitis in children less than 2 years old

Background: Bronchiolitis is an acute respiratory illness which is the leading cause of respiratory distress in infancy and early childhood with its greatest morbidity in infants. Although zinc supplementation is effective in both preventing and treating pneumonia but its role in acute bronchiolitis has rarely been examined.
 Objective: To assess the effect of zinc sulfate to improve the clinical manifestations of acute bronchiolitis (Severe cases) in children less than 2 years of age.
 Materials and Methods: This was a double blind randomized clinical trial on 70 patients aged 2 to 23 months admitted in the Pediatric ward of Khwaja Yunus Ali Medical College and Hospital from September 2019 to September 2020 with the diagnosis of acute bronchiolitis. Patients were randomly divided equally into 2 groups: a case group was assigned oral zinc sulfate and the control group received placebo.
 Results: Mean age of case group was 174.63±98.7 days and control group 176.86±97.43 days ( p=0.924) with male predominance in both groups. Symptoms and signs of acute bronchiolitis (Severe cases) were compared between the 2 groups during admission and then at 24, 48 and 72 hours after initiation of treatment. No statistically significant differences were observed between the 2 groups in improvement of symptoms and signs including fever, fast breathing, chest indrawing and wheezing on 48 and 72 hours after treatment with zinc sulfate ( p>0.05). The duration of hospitalization was 4.2±2.6 days in the case group and 4.4±2.2 days in the control group and this difference was not significant.
 Conclusion: The present study showed that zinc sulfate has no benefit in improving the clinical manifestations of acute bronchiolitis.
 Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 535-538

Failure Factors of Bubble CPAP in Neonates with Respiratory Distress

Background: Respiratory distress is the most frequent presenting complaint of newborn encountered within the first 48–72 hours of life. An infant who is breathing on instinct is given non-invasive respiratory support called Bubble Continuous Positive Airway Pressure (Bubble CPAP) to help them to maintain a long volume during expiration. The study aimed to identify failure factors of Bubble CPAP in neonate with respiratory distress. Material & Methods: From April to September 2017, a cross-sectional study was carried out at the Department of Neonatal Medicine in Bangladesh Shishu Hospital & Institute. One hundred and eight (N=108) newborns with respiratory distress who were given Bubble CPAP were enrolled for the study. After receiving the parent’s or guardian’s written informed consent, all the necessary information were recorded in a predesigned proforma that included the patient’s specifics. Then completed data forms were reviewed, updated, and prepared for computer data input. The “t” test, “r” test and Statistical Package for the Social Sciences (SPSS) Version 23.0 were used to analyze the data. Results: Among study patients (N=108), most of the neonates 49 (45.4%) belonged to age ≤24 hours and the neonates with respiratory distress which needed Bubble CPAP support 18 (16.7%) had RDS, 18 (16.7%) had PNA, 15(13.9%) had pneumonia, 14(13.0%) had PPHN, and 10(9.3%) had sepsis. More than three-fourths of the patients (85) were found successfully weaned and one-fifth of the patients (23) failed. Conclusion: The most frequent causes of respiratory distress were RDS, PNA, PPHN, Sepsis, congenital pneumonia, and pneumonia. Grunting respiration, higher RR, lower SPO2, higher FiO2 and cyanosis were substantially associated with Bubble CPAP failure among the respiratory distress symptoms. PPHN and sepsis have a causal relationship with Bubble CPAP failure. More duration of Bubble CPAP and more hospital stay also have relation with Bubble CPAP failure. The majority of patients were weaned, however, patients who failed Bubble CPAP died more frequently.

Evaluation of etiology and clinical spectrum of respiratory distress in neonates admitted in tertiary care NICU

Background: Neonatal period is defined as up to first 28 days of life and further divided into very early (birth to <24 h), early (birth to <7 days), and late neonatal period (7 days to <28 days). Neonatal period is the most vulnerable period of human life as it accounts for very high morbidities and mortalities and most of these are preventable. India contributes to one-fifth of global live births and more than a quarter of neonatal deaths. Respiratory distress is most common cause of NICU admission Aim of current study was to determine the etiology of respiratory distress in neonates presenting in NICU, clinical spectrum of respiratory problems in neonates having respiratory distress and the management of respiratory distress. Methods: The present study was a prospective, observational, comparative study. This study was conducted from January 2019 to October 2019 at Mata Channan Devi hospital Janakpuri, New Delhi. 80 patients were included in this study. Results: In our study 93.75% cases of respiratory distress was of respiratory origin, while 3.75% was due to cardiac cause and 2.5% was central nervous system due to birth asphyxia and in our study group most common clinical finding of respiratory distress was tachypnea found in 97.5% of patients. Result showed, overall incidence of respiratory distress among in borns was 10.34%. In our study TTNB was most common cause of respiratory distress among new born. Conclusions: There was no significant difference of incidence in male and female babies. The etiology varies with gestational age. In spite of all advances in primary maternal care, delivery and early new born care respiratory distress is still the most common cause of morbidity and NICU admission in newborn babies.

Bilateral vocal cord palsy as complication of CNS tuberculosis

BackgroundTuberculous meningitis, a rare but severe form of extrapulmonary tuberculosis, frequently affects cranial nerves. While nerves III, VI and VII are commonly involved, involvement of caudal cranial nerves is rarely described. Here, we report a rare case of bilateral vocal cord palsy secondary to caudal cranial nerve involvement in tuberculous meningoencephalitis, that occurred in Germany, a country with low tuberculosis incidence.Case presentationA 71-year-old woman was transferred for further treatment of hydrocephalus as a complication of presumed bacterial meningitis with unknown pathogen at that time. Because of decreased consciousness, intubation was performed and an empiric antibiotic therapy with ampicillin, ceftriaxone and acyclovir was initiated. Upon admission to our hospital, an external ventricular drainage was placed. Cerebrospinal fluid analysis revealed Mycobacterium tuberculosis as the causative pathogen, and antitubercular treatment was initiated. Extubation was possible one week after admission. Eleven days later, the patient developed inspiratory stridor that worsened within a few hours. Flexible endoscopic evaluation of swallowing (FEES) revealed new-onset bilateral vocal cord palsy as the cause of respiratory distress, which required re-intubation and tracheostomy. The bilateral vocal cord palsy persisted despite continued antitubercular therapy on the follow-up examination.ConclusionConsidering the aetiology of infectious meningitis, cranial nerve palsies may be suggestive for tuberculous meningitis as underlying disease given their rarity in other bacterial forms of meningitis. Nevertheless, intracranial involvement of inferior cranial nerves is rare even in this specific entity, as only extracranial lesions of inferior cranial nerves have been reported in tuberculosis. With this report of a rare case of bilateral vocal cord palsy due to intracranial involvement of the vagal nerves, we emphasize the importance of timely initiation of treatment for tuberculous meningitis. This may help to prevent serious complications and associated poor outcome since the response to anti-tuberculosis therapy may be limited.

Clinico-Demographic Profile of Term Newborns Admitted with Respiratory Distress at a Tertiary Hospital in India

Background: Respiratory distress (RD) is the most common cause of morbidity and mortality in newborns. Over the last three decades, significant improvements have been introduced to decrease the incidence, severity, and mortality of neonatal RD. This study aims to analyze the clinical and demographic profile of term newborns with RD and to explore associated risk factors and co-morbidities. Methods: This analytical cross-sectional study included 250 term newborns (gestational age: 37 to 42 weeks) diagnosed with RD. The study was conducted at the Department of Pediatrics, Santosh Medical College, over a one-year period from June 2018 to June 2019. Results: The male-to-female ratio was 1.7:1. Among the admissions, 65% were term pregnancies and 35% were late-term pregnancies. Severe RD was observed in 10% of newborns, while 35% had moderate RD. There was a significant correlation between gestational period and RD severity (P = 0.024), and hospital stay also exhibited a significant association with RD severity (P = 0.001). Meconium-stained amniotic fluid was the most common maternal risk factor (25%), while sepsis was the most prevalent co-morbidity (23%). Transient tachypnea of the newborn (TTNB) was the leading cause of RD, accounting for 47% of cases. Conclusions: A comprehensive clinical assessment and appropriate investigations are vital for accurate diagnosis and effective treatment of infants with RD. Swift identification of severe underlying conditions is essential for improving outcomes.

The epidemiology of neonatal respiratory distress in a tertiary care neonatal Centre Kashmir India

Background: Respiratory distress is most common cause of neonatal admission to NICU and has different etiologies with similar clinical presentation. Early diagnosis of specific cause for respiratory distress is very important as different etiologies have different specific treatment and require altogether different ventilatory strategies. Objectives were to study the demographic and etiological profile of neonatal respiratory distress. Method: Hospital based prospective observational study conducted in department of pediatrics, associated hospital of GMC Srinagar. Results: Respiratory distress was more common in males 56.30%, frequency of prematurity was 68% and most common mode of delivery lower section caesarian section (LSCS) 69.10%. Different maternal risk factors associated with adverse outcome premature rupture of membranes (PROM) (37.7%), meconium-stained amniotic fluid (MSAF) (34.60%), maternal hypertension (31.50%), gestational diabetes mellitus (GDM) (26.9%). Common causes for respiratory distress in neonate were transient tachypnea of newborn (TTN) (22.0%), respiratory distress syndrome (RDS) (20%), meconium aspiration syndrome (MAS) (16.90%), sepsis (14%) and perinatal asphyxia (12%). Conclusions: Early diagnosis of specific cause for respiratory distress is very important as different etiologies have different specific treatment and require altogether different ventilatory strategies. The TTN was the most common cause of distress in term newborns, followed by perinatal asphyxia, meconium aspiration, neonatal sepsis, and congenital heart diseases (CHD). Therefore, timely diagnosis and management of these conditions is very imperative to discharge an intact neonate from the NICU.

Effect of inhaled budesonide therapy in term newborns with meconium aspiration syndrome

Background: Meconium aspiration syndrome is a common cause of respiratory distress in neonates. This study explores the possibility of altering the course of the disease by using anti-inflammatory agents to counter the chemical and inflammatory pneumonitis caused by meconium. The objective is to determine if inhaled budesonide therapy can alter the clinical course of the disease and improve outcome without causing any serious adverse effects. Methods: A comparative study was conducted in NICU of Cheluvamba hospital, Mysore over 12 months. Neonates with MAS were divided into interventional and control groups. Interventional group received budesonide nebulization 12th hourly starting after 6 hours of life, while control group received saline nebulization 12 hourly. Data was analysed by SPSS 20 software and student t test and chi square test were used to assess statistical significance. Results: The patient profile of the two groups was similar, with the interventional group showing early normalization of Downes score compared to controls. The duration of respiratory distress, oxygen dependency, and duration of hospital stay was significantly less in the steroid treated group compared to controls. There was no significant difference in the incidence of sepsis between the two groups, and three patients died during hospital stay due to pneumothorax with overwhelming sepsis with DIC. Conclusions: Nebulized budesonide improves clinical outcome in terms of morbidity and is relatively safe, however long term follow up required to recommend inhalational steroids as safe and effective.