Neonatal Distress Syndrome Research Articles

Risk factors for the incident of respiratory distress syndrome in neonates at the Regional General Hospital of Buleleng District, 2020

<p><strong><em>Background</em></strong><em> : The main causes of death in neonates are complications of pregnancy and childbirth, such as asphyxia, sepsis and low birth weight complications. Respiratory Distress Syndrome (RDS) is a condition related to the respiratory system of neonates. The large number of RDS cases is one of the highest causes of death in neonates.</em></p><p><strong><em>Objectives</em></strong><em>: The aim of this study is to determine the risk factors for the incidence of RDS at Buleleng District Hospital, especially in premature neonates in 2020.</em></p><p><strong><em>Methods</em></strong><em>: This research method uses a retrospective cohort study. Where the data was taken using secondary data in the NICCU room at Buleleng Regional Hospital. The independent variables included are the characteristics of the neonate including gestational age, history of hypertension experienced by the mother during pregnancy, birth weight, history of premature rupture of membranes, history of asphyxia experienced during the birth process. The dependent variable in this study was the incidence of RDS in neonates. The sample included in this research was 64 mothers who gave birth at the Buleleng District Hospital in 2020. This research used univariate analysis to assess the frequency distribution of each variable, then continued using bivariate analysis to determine the variables that were included in the multivariate analysis. Multivariate analysis was carried out computerized using logistic regression</em></p><p><strong><em>Results</em></strong><em>: The results of this study found that there were 2 risk factors that directly increased the incidence of RDS in neonates including premature gestational age with a value of p 0.01 (19.8, 95% CI 1.8-133.7, low birth weight ( 2.9, 95% CI 1.9-8.4). </em></p><p><strong><em>Conclusions</em></strong><em>: The conclusion is that there are 2 risk factors that are associated and increase the incidence of RDS in neonates, namely premature gestational age and low birth weight.</em></p>

Neonatal ICU therapy: a literature review on pharmacotherapies

INTRODUCTION: The neonatal period is an age group of vulnerability, which is subject to adverse effects related to conventional drug treatments and therapies, many drugs are empirically applied in the neonatal ICU (NICU), in off-label or non-licensed ways, currently the scientific basis on pediatric pharmacological assistance is scarce, constituting an unpredictable scenario of adverse and severe drug reactions. OBJECTIVE: To analyze the main pharmacological practices in the neonatal ICU, observing the possible effects on the newborn patient. METHODOLOGY: literature review that used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The search for articles was carried out in PubMed, SciELO and LILACS databases, applying descriptors from Descritores em Ciências da Saúde (DeCS) and Medical Subject Headings (MeSH). RESULTS: 415 articles were found and 26 were included in the study. It was noted that there is a high prevalence of overdoses and unnecessary prolongation of antibiotic therapy, adverse effects linked to bacterial resistance and alteration of the newborn’s (NB) microbiota may occur, generally these drugs were used in the scenario of neonatal sepsis and in an off-label way, vancomycin stood out as the most widely used antibiotic among the studies. The NB’s respiratory problems were pharmacologically treated with exogenous surfactant, propofol, hydrocortisone and milrinone, the clinical situations of use include Respiratory Distress Syndrome in Neonates and sedation for intubation. Painful procedures are common in the NICU, requiring pharmacological measures such as the use of analgesics and sedatives, including fentanyl, morphine, dipyrone, non-steroidal anti-inflammatory drugs and benzodiazepines, the safe application is also difficulty with these medications. Local anesthetics, such as lidocaine, are the most used for surgical pain, epidural anesthesia helps to reduce surgical stress, and topical anesthetics are useful for pain caused by skin barrier rupture. The group of drugs most used in an off-label way, according to the Anatomic Therapeutic Chemical (ATC) classification, were the group of anti-infectives for systemic use and drugs that act on the nervous system. CONCLUSION: the need for more scientific depth in the context of pharmacology at the NICU became extremely explicit during the study’s development, the lack of consensus for appropriate medical prescriptions leads to the need for greater care when prescribing for neonates, considering the inherent characteristics of the organism of these patients that alter the pharmacokinetics and pharmacodynamics of medications.

Hubungan antara Diabetes Mellitus Gestasional dan Berat Badan Lahir dengan Kejadian Respiratory Distress Syindrom pada Neonatus di RSU Bina Kasih Tahun 2022

Respiratory Distress Syndrome (RDS) is an acute and severe lung disease that affects infants, especially in preterm infants, where the infant's respiratory system is unable to perform gas exchange normally without assistance. The purpose of this study was to determine the relationship between gestational diabetes mellitus and birth weight with the incidence of respiratory distress syndrome in neonates at Bina Kasih General Hospital in 2022. This research method used an analytical survey with a cross sectional approach. The population in this study were all neonates with the incidence of Respiratory Distress Syndrome in July at Bina Kasih General Hospital in 2022 totaling 39 respondents. The sample of this study used the total population technique. Data collection uses primary data and secondary data. The data analysis technique is using the Chi-Square Test. The results obtained from data analysis using the chi-square test showed that from 39 respondents, there were 12 respondents (30.8%) who had gestational diabetes mellitus where all neonates with gestational diabetes mellitus experienced Respiratory Distress Syndrome and 18 respondents (46 ,2%) neonates with low birth weight where the majority experienced Respiratory Distress Syndrome, namely 13 respondents (33.3%). so it can be concluded that there is a relationship between gestational diabetes mellitus and birth weight with the incidence of respiratory distress. Syndrome in Neonates at Bina Kasih General Hospital in 2022.

Utility of Lung Ultrasound in Diagnosis of Respiratory Distress Syndrome in Neonates: A Cross-sectional Study

Introduction: Respiratory Distress Syndrome (RDS) is one of the most common conditions leading to significant morbidity and mortality. Early diagnosis with a non-invasive imaging tool such as ultrasound, with no radiation hazard will be beneficial for timely intervention in neonates. Aim: To evaluate the utility of Lung Ultrasound (LUS) in diagnosing RDS in neonates and to compare it with chest X-ray (CXR). Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in Department of Pediatrics, AJ Institute of Medical Sciences, Mangalore, Karnataka, India, from June 2017 to December 2018. Forty neonates (preterm and term) admitted to Neonatal Intensive Care Unit (NICU) with symptoms of respiratory distress within six hours of life and fulfilling clinical criteria of RDS were included in the study. CXR and LUS were performed and interpreted by the same radiologist. The disease was graded as mild and severe by LUS based on the indices like B (Beam like comet-tail pattern) lines, alveolar consolidation, air bronchogram and white lung and it was compared with CXR in terms of sensitivity and specificity to diagnose RDS. Data were statistically analysed using Kendall’s tau-b test. Results: Eighteen (45%) neonates were <32 weeks, 19 (47%), between 32-34 weeks and 3 (7.5%) were >34 weeks of gestation. Twenty-six (65%) were males and 14 (35%) were females. Mean gestational age of the study cohort was 32±2 weeks. Mean birth weight in the study group was 1.7±0.5 kg. 14 out of the 40 neonates (65%) received steroids prior to delivery. LUS detected signs of RDS in all the 40 cases (100% sensitivity). Sixteen out of 40 (40%) neonates were graded as mild RDS and 24 out of 40 neonates (60%) as severe RDS. The sensitivity to detect severe cases was 100% when compared to CXR but specificity to detect mild cases was found to be 59%. The Positive Predictability Value (PPV) was found to be 54% and the Negative Predictable Value (NPV) was found to be 100%. Conclusion: LUS can be used as a reliable, bed side screening tool for the early diagnosis of RDS in NICU without side-effects of radiation.

Lung Ultrasound for the Diagnosis and Management of Neonatal Respiratory Distress Syndrome: A Minireview.

Lung ultrasound (LUS) is useful for diagnosis of respiratory distress syndrome in neonates. Recently, it has been proved to play an important role in the management of neonatal respiratory distress syndrome (RDS). It is feasible to grade RDS and select therapeutic modalities accordingly by LUS. The treatment also should be adjusted with the change in ultrasound images. In conclusion, LUS is valuable for the diagnosis and management of neonatal respiratory distress syndrome.

Serum Vitamin A Levels as a Novel Predictor for Respiratory Distress Syndrome in Neonates: Is It Beneficial?

Neonatal Respiratory Distress Syndrome (RDS) is a dangerous disease in neonates and is accompanied by neonatal complications and death. The aim of this study was the early determination of neonatal serum vitamin A levels as a possible novel predictor for neonatal RDS. A case-control study with the identification number TCTR20210206001, was performed on 100 neonates who were admitted to the Neonatal Intensive Care Unit (NICU) of Tanta University Hospital (TUH) suffering from RDS (patient group) and 100 healthy neonates (control group). Estimation of serum vitamin A (retinol) was made for all neonates of this study within the first four hours after birth before any nutrition or therapies. The results showed no significant difference between serums retinol (RT) levels in grade 1 & 2 RDS neonates (patient group) and the serum RT levels in the control group, while there was a significant difference between serums retinol levels in grade 3 & 4 RDS neonates (patient group) and the serum retinol levels in the control group where the P-value was 0.006 and 0.002 respectively. Serum vitamin A levels in neonates were found to be decreased in RDS neonates and could be used as a predictor for the development and severity of RDS. It is recommended to carry out routine estimation of serum vitamin A levels in neonates as a novel predictor for neonatal RDS.

Role of Fetal Pulmonary Artery Doppler in predicting risk of neonatal respiratory distress syndrome

INTRODUCTION- To determine the optimal time to safely deliver a baby prematurely due to various clinical situations, it is crucial to accurately assess fetal lung maturity. Sonography which is a non-invasive technique for evaluating fetal lung maturity can be useful in predicting risk for developing neonatal respiratory distress as compared to amniocentesis which is an invasive procedure with associated risks. AIM - Purpose of this study was to determine if fetal main pulmonary artery doppler can play a role in predicting the risk of developing respiratory distress syndrome in neonates. MATERIAL AND METHODS – The participants in this prospective cross-sectional study were 75 pregnant women with gestational ages ranging from 34weeks to 36 weeks +6 days. Ultrasound doppler examination was conducted and peak systolic velocity (PSV), Systolic /Diastolic ratio, pulsatility index, resistive index were measured and acceleration time/ejection time ratio was calculated for the fetal main pulmonary artery. Diagnostic accuracy of these values was tested for predicting neonatal respiratory distress. RESULT - Of the 75 fetuses included in the study, 15 (20%) showed some signs of neonatal respiratory distress syndrome (RDS). The Acceleration time/Ejection time (AT/ET) ratio in fetal pulmonary artery correlated significantly with development of respiratory distress syndrome in neonates (P=0.001). Fetuses with respiratory distress syndrome had higher Pulsatility Index and Resistive Index values, while their AT/ET ratio was low. AT/ET was found to predict respiratory distress development with a cutoff value of 0.30 (sensitivity: 98.3 percent; specificity: 86.67 percent). Pulsatility Index and Resistive Index displayed lower sensitivity and specificity than AT/ET ratio. CONCLUSION- The fetal main pulmonary artery AT/ET ratio has a high sensitivity and specificity for predicting the development of neonatal respiratory distress syndrome. Thus, we recommend that a fetus with an AT/ET ratio of <0.30 be delivered in a facility with good neonatal care.

INCIDENCE AND ETIOLOGY OF RESPRATORY DISTRESS IN LOW BIRTH WEIGHT NEONATES BORN IN RURAL TERTIARY CARE CENTRE.

Background : To Study The Incidence And Etiology Of Respratory Distress In Low Birth Weight Neonates Born In Rural Tertiary Care Centre. Methods: This is a prospective observational study. It was carried out in neonatal division of department Of pediatrics MMIMSR, Mullana. The study included 200 low birth weight neonates born during the study period. Results: Out of 200 neonates 63 had respiratory distress. The incidence of respiratory distress in index study was 31.5%. According to weight distribution the incidence of respiratory distress among neonates with 1.5kg to 2.499kg was 27.6% , 1kg to <1.5kg was 57.1% and <1kg was 100%. According to gestation the incidence of respiratory distress among term was 29.8% and preterm was 33.6%. The most common cause of respiratory distress was transient tachypnea of newborn(33.8%) followed by hyaline membrane disease(24.1%), sepsis(17.7%), apnea(9.6%), CVS disorder(6.4%). Conclusion: Low birth weight and preterm deliveries are at higher risk for morbidity during and after the birth. Early antenatal care will greatly reduce the incidence of respiratory distress syndrome in neonates. The incidence increases as birth weight and gestation decreases in neonates Due to recent medical advances and skilled clinical practice the incidence of RDS has decreased. Transient tachypnea of newborn remains the main etiology of respiratory distress in neonates.

Novel predictor markers for early differentiation between transient tachypnea of newborn and respiratory distress syndrome in neonates.

Neonatal Respiratory Distress Syndrome (RDS) and Transient Tachypnea of newborn (TTN) are common similar neonatal respiratory diseases. Study the early predictor markers in differentiation between TTN and RDS in neonates. A prospective case control study which was done in Neonatal Intensive Care Unit (NICU) of Tanta University Hospital (TUH) from September 2016 to March 2018. Three groups of neonates were included in the study: RDS group (45 neonates), TTN group (45 neonates), and control group (45 healthy neonates). There were statistically significant difference (SSD) between our studied three groups as regard serum Malondialdehyde (MDA), Superoxide dismutase SOD, Lactate dehydrogenase (LDH), and blood PH and P-values were 0.001* for these comparative parameters. The ROC curve of RDS cases revealed that the serum MDA Cut off, sensitivity and specificity were 1.87 mmol/L, 98%, 96%, respectively which had the highest sensitivity and specificity followed by the serum SOD then the serum LDH and lastly the blood PH while in TTN cases, the serum MDA Cut off, sensitivity and specificity were 0.74 mmol/L, 96%, 93%, respectively then the serum SOD then the serum LDH and lastly the blood PH. Serum MDA, SOD, LDH, and PH had a beneficial role as early predictors in differentiation between TTN and RDS in neonates.

Premature rupture of the amniotic membrane: what’s new in its management and delivery tactics?

Background. Premature rupture of the amniotic membranes (PRAM) is a spontaneous rupture before the onset of labor at 22-37 weeks. The main complications of PRAM for mother and fetus include infection, premature birth, asphyxia of the fetus during labor, and the increased frequency of cesarean sections. Deformations of extremities, face and lungs are observed in case of a long oligohydramnion (>3 weeks).
 Objective. To describe the features of the management of pregnant women with PRAM.
 Materials and methods. Analysis of literature sources on this topic.
 Results and discussion. Gynecological and extragenital pathology of mother, genetic predisposition, adverse environmental factors and infections are risk factors for PRAM. Prevention of PRAM includes detection and treatment of urogenital infections, quitting of smoking and alcohol intake, screening for bacteriuria and bacteriological culture for β-hemolytic streptococcus (BHS) at 35-37 weeks of pregnancy. From 22 to 34 weeks of pregnancy, pregnant women with PRAM are hospitalized to the tertiary level hospitals, since 35 weeks care can be provided in secondary level hospitals. The management algorithm is the following: 1) history taking; 2) establishment of gestational age; 3) establishment of the approximate time of PRAM; 4) general physical examination; 5) external obstetric examination; 6) cardiotocogram (CTG), tests of fetal movements (TFM), ultrasonography (US); 7) blood test with leukocyte formula, determination of C-reactive protein; 8) bacterioscopic examination of vaginal discharge; 9) collection of amniotic fluid for microbiological examination, study of rectogenital smear for BHS; 10) sanitation of the vagina with a solution of antiseptic decamethoxine after collection of vaginal secretions and amniotic fluid. PRAM management involves active or waiting tactics. Waiting tactic includes monitoring of the fetus and mother (thermometry and pulsometry, the number of leukocytes and C-reactive protein, bacterioscopy of vaginal discharge, CTG, TFM, US). Antibiotic prophylaxis (semi-synthetic penicillins + macrolides, reserve – second-generation cephalosporins) in PRAM significantly prolongs the latent phase of delivery, reduces the incidence of infections in both mother and newborn, reduces the need for surfactant and oxygen therapy. In the presence of chorioamnionitis, delivery should be performed within <12 hours. In case of PRAM in the term of 24-34 weeks the course of corticosteroids is administered. Delivery delay for 48 h for steroid prophylaxis is the main indication for tocolysis in PRAM. In general, the tactics of pregnancy management in PRAM at 24-34 weeks include monitoring of the mother and fetus, steroid prophylaxis, tocolytic therapy and the use of magnesium sulfate. Waiting tactic should be followed until 34 weeks. In women with PRAM without contraindications to prolonging pregnancy, the waiting tactic is accompanied by better results for both mother and fetus. Signs of infection or other complications of pregnancy indicate the need for termination of the waiting tactic and delivery management according to the clinical situation. Within 34-37 weeks, the waiting tactic is followed for 24 hours. Antibiotic prophylaxis is prescribed after 18 hours of anhydrous interval, and in case of BHS – immediately after PRAM. In the absence of active labor process, an internal obstetric examination is performed to decide the tactics of delivery. Other procedures include cervix preparation, induction of labor and washing of the vagina with decamethoxine solution. Cesarean section is indicated for PRAM at 26-32 weeks and immaturity of the birth canal.
 Conclusions. 1. Hospitalization and delivery in women with PRAM is carried out in hospitals of secondary and tertiary level. 2. Routine use of antibiotics in PRAM prolongs the latent phase of delivery and reduces the incidence of neonatal sepsis. 3. Waiting tactic in pregnant women with PRAM in the period of 24-34 weeks is accompanied by good outcomes for both mother and child. 4. Pregnant women with PRAM in 24-34 weeks should be treated with corticosteroids to prevent acute respiratory distress syndrome in neonates.

Efficacy of high-flow nasal cannula versus nasal continuous positive airway pressure in the treatment of respiratory distress syndrome in neonates: a Meta analysis

Objective To systematically evaluate the efficacy and safety of high-flow nasal cannula (HFNC) therapy versus nasal continuous positive airway pressure (nCPAP) in the treatment of respiratory distress syndrome (RDS) in neonates. Methods PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine disc, Wanfang Database, CNKI, and Weipu Database were searched for the randomized controlled trials (RCTs) of HFNC versus nCPAP in the treatment of neonatal RDS published up to April 1, 2020. RevMan5.3 software was used to perform a Meta analysis of the eligible RCTs. Results A total of 12 RCTs were included, with 2 861 neonates in total, among whom 2 698 neonates (94.30%) had a gestational age of ≥28 weeks and 163 (5.70%) had a gestational age of 0.05). For primary respiratory support and post-extubation respiratory support, the HFNC group had a significantly lower incidence rate of nasal injury than the nCPAP group (P 0.05). Conclusions Based on the current clinical evidence, HFNC has a higher failure rate than nCPAP when used as primary respiratory support for neonates with RDS, and therefore it is not recommended to use HFNC as the primary respiratory support for neonates with RDS. In RDS neonates with a gestational age of ≥28 weeks, HFNC can be used as post-extubation respiratory support in the weaning phase.

Impact of an educational program on improving nurses knowledge and practice concerning caring for neonates with respiratory distress syndrome

Abstract Respiratory distress syndrome in neonates reported with 60% -70% mortality rates. Aim of the study was to develop, apply and evaluate an educational program for nurses to improve their knowledge and practice about care of neonates with respiratory distress syndrome. Study design a quasi- experimental study design was used to conduct this study. Subjects and methods: the study was carried out in the neonatal intensive care unit at Assuit police hospital. Sample composed of 50nurses. Two tools were used to collect necessary data .1. A structured interview questionnaire was used to assess nurses’ knowledge regarding respiratory distress syndrome. 2. An observational checklist to assess nurses’ practice regarding their care provided for neonates. Results: This study revealed that mean knowledge and practice score were much higher in the post program implementation 9.58±1.43, 293.64±7.51 respectively compared to preprogram 6±1.88, 166.1±29.22 respectively. At follow up phase the mean knowledge and practice score were slightly decreased to 8.1±1.95, 251.04±10.36. Conclusion: Statistically significant improvement was revealed in total knowledge and practice. These scores were much higher in the post program implementation compared to pre- program and slightly decline in the follow up phase. Recommendation: Educational program is needed for updating nurses’ knowledge and improving their practice.

Maternal Betamethasone for Prevention of Respiratory Distress Syndrome in Neonates: Population Pharmacokinetic and Pharmacodynamic Approach.

Despite antenatal corticosteroids therapy, respiratory distress syndrome (RDS) is still a leading cause of neonatal morbidity and mortality in premature newborns. To date, the relationship between in utero fetal drug exposure and occurrence of RDS remains poorly evaluated. This study aims to describe the pharmacokinetics of betamethasone in pregnant women and to evaluate the transplacental drug transfer and administration scheme for the prevention of RDS. Pregnant women >27weeks' gestation and who received at least a single dose of betamethasone for prevention of RDS were enrolled. Maternal, cord blood, and amniotic fluid betamethasone time-courses were analyzed using the Monolix software. A total of 220 maternal blood, 56 cord blood, and 26 amniotic fluid samples were described by a two-compartment model with two effect compartments linked by rate transfer constants. Apparent clearances and volumes of distribution parameters were allometrically scaled for a 70kg third trimester pregnant woman. The impact of a twin pregnancy was found to increase maternal clearance by 28%. Using a fetal-to-mother exposure ratio, the median (95% confidence interval (CI)) transplacental transfer of betamethasone was estimated to 35% (95% CI 0.11-0.67). After adjustment for gestational age and twin pregnancy, RDS was found to be associated to the time spent in utero below quantifiable concentrations (i.e., <1ng/mL): odds ratio of 1.10 (95% CI 1.01-1.19) per day increase (P<0.05). Trying to take into account both efficacy and safety, we simulated different dosing schemes in order to maintain a maximum of fetuses above 1ng/mL without exceeding the total standard dose.

Respiratory Distress Syndrome in Neonates Delivered at Term-gestation by Elective Cesarean Section at Tertiary Care Hospital in Oman.

ObjectivesWe sought to assess the relationship between respiratory distress syndrome (RDS) in neonates delivered by elective cesarean section at term gestation with and without corticosteroids cover. We also aimed to determine other neonatal complications such as sepsis, hypoglycemia, and hyperbilirubinemia.MethodsWe conducted a retrospective descriptive study from January 2010 to December 2015 on all Omani women who delivered by elective cesarean section at Sultan Qaboos University Hospital between 37+0 and 38+6 weeks gestation.ResultsAmong 650 patients included in the study, 20.8% (n = 135) received corticosteroids antenatally and 79.2% did not. RDS was found in 16 out of 650 neonates, making the prevalence of RDS 2.5%. Higher gravidity and parity and a mean gestational age of less than 37.6 weeks, were associated with a significant risk of RDS. Administration of antenatal corticosteroids did not change the respiratory morbidity in the newborns (p = 0.340). A mean birth weight of 2.9 kg was associated with a significant risk of RDS (p = 0.043). All 16 newborns required neonatal intensive care unit admission and ventilator support. The most common ventilatory support used was continuous positive airway pressure (56.2%). The most common secondary complication in neonates diagnosed with RDS was transient tachypnea of the newborn (53.8%).ConclusionsThe prevalence of RDS was low. Giving antenatal corticosteroids for patients with planned elective cesarean at term did not seem to have a beneficial effect on neonatal respiratory morbidity. Further studies with larger sample size including multiple centers is recommended.

The Use of Chest Radiograph in Early Assessment of Respiratory Distress Syndrome in Neonates in NICU Patients

The Use of Chest Radiograph in Early Assessment of Respiratory Distress Syndrome in Neonates in NICU Patients

Increased incidence of respiratory distress syndrome in neonates of mothers with abnormally invasive placentation.

BackgroundThe incidence of abnormally invasive placentation (AIP) is increasing. Most of these pregnancies are delivered preterm. We sought to characterize neonatal outcomes in AIP pregnancies.MethodsIn this retrospective case-control study (2006–2015), AIP neonates (n = 108) were matched to two controls each for gestational age, antenatal glucocorticoid exposure, sex, plurity, and delivery mode. Medical records were reviewed for neonatal and maternal characteristics/outcomes. Univariate and multivariate Poisson regressions were performed to determine relative risk ratios (RR).ResultsThere were no mortalities. All neonatal outcomes were similar except for respiratory distress syndrome (RDS), which affected 37% of AIP neonates (versus 21% of controls). AIP neonates required respiratory support (64.8% vs. 51.9%) and continuous positive airway pressure (53.7% vs. 42.1%) for a longer duration. Univariate regression yielded elevated RRs for RDS for AIP (RR 1.78, 95% CI 1.24–2.54), placenta previa (RR = 1.94, 95% CI 1.36–2.76), and placenta previa with bleeding (RR 2.29, 95% CI 1.36–3.86). One episode of bleeding had a RR of 2.43 (95% CI 1.57–3.76), 2 or more episodes had a RR of 2.95 (95% CI 1.96–4.44), and bleeding/abruption as the delivery indication had a RR of 2.57 (95% CI 1.82–3.64). A multivariate regression stratifying for AIP and evaluating the combined and individual associations of AIP, bleeding, placenta previa, and GA, resulted in elevated RRs for placenta previa alone (RR 2.16, 95% CI 1.15–4.06) and placenta previa and bleeding (RR 1.69, 95% CI 1.001–2.85).ConclusionsThe increased incidence of RDS at later gestational ages in AIP is driven by placenta previa. AIP neonates required respiratory support for a longer duration than age-matched controls. Providers should be prepared to counsel expectant parents and care for affected neonates.

The classification of ATP-binding cassette subfamily A member 3 mutations using the cystic fibrosis transmembrane conductance regulator classification system.

ImportanceThe ATP‐binding cassette subfamily A member 3 (ABCA3) protein plays a vital role in surfactant homeostasis. Mutations in the ABCA3 gene lead to the development of interstitial lung disease. In the most severe manifestation, mutations can lead to a fatal respiratory distress syndrome in neonates. ABCA3 belongs to the same ATP‐binding cassette transporter superfamily as the cystic fibrosis transmembrane conductance regulator (CFTR), the gene that causes cystic fibrosis.ObjectiveTo classify ABCA3 mutations in a manner similar to CFTR mutations in order to take advantage of recent advances in therapeutics.MethodsSequence homology between the CFTR protein and the ABCA3 protein was established. The region of CFTR that is a target for the new potentiator class of drugs was of particular interest. We performed a literature search to obtain all published mutations that were thought to be disease causing. We classified these mutations using the established CFTR classification system. When possible, we drew on previous experimental classification of ABCA3 mutations.ResultsAlthough the proteins share the same overall structure, only a 19% identity was established between CFTR and ABCA3. The CFTR therapeutic target region has a 22% homology with the corresponding ABCA3 region. Totally 233 unique protein mutations were identified. All protein mutations were classified and mapped to a schematic diagram of the ABCA3 protein.InterpretationThis new classification system for ABCA3, based on CFTR classification, will likely aid further research of clinical outcomes and identification of mutation‐tailored therapeutics, with the aim for improving clinical care for patients with ABCA3 mutations.

Functional rescue of misfolding ABCA3 mutations by small molecular correctors.

Adenosine triphosphate (ATP)-binding cassette subfamily A member 3 (ABCA3), a phospholipid transporter in lung lamellar bodies (LBs), is essential for the assembly of pulmonary surfactant and LB biogenesis. Mutations in the ABCA3 gene are an important genetic cause for respiratory distress syndrome in neonates and interstitial lung disease in children and adults, for which there is currently no cure. The aim of this study was to prove that disease causing misfolding ABCA3 mutations can be corrected in vitro and to investigate available options for correction. We stably expressed hemagglutinin (HA)-tagged wild-type ABCA3 or variants p.Q215K, p.M760R, p.A1046E, p.K1388N or p.G1421R in A549 cells and assessed correction by quantitation of ABCA3 processing products, their intracellular localization, resembling LB morphological integrity and analysis of functional transport activity. We showed that all mutant proteins except for M760R ABCA3 were rescued by the bithiazole correctors C13 and C17. These variants were also corrected by the chemical chaperone trimethylamine N-oxide and by low temperature. The identification of lead molecules C13 and C17 is an important step toward pharmacotherapy of ABCA3 misfolding-induced lung disease.

Prevalence of Respiratory Distress Syndrome in Neonates

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.

Maternal glycoregulation in pregnancies complicated by diabetes mellitus in the prediction of fetal echography findings and perinatal outcomes.

We aimed to determine maternal hemoglobin A1c (HbA1c) levels and pregestational body mass index (BMI) as the predictors of glycemic control and its importance for fetal echography findings and perinatal outcomes in pregnancies complicated by diabetes mellitus (DM). Our intention was to evaluate how BMI and HbA1c levels might be used to predict fetal interventricular septum (IVS) thickness, atrioventricular inflow early diastole (E)/ atrial systole (A) velocity ratio, and perinatal outcomes. Patients in the 38th gestational week were divided into three groups according to their insulin therapy: (i) patients with gestational diabetes mellitus (GDM) treated only with dietary changes (GDM group, n = 32); (ii) patients with GDM treated with insulin therapy (DM2 group, n = 27); and (iii) patients with type 1 DM (DM1 group, n = 22). In the DM1 group, we found statistically significant correlations between BMI and IVS thickness (P = 0.036), HbA1c and IVS thickness, as well as the mitral E/A velocity ratio (P = 0.013 vs P = 0.007). In this group, HbA1c showed a statistically significant correlation to neonatal birth weight (P = 0.037) and BMI influenced on appearance respiratory distress syndrome in neonates in DM1 group (P = 0.027). The values of HbA1c predict neonatal respiratory distress syndrome in DM2 and GDM groups (P = 0.036). As good predictors of maternal glycoregulation, BMI and HbA1c levels determine fetal echography findings as well as neonatal outcomes in pregnancies complicated by DM.