Distress In Newborn Research Articles

Impact of anesthesiologist experience on neuraxial anesthesia outcomes in cesarean sections.

Despite the requirement for meticulous management of cesarean anesthesia, no study has explored the impact of novice trainee anesthesiologists in this field. This study assessed challenges in neuraxial anesthesia for cesarean sections and compared outcomes between novice and senior anesthesiologists. We retrospectively analyzed 446 cesarean sections with neuraxial anesthesia. The primary objective was to evaluate the impact of anesthesiologists' experience on the time required to administer neuraxial anesthesia and whether maternal body mass index (BMI) influenced this relationship. Secondary objectives included examining maternal hemodynamic variability, operative details, and newborn outcomes relative to the anesthesiologist's experience. Novice anesthesiologists required a significantly longer time to perform neuraxial anesthesia (24.9 [7.1] min vs. 18.2 [7.0] min, P<0.001) than their senior counterparts. A significant interaction was observed between anesthesiologist experience and maternal BMI on the time to administer neuraxial anesthesia (P=0.017), with a moderate correlation between BMI and administration time for novices (r=0.50, P<0.001) and only a slight correlation for seniors (r=0.17, P=0.001). Experience level did not significantly affect intraoperative hemodynamics, Apgar scores, or umbilical cord blood gas analyses. The effect of maternal BMI on the difficulty of performing neuraxial anesthesia in parturients can be more pronounced for novice anesthesiologists than for experienced ones. Despite requiring more time to perform neuraxial anesthesia, novice anesthesiologists do not significantly affect maternal hemodynamics or newborn distress during obstetric anesthesia, provided that they are under the supervision of experienced anesthesiologists.

Poppy intoxication in children: The interest of early administration of naloxone

In Morocco, medicinal plants are widely used because of their availability, accessibility, and the general public's impression that these remedies are harmless. However, the indiscriminate use of plant agents can lead to serious side effects and even death. Papaver somniferum (opium poppy) is commonly used for its therapeutic properties, as well as for its sedative effects. We report the case of a two-month-old infant who developed respiratory distress and hypotonia after his mother administered an oral preparation of opium poppy to calm him and help him sleep at a family party. The infant recovered well with early supportive and antidotal treatment. This case is reported for three reasons:To draw attention to these widespread dangerous practices among parents in order to make them aware of the risks that may endanger the lives of their children.To alert healthcare professionals to the potential exposure to such substances, which should be considered in cases of unexplained distress in newborns or infants.To highlight the importance of the availability and rapid administration of antidotal treatment.

Respiratory distress in newborns: current state of the problem

Respiratory distress in newborns: current state of the problem

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.

385 - Respiratory distress in newborn: an atypical case of nasolacrimal duct cyst obstruction

385 - Respiratory distress in newborn: an atypical case of nasolacrimal duct cyst obstruction

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.&#x0D; 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.&#x0D; 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.

Faktor-Faktor yang Berhubungan dengan Respiratory Distress pada Bayi Baru Lahir di Ruang Perinatologi RS X Jakarta

In newborns (BBL) respiratory disorders cause apnea, respiratory failure, to cardiac arrest and cause death. This study aims to determine the factors associated with respiratory distress in newborns in the perinatology ward of X Hospital from January 2018 to December 2020. The quantitative research method used an analytical survey approach (retrospective) and cross sectional design. The population is 795 BBL and the sample is 265 BBL using purposive sampling technique. The instrument used in the study was a medical record data collection form which contained data from the variables to be taken in this study.The bivariate analysis test used is the chi square test. The results of the study 56.6% of newborns experienced respiratory distress and came from a normal placental incidence of 94.7%; birth parity 1-3 times 95.1%; did not experience gestational diabetes 97.4% and women who were not pregnant 92.8%. The results of the bivariate test showed that there were no factors related to the occurrence of Respiratory Distress in newborns in the Perinatology room at X Hospital with a p-value&gt; 0.05.Conclusion: placental factors, parity, diseases experienced by the mother and gemelli are not related to the incidence of respiratory distress in newborns at X Hospital. It is expected that health workers will provide counseling about respiratory distress so that pregnant women understand more and can minimize the impact on the survival of the baby who was born.

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.&#x0D; 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.&#x0D; 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.&#x0D; 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.

Importance of antenatal identification of small for gestational age fetuses on perinatal and childhood outcomes: A register-based cohort study.

Fetal growth restriction (FGR) is associated with increased risk for stillbirth, perinatal morbidity, cerebral palsy, neurodevelopmental disorders and cardiovascular disease later in life. Identifying small-for-gestational-age (SGA) fetuses is crucial for the diagnosis of FGR. The aim of this study was to investigate the association between antenatal identification of SGA fetuses and severe adverse perinatal and childhood outcome. A register-based cohort study of all newborns delivered in Stockholm in 2014 and 2017. singleton pregnancies without chromosomal aberrations or structural abnormalities, with a gestational age at delivery between 22+0 and 43+0 (n = 48 843). Data from childbirth records were linked to data from nationwide Swedish registers. Pregnancy including offspring data were reviewed. Adverse outcomes for non-identified and identified SGA newborns were compared using logistic regression models. Primary outcome was a composite outcome called severe adverse outcome, defined as at least one of the following: stillbirth, severe newborn distress (Apgar score <4 at 5 min, pH <7 or resuscitation activities >10 min), severe neonatal outcome (hypoxic ischemic encephalopathy 2-3, necrotizing enterocolitis, neonatal seizures, intraventricular hemorrhage grade 3-4, bronchopulmonary disease or death at <1 year), severe childhood outcome (cognitive impairment or motor impairment or cerebral palsy or hearing impairment or visual impairment or death at 1-3 years old). Secondary outcomes were stillbirth, severe newborn distress, severe neonatal outcome, severe childhood outcome. No association was found between antenatal identification of SGA fetuses and severe adverse outcome using the complete composite outcome (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 0.93-1.53). In subgroup analyses, non-identified SGA fetuses had an almost fivefold increased risk for stillbirth (aOR 4.79, 95% CI 2.63-8.72) and an increased risk for severe newborn distress (aOR 1.36, 95% CI 1.02-1.82), but a decreased risk for severe childhood outcome (aOR 0.63, 95% CI 0.40-0.99). No association was found between antenatal identification of SGA and severe neonatal outcome. Non-identified SGA fetuses have an increased risk for stillbirth and severe newborn distress. Conversely, identified SGA fetuses have an increased risk for severe childhood outcome.

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.

Epidemiology and outcomes of respiratory distress in newborns

Respiratory distress of newborns is one of the most frequent causes of infant admission to intensive care units, the development of severe complications of the neonatal period and lethal outcomes.The objective was to study the epidemiology and outcomes of respiratory distress in newborns requiring intensive care measures.Materials and methods. The design was a retrospective observational study. We examined 180 newborns, the mean weight was 1620 (1075–2197.5) g, and the gestational age was 31.8 (29–34.5) weeks. Apgar score at minute 1 was 5 (4–7) and at minute 5 was 7 (6–7) scores. The duration of artificial lung ventilation was 2 (12.5–242) hours, and the duration of treatment in the NICU was 10 (6–19) days. Lethal outcomes occurred in 6 (3%) cases.Results. The most frequent cause of respiratory distress in newborns was respiratory distress syndrome in newborns (53%). The second place was occupied by asphyxia in childbirth (31%). Intra-amniotic infection was detected in 11 (6%) newborns, and intrauterine pneumonia in 5 (3%) infants. Transient tachypnea was registered in 6 (3%) newborns, and meconium aspiration syndrome – in 8 (4%) patients. In premature infants, the most severe course of respiratory distress was noted in pneumonia and asphyxia, in mature infants – in meconium aspiration syndrome. The maximum duration of intensive care measures was observed in intra-amniotic infection – 16 days and respiratory distress syndrome – 11 days. The outcome in 47% was favorable – complete recovery. Unfavorable outcomes included intraventricular hemorrhage (12%), combination of two or more complications (20%), bronchopulmonary dysplasia (5%), and persistent arterial ductus (4%).Conclusion. The outcome of respiratory distress in newborns with adequate assessment of the severity of the condition and timely initiated evidence-based treatment is determined not by the main clinical diagnosis, but by the gestational age and severity of the infant condition at the time of birth.

“A STUDY TO CORRELATE RISK FACTORS AND OUTCOMES WITH MORBIDITY AND MORTALITY PATTERN OF RESPIRATORY DISTRESS IN NEONATES IN NICU OF A TERTIARY CARE CENTRE IN RURAL SETUP”

Background: One of the most frequent illnesses in the rst 48 to 72 hours of neonatal life is respiratory distress. The most frequent reason for NICU hospitalization and the leading cause of morbidity in newborn is respiratory distress. The present study is aimed to determine and correlate the incidence, risk factors, causes and outcomes of respiratory distress in neonates in a neonatal intensive care unit of a tertiary care facility. Impressive outcomes are achieved when neonatal respiratory illness is diagnosed early and managed with appropriate interventions. Material &amp; Methods: A prospective observational study was conducted for a period of 18 months in the inborn &amp; outborn NICU of Department of Pediatrics, Index Medical College Hospital &amp; Research Centre, Indore after valid approval from Institutional ethics committee on. 100 babies who presented with respiratory distress irrespective of their status at time of delivery (preterm, term or post term) and qualied the inclusion criteria were enrolled after taking written informed consent from the parents/caretakers. Following the admission of the newborn, data were recorded in the predesigned proforma. Statistical analysis was done with P value &lt;0.05 signicant. Out Results: of 100 babies included in the study, 62 were males while 38 were females. Pulmonary cause was the most frequent cause of respiratory distress in newborn out of which TTNB (33%) was the commonest followed by RDS (20%). Prematurity (37%), MSAF (18%), Caesarean section against precipitous labour (9.5%), obstruction/non progression of labour (8%) were the major risk factors to develop. 58% of babies were born via LSCS with MSAF (24.1%), previous Caesarean section (20.7%) and obstructed labour (13.8%) as the main indications. Under treatment intervention,62 (62%) babies required only Oxygen while 20 babies (20%) required CPAP and 18 babies (18%) required mechanical ventilation. Morbidity was seen in 34% of newborns with RD which included sepsis, ROP, IVH, HIE, BPD. Out of 20 deaths,14 babies (70%) were males, and 6 babies (30%) were females. In Conclusion: cidence of respiratory distress was 9.8% among live births. Transient tachypnea of the newborn is the most common cause of respiratory distress in newborn. Antenatal risk factors increase the incidence of RD. Risk factors like Prematurity, meconium-stained liquor, cesarean delivered newborns, obstructed labour, Oligo/polyhydramnios, foetal distress, PROM was associated with respiratory distress in newborns. Prematurity is the most common and most important risk factor for the development of RD in newborn. There was male predominance &amp; most of the babies were delivered via caesarean section. Frequency and severity of RD is inversely related to gestational age and birth weight. Early term and preterm babies constituted majority of the babies with respiratory distress. Most of the babies had mild to moderate respiratory distress with Downe's score between 2-6. RDS was the most common cause for CPAP and ventilation. The mortality rate was 20% among the respiratory distress cases admitted in NICU, rest 80% survived. The most common cause of death was RDS. Early diagnosis and identication of causes of respiratory distress in neonate is critical in the management. The neonatal outcome will improve with efforts made to prevent preterm birth, identify various maternal risk factors and intervene early with appropriate interventions.

A neural substrate for negative affect dictates female parental behavior

Parental behaviors secure the well-being of newborns and concomitantly limit negative affective states in adults, which emerge when coping with neonatal distress becomes challenging. Whether negative-affect-related neuronal circuits orchestrate parental actions is unknown. Here, we identify parental signatures in lateral habenula neurons receiving bed nucleus of stria terminalis innervation (BNSTLHb). We find that LHb neurons of virgin female mice increase their activity following pup distress vocalization and are necessary for pup-call-driven aversive behaviors. LHb activity rises during pup retrieval, a behavior worsened by LHb inactivation. Intersectional cell identification and transcriptional profiling associate BNSTLHb cells to parenting and outline a gene expression in female virgins similar to that in mothers but different from that in non-parental virgin male mice. Finally, tracking and manipulating BNSTLHb cell activity demonstrates their specificity for encoding negative affect and pup retrieval. Thus, a negative affect neural circuit processes newborn distress signals and may limit them by guiding female parenting.

Admissions Due to Perinatal Respiratory and Cardiovascular Disorders in England.

The aim of this study was to look into the rates of perinatal admissions for respiratory, cardiac, and cardiovascular diseases in England. This ecological study was conducted in England. The Hospital Episode Statistics (HES) database in England provided the study with the publicly accessible data. The data set for this study was considered between April 01, 2012 and April 01, 2020. The HES database contains information on patients' admissions to hospitals, notably for those hospitalised with perinatal cardiovascular and respiratory diseases.We used the chi-squared test to assess the difference between the hospital admission rates between 2012 and 2020. An increase of 15.6% was observed in hospital admissions rate during the study period [from 10,940.37 (95% CI 10,865.99-11,014.75) in 2012 to 12,649.00 (95% CI 12,565.03-12,732.98) in 2020 per 100,000 people, p<0.05]. Intrauterine hypoxia, chest congestion and breathing-related respiratory distress of newborns, and other perinatal respiratory disorders accounted for 35.5%, 29.8%, and 21.3%, respectively. Males contributed for more than half of them (56.7%). The rate of hospital admission among males increased by 15.1% [from 12,227.79 (95% CI 12,118.83-12,336.74) in 2012 to 14,074.77 (95% CI 13,952.11-14,197.43) in 2020 per 100,000 persons, p<0.05]. The rate of hospital admission among females increased by 17.4% [from 9,646.15 (95% CI 9,545.31-9,747.00) in 2012 to 11,324.20 (95% CI 11,209.47-11,438.92) in 2020 per 100,000 persons, p<0.05]. The study's findings show that the most common causes of hospital admissions for respiratory and cardiovascular disorders were intrauterine hypoxia, neonatal respiratory distress, and other perinatal respiratory issues, which were detected particularly during the perinatal period. Further research is warranted to identify risk factors of hospital admissions for respiratory and cardiovascular disorders during the perinatal period.

Was It Pneumothorax? A Case Report of a Neonate with Congenital Pulmonary Airway Malformation from Rural Nepal

Formerly called congenital cystic adenomatoid malformation (CCAM), congenital pulmonary airway malformation (CPAM) is a rare but most common congenital lung malformation that may manifest as an asymptomatic lesion at birth or in later life. The diagnosis may be difficult and is easily confused for pneumothorax often resulting incorrect ICD insertion on an emergency basis, which causes complications and delays accurate diagnosis. We report a case of a neonate, who presented with increasing respiratory distress at birth and hyperlucency in a chest radiograph initially misdiagnosed as pneumothorax and ICD inserted, later correctly diagnosed as CPAM type I with help of a CT chest. This case report is presented to highlight that CPAM is a rare cause of respiratory distress in newborns at birth.

Practical Tips for Surgical Management of Bilateral Choanal Atresia.

Choanal atresia refers to congenital blockage of posterior choana of nose by the presence of a bony or membranous soft tissue. It causes respiratory distress innewborn which requires emergency surgical intervention. Various surgical methods areavailable for correction of choanal atresia and endoscopic approach is the commonlyused one. However there is risk of re-stenosis after surgery. This article focuses onsurgical refinements to improve the surgical outcome.It is a retrospective study done on eight newborns with bilateral congenital choanalatresia. Data included gestational age, any ante-natal issues, breathing activity at birth, diagnostic tests for choanal atresia and Head to Foot examination findings. Initialdiagnostic work up included CT scan of paranasal sinus and Echocardiography to ruleout associated cardiac anomalies. All the newborns were treated initially in NICU withventilator support and then taken up for endoscopic correction of atresia. After surgery, newborns were successfully weaned off from ventilator.Among the 8 newborns, there were 5 males and 3 females and their gestational agewas full term. (except in one). Initial presentation included respiratory distress on day 1of life with difficulty in inserting feeding tube through the nose. Imaging showedbilateral atresia in 7 newborns and unilateral atresia in one newborn. 5 of themunderwent atresia surgery using endoscopic approach. One newborn required revisionsurgery. Remaining newborns remained symptom free during the follow up period.Currently endoscopic approach remains a safer method for correction of choanalatresia with very minimal chance of re-stenosis. Surgical refinements like adequatewidening of neo-choana and usage of mucosal flaps to cover the raw area has beenfound to improve the surgical outcome.

Meconium Aspiration Syndrome in Animal Models: Inflammatory Process, Apoptosis, and Surfactant Inactivation.

Meconium Aspiration Syndrome is a condition that causes respiratory distress in newborns due to occlusion and airway inflammation, and surfactant inactivation by meconium. This condition has been described in animal species such as canids, sheep, cattle, horses, pigs, and marine mammals. In its pathogenesis, the pulmonary epithelium activates a limited inflammatory response initiated by cytokines causing leukocyte chemotaxis, inhibition of phagocytosis, and pathogen destruction. Likewise, cytokines release participates in the apoptosis processes of pneumocytes due to the interaction of angiotensin with cytokines and the caspase pathway. Due to these reactions, the prevalent signs are lung injury, hypoxia, acidosis, and pneumonia with susceptibility to infection. Given the importance of the pathophysiological mechanism of meconium aspiration syndrome, this review aims to discuss the relevance of the syndrome in veterinary medicine. The inflammatory processes caused by meconium aspiration in animal models will be analyzed, and the cellular apoptosis and biochemical processes of pulmonary surfactant inactivation will be discussed.

Role of point of care lung ultrasound in neonatal respiratory distress in comparison with chest X-ray-a clinico-radiological evaluation

Background: The use of ultrasound for immediate management of life-threatening conditions is one among the main changes of these last decades. Lung ultrasound has become more and more popular in the first decade of the 21st century, both in neonatal and in paediatric age groups. The lung ultrasound may be tool in differential diagnosis of respiratory distress in newborns. Aims and objectives: To assess diagnostic role of point of care lung ultrasound in neonates presented with respiratory distress and analyse the possibility of initiating management protocol based on lung ultrasound finding.Methods: Present non-randomized study-a hospital based analytical cross-sectional study was carried out in 60 patients with respiratory distress for a period of 18 months (January 2020-30 June 2021). Neonates suffering from respiratory distress (Pulmonary cause with Downe’s score &gt;4) were included. Routine investigations, lung USG and chest x-ray examination was recorded. Detailed perinatal history were obtained.Results: Mode of delivery was LSCS among 38.3% and vaginal delivery among 61.7% subjects. The mode of respiratory support was CPAP among 33.3% and ventilator among 66.7% subjects. Mean birth weight of the study population was 2003.51±767.35 grams. Final diagnosis of the present study shows that majority of neonates had respiratory distress syndrome (38.33%) followed by birth asphyxia with respiratory distress (28.33%) followed by TTNB (11.66%). A total of 25.0% neonates had Downes score 4, 16.7% had 5, 25.0% had 6, 26.7% had 7 and 6.7% neonates had 8 score. X-ray findings showed sensitivity 56.67% and positive predictive value 100% were observed. On the basis of USG findings, 93.22% sensitivity and positive predictive value 98.21% were observed.Conclusions: Lung ultrasound is a non-invasive, bedside and repeatable method that could improve the management of neonatal respiratory distress. Neonatal lung ultrasound is a useful predictor of the need for intubation over chest x-ray. Combined lung consolidation, pleural line abnormalities and absence of A line findings were the most specific lung ultrasound findings in RDS which were present among majority of the patients.

Respiratory distress in small for gestational age infants based on local newborn curve prior to hospital discharge.

BackgroundRespiratory distress in newborns, which may lead to risks of morbidity and death, is one of the reasons for a referral to the more advanced health facilities. Respiratory distress analysis in small for gestational age (SGA) infants remains controversial. SGA infants are a big problem for and burden the low-medium income countries. Frequentness of SGA infants varies, depending on birth weight curve used.ObjectiveTo identify the risks, complications, death induced by respiratory distress in SGA infants prior to hospital discharge.MethodsA retrospective cohort study was conducted on live- born infants at Sardjito Hospital. Singleton and gestational age 26–42 weeks were the inclusion criteria. The exclusion criteria included major congenital anomaly, chromosomal abnormalities, out-born infants admitted >24 h, discharge against medical advice, and incomplete data. The samples were categorized into appropriate gestational age (AGA) and SGA by a local newborn curve. The samples were also classified as full-term (FT)-AGA, preterm (PT)-AGA, FT-SGA, and PT-SGA. Odds ratio (OR) was based on entire respiratory distress. Complications of respiratory distress analyzed were length of hospital stay, administration of oxygen, Continuous Positive Airway Pressure (CPAP), and ventilator. Reverse Kaplan-Meier and Cumulative Mortality Incidence (CMI) were used to analyze respiratory distress-induced mortality. Stata 13 was used to analyze the data.ResultsThere were 12,490 infants eligible for the study, consisting of 9,396 FT-AGA infants, 2,003 PT-AGA infants, 771 FT-SGA infants, and 320 PT-SGA infants. Nine hundred and thirty-two infants developed respiratory distress. Multiple logistic regression analysis revealed highest risk of respiratory distress in PT-SGA infants with OR 5.84 (4.28–7.99). The highest respiratory distress complications were found in PT- SGA with significant difference on length of hospital stay and IRR 2.62 (2.09–3.27). In addition, the highest use of mechanical ventilator was found in PT-SGA with significant difference. CPAP use was the highest in PT-AGA infants. There was no significant difference in oxygen administration among the groups. Respiratory distress-induced mortality analysis found the highest CMI in PT-SGA infants.ConclusionPT-SGA had the highest risk of respiratory distress with complications of length of hospital stay, and ventilator use. Mortality analysis discovered the highest CMI in PT-SGA infants. We should therefore be alert when dealing with PT-SGA infants.