Neonatal Distress Syndrome Research Articles

The Frustration of Knowledge—Medicine in Russia

Russian physicians face financial restraints which hinder the supply of lifesaving medications. Drugs which are not available include surfactant—a treatment for respiratory distress syndrome in neonates. The author recently visited Tver, Russia, and comments on the maternal-newborn programme in this academic centre.

Volume-Outcome Relationships and Inhospital Mortality: The Effect of Changes in Volume Over Time

This study examines whether patient outcomes are affected by changes in volume over time within hospitals and whether such effects are consistent with cross-sectional results previously reported in the literature. Investigating the existence of volume-outcome relationships longitudinally for specific groups of patients relates directly to the policy issue of whether, and how, specific inpatient services should be regionalized. The analysis uses up to 8 years of observations from a national sample of nearly 500 community hospitals. Outcomes are measured as inhospital mortality adjusted for case severity. Instrumental variables techniques are used to test and control for the possibility of selective referral. The results suggest that higher volume leads to better outcomes for certain groups of patients. Among the groups studied here, increases in volume lowered adjusted mortality rates for acute myocardial infarction, hernia repair, and respiratory distress syndrome in neonates; correlations were observed between volume and outcome for coronary artery bypass grafts, which seemed to be due primarily to referral patterns; and, no significant findings were found for hip replacements. In general, the effects of volume on outcome appear to be larger when estimated from longitudinal, rather than cross-sectional, data.

The paradox of adult respiratory distress syndrome in neonates

Six full-term newborn infants are described who suffered from severe adult respiratory distress syndrome (ARDS). The triggering event was intrauterine/perinatal asphyxia in five, and group B streptococcal (GBS) septicemia in three. All had severe respiratory distress/failure and were ventilated mechanically with high concentrations of inspired oxygen and positive end-expiratory pressure. Radiography of the chest showed dense bilateral consolidation with air bronchograms and reduced lung volume. Persistent pulmonary hypertension (PPH) was documented in all cases. The coincidence of ARDS and PPH rendered respiratory management extremely difficult. For this reason high-frequency ventilation was instituted in all patients in order to improve CO2 elimination and induce respiratory alkalosis. Acute complications of respiratory therapy were encountered in five patients (pneumothorax, pulmonary interstitial emphysema, pneumopericardium). Three infants died (irreversible septic shock, progressive severe hypoxemia, and sudden cardiac arrest) after 17, 80, and 175 h of life. Histologic examination of the lungs was possible in all fatal cases and revealed typical changes of acute to subacute stages of ARDS. Three infants survived, the mean time of mechanical respiratory support being 703 h. Two patients were still dependent on oxygen after 1 month of life, and all survivors had increased interstitial markings and increased lung volumes on their chest roentgenograms at this time.

The coexistence of pneumonia and the idiopathic respiratory distress syndrome in neonates.

Abstract The chest radiographs of 54 neonates dying within 48 hours of birth have been analysed. All cases had evidence of the classical idiopathic respiratory distress syndrome. Nineteen cases were complicated by pneumonia, five of these probably being of intra-uterine origin. Five other cases were complicated by other lung pathology. A good correlation was obtained between the radiological analysis and the histological findings. Almost all (23/24) cases with an uncomplicated reticulo-granular pattern showed no pneumonia at post-mortem. Minor variations in this pattern indicated the presence of complicating consolidation in about half the cases, while complete opacity of the lungs commonly (6/8) was due to complicating pneumonia. All cases (9/9) with atypical appearances were found to have pneumonia. It is concluded that more precise information in the diagnosis of pneumonia complicating RDS can be obtained from the chest radiograph than has previously been appreciated. It is suggested that chest radiogr...