Etiology Of Respiratory Distress Research Articles

Lung Ultrasound Findings in the Diagnosis of Transient Tachypnea of Newborn in Late Preterm and Term Neonates

Background: Transient tachypnea of the newborn (TTN) is a prevalent etiology of respiratory distress (RD) in neonates. The condition is a result of the accumulation of fetal lung fluid owing to defective processes responsible for its removal. However, differentiating TTN from various etiologies of RD may provide challenges. Lung ultrasound (LUS) has effectively been used to diagnose and differentiate infant RD. The objective of this research was to evaluate the ultrasonographic findings in the diagnosis of TTN in late preterm and full-term neonates.
 Methods: All neonates had been exposed to full taking of history, full clinical assessment, chest X-ray, routine laboratory tests, and LUS assessment was performed on 80 late preterm and full-term neonates diagnosed with TTN by clinical and radiological findings and performed on control group.
 Results: Among 80 neonates who were diagnosed to have TTN, double lung point sign (DLP) was present in 62 (77. 5 %), pleural line abnormalities had been observed in 80 (100%), alveolar interstitial syndrome (AIS) was observed in 68 (85.0%), while white lung was present only in 12 TTN cases (15%), and no pleural effusion was found in any of the patients. While these findings weren’t detected in the control group.
 Conclusion: LUS could be accurately and reliably used in the diagnosis and screening of TTN. Most common findings in TTN were pleural line abnormalities followed by AIS and DLP.

Rare Cause of Respiratory Distress in an Infant

Abstract Respiratory distress is one of the most common problems faced by pediatricians worldwide. There are various medical and surgical causes which manifests as respiratory distress in infants. The management of these infants depends on the etiology of respiratory distress. Congenital Pulmonary Airway Malformation (CPAM), previously called Congenital Cystic Adenomatoid Malformation of the lungs is one of the surgical causes of respiratory distress in infants. With various advances in antenatal ultrasound, many cases are detected in the prenatal period. However, some cases are missed and these infants present as respiratory distress due to secondary infection of the cysts in early infancy. Surgical management (lobectomy) is the cornerstone of this malformation if these infants are symptomatic. Here, we report a 2-month and 15-day-old infant who presented with respiratory distress secondary to CPAM with infection.

SIGNS AND ETIOLOGIES OF RESPIRATORY DISTRESS AMONG MECHANICALLY VENTILATED PATIENTS ATTENDING CHITWAN MEDICAL COLLEGE, BHARATPUR

Background: Respiratory distress (RD) in mechanically ventilated patients may signify life-threatening complications which may be potentially reversible. The aim of the study was to determine the signs and etiologies of respiratory distress in patients under mechanical ventilation. Methods: A hospital-based cross-sectional study was done on adult patients on mechanical ventilation (MV) with Respiratory distress admitted at Chitwan Medical College, Nepal from January 2021 to June 2021.We studied various signs and etiologies of RD in different days on MV. Descriptive analysis was carried out using IBM SPSS version 20. Results: Total 66 patients were included in the study with mean ± SD of age was 55.3 ± 15.8 years with equal proportion of male and female. Out of total 154 occurrences of 11 signs in 66 patients, agitation was the most common one occurring 29.3% of times followed by use of accessory muscle in 15.9%. Most common cause of respiratory distress was interstitial syndrome of increased extra-vascular lung water or density on ultrasound was present more in patients on MV for ≥ 5 days. Most patients (74.2%) had multiple RD signs and 25.8% had only a single sign. Gasping was more common in patients on MV ≥ 5 days and agitation and delirium more in early days of MV. Conclusions: More than half of the conditions associated with RD on MV are relatively reversible and as the patients can develop RD any time or any day after being put on MV, a continued vigilance system is essential for their timely assessment and management.

YOUNG MALE WITH COVID-19 PRESENTING IN CARDIOGENIC SHOCK

TYPE: Late Breaking Case Report TOPIC: Cardiovascular Disease INTRODUCTION: Although COVID-19 usually presents with pulmonary disease, suspicion for other etiologies of respiratory distress must be present. CASE PRESENTATION: A 25-year-old patient presented with general malaise, fevers, chill, and shortness of breath on exertion. He was treated with Dexamethasone and Tocilizumab. The patient had rapid deterioration with respiratory distress. On physical exam, the patient was clinically in heart failure with low blood pressure. Further evaluation revealed elevated troponin, 15% ejection fraction with global hypokinesis, and nonischemic cardiomyopathy. DISCUSSION: Several cardiac manifestations of COVID-19 have been reported, including myocarditis, arrhythmias, acute coronary syndrome. However, its incidence remains unknown. The pathophysiology based on its late presentation suggests an exacerbated host immune response. Diagnosis is similar to other causes, based mainly on clinical history, physical exam laboratory findings, noninvasive imaging studies, and if needed, endomyocardial biopsy. There is no research investigating the treatment of COVID-19 in patients whose only presentation is myocarditis. Management depends on the severity of heart injury in conjunction with COVID-19 treatment. Core measures for heart failure management with beta-blocker, and ACE/ARB as main drugs. Mineralocorticoids, diuretics, digoxin and sacubritil/valsartan, SGLT-2 as needed. Inotropic medications and mechanical circulatory support as needed. Early recognition and management are crucial due to the high risk of in-hospital mortality. CONCLUSIONS: Few cases of COVID-19 myocarditis have been reported since the beginning of the pandemic. This case remarks the importance of early recognition of the different presentations of COVID-19 due to the high risk of in-hospital mortality. DISCLOSURE: Nothing to declare. KEYWORD: myocarditis

Respiratory Distress in Full and Post Term Neonates: Prevalence, Etiologies and Outcomes in a Tertiary Health Center in Yaoundé

Introduction: Respiratory pathologies are top listed amongst neonatal morbidities. Our objective was to describe the clinical features, causes and treatment of respiratory distress (RD) in full and post term neonates in a tertiary health center in Yaoundé, the Essos Hospital Centre (EHC). Patients and Method: This was a retrospective study. Full/post term neonates with RD from January 2017-December 2018 were included. Main parameters: incidence of RD, etiologies, risk factors for severity and mortality. Results: We included 186 neonates among 2312 newborn babies. The RD prevalence rate was 8%. Sex ratio of 2.15 was favoring male, median gestational age of 38 weeks. Clinical signs of RD were dominated by a Silverman score above 4/10 in 64%. Main etiologies were pneumonia (44%), followed by transient tachypnea (35.4). Perinatal asphyxia (OR = 9.412, P = 0.005) and cyanosis (OR = 6.509; P 0.001) were worsening RD, while caesarian section was protective (OR = 0.412; P = 0.050). Mortality rate (MR) was 10.4%. Therapeutic measures briefly consisted in oxygen therapy for 98.9% of patients and probabilistic antibiotic therapy. Conclusion: Neonatal pneumonia was the preeminent etiology of RD in this population; the MR was high.

Accuracy and Reliability of Lung Ultrasound to Diagnose Transient Tachypnoea of the Newborn: Evidence from a Meta-analysis and Systematic Review.

Transient tachypnoea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD) during the newborn period. Chest radiography (CXR) is commonly used to rule out the diagnosis, but TTN is often misdiagnosed as neonatal respiratory distress syndrome (NRDS) on the basis of CXR alone. Increasing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic tool for transient tachypnoea of the newborn. However, studies of the diagnostic efficiency of LUS are still lacking. This study was aimed to evaluate the accuracy and reliability of LUS for diagnosing TTN by conducting a systematic review and meta-analysis. We searched for articles in the Embase, PubMed, and Cochrane Library databases from inception until May 31, 2020. The selected studies were diagnostic accuracy studies that reported the utility of LUS in the diagnosis of TTN. Two researchers independently extracted data and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Then, we created a bivariate model of mixed effects to calculate the sensitivity and specificity of LUS in diagnosing TTN. A summary receiver operator characteristic (SROC) curve was constructed to summarize the performance characteristics of LUS. Six studies involving 617 newborns were included in the review. LUS had a pooled sensitivity of 0.98 (confidence interval [CI]: 0.92-1.00) and a specificity of 0.99 (CI: 0.91-1.00). The area under the curve for LUS was 1.00 (0.98-1.0). Meta-regression revealed that LUS had a significant diagnostic accuracy for TTN. The performance of ultrasound for the detection of TTN was excellent. Considering the various advantages of LUS compared with chest radiographs in diagnosing TTN, this study supports the routine use of LUS for the detection of TTN. · Lung ultrasound is a highly accurate diagnostic tool, which may be a viable and superior alternative to CXR, in diagnosing TTN.. · Lung ultrasound can help differentiate TTN from other etiologies of respiratory distress in neonates.. · There are still some controversies on the ultrasound diagnostic criteria of TTN..

Comparison of Efficacy of LUS and CXR in the Diagnosis of Children Presenting with Respiratory Distress to Emergency Department.

ABSTRACTIntroductionRespiratory distress (RD) in children is a life-threatening condition. Delay in diagnosis has a deleterious effect on morbidity and mortality. The bedside lung ultrasound in emergency (BLUE) is a fast method that aims to accelerate the diagnosis with minimal radiological exposure. We targeted to evaluate the efficacy of BLUE protocol to speed and increase the precision of recognizing the cause of RD compared with chest X-ray (CXR) in the emergency department.Materials and methodsA cross-sectional study on 63 children with RD attended the emergency of a tertiary, university-affiliated, pediatric medical center between January 2017 and January 2018.ResultsMost cases were males 52.4%. We designed to estimate the value of BLUE as a diagnostic tool for RD and comparing it with CXR. Pneumonia with or without pleural effusion was the main etiology of RD detected by BLUE in 47.7% of studied children, pulmonary edema in 22.2%, bronchiolitis and asthma in 17.4%, and pneumothorax in 12.7%. Lung ultrasound (LUS) was superior to CXR in the diagnosis of RD cause, and most cases, 47.7% were diagnosed with pneumonia with a sensitivity of 93.5% and specificity 96.9%.ConclusionBedside lung ultrasound in emergency is an effective tool for identifying the cause of RD which is more sensitive and specific compared with CXR.How to cite this articleHegazy LM, Rezk AR, Sakr HM, Ahmed AS. Comparison of Efficacy of LUS and CXR in the Diagnosis of Children Presenting with Respiratory Distress to Emergency Department. Indian J Crit Care Med 2020;24(6):459–464.

N-terminal pro-brain natriuretic peptide as a biomarker for differentiating cardiac and pulmonary disease in term neonates with respiratory distress.

ObjectiveBrain natriuretic peptide (BNP) is synthesized in the cardiac ventricles and released in response to volume or pressure load. The aim of the study was to determine whether plasma level of N-terminal pro BNP (NT-pro BNP) can distinguish between cardiac and pulmonary disease (PD) among neonates with respiratory distress (RD).Patients and methodsThe study included 48 term neonates in the first month of life with signs of RD. They were recruited from Neonatal Intensive Care Unit of Al-Galaa Teaching Hospital. Twenty-six healthy neonates were included as a control group. The degree of RD was assessed using Silverman–Anderson score. Chest X-ray, echocardiography, and laboratory measurement of NT-pro BNP were performed.ResultsAccording to the underlying disease, neonates with RD were divided into 28 neonates with PD and 20 neonates with congenital heart disease (CHD). Regardless the etiology of RD, NT-pro BNP was significantly higher in the RD group than in the control (p = 0.001). There was a significant difference between and within the three groups regarding NT-pro BNP (p = 0.001). NT-pro BNP was significantly higher in the CHD group than in the PD group (p = 0.001). There was a significant difference between and within RD subgroups. The NT-pro BNP is a very useful test for identification of CHD in neonates with RD. Area under the receiver operating characteristic curve for CHD was 0.857 (p = 0.01), sensitivity 66%, specificity 85%, and cutoff point was 24.5 pg/mL. The area under the curve for PD was 0.646 (p = 0.1) with poor sensitivity and specificity, indicating that NT-pro BNP is a poor test for identification of PD in neonates with RD.ConclusionTerm neonates with RD have increased plasma levels of NT-pro BNP. NT-pro BNP is a very good test for identification of CHD in neonates with RD, in comparison with PD. Therefore, plasma NT-pro BNP can be used to differentiate between cardiac and pulmonary cause of RD.

Clinico-etiological profile of respiratory distress in the new-born and its out-come

Objectives: The objectives of the study are to estimate the incidence of respiratory distress (RD) with etiology and associated risk factors in newborns admitted to neonatal intensive care units and to propose adequate management plan for better clinical outcome. Study Design: This was a hospital-based prospective, longitudinal study. Setting: The study was conducted in a tertiary care teaching hospital of Odisha between November 2015 and October 2017. Study Population: A total of 202 newborns, born with RD, constitute the study population. The risk factors are delineated with outcome. Results: Out of 202 newborns with RD, 107 (53%) were males and 95 (47%) were females. Based on birth weight and gestational age, 35% were of very low birth weight (< 2000 grams; VLBW) and 19.8% were of low birth weight (2000 to <2500 grams; LBW). Both these groups accounted for 54.9% of all babies under the study. Pre-terms were 50.5% among VLBW and 9.9% among normal birth weight (NBW) babies. Most common etiology was found to be RD syndrome (RDS, 39.6%). 95% of cases survived while 5% resulted in death. 60% of the death was contributed by RDS and prematurity, while 40% of deaths were seen in term gestation with NBW resulting from birth asphyxia in this study. Although the death ratios in each group of newborns VLBW, LBW, and NBW were almost equal, the etiology of RD and death in the respective groups was different. Conclusion: The study shows an association between mortality and onset of RD. Early onset of RD increases mortality. Antenatal steroid administration has a positive outcome. VLBW and LBW newborns succumb more to RD. The etiology of RD is different in different categories of birth weight. Continuous positive airway pressure is the cornerstone in management of RDS.

N-terminal pro-brain natriuretic peptide as a biomarker for differentiating cardiac and pulmonary disease in term neonates with respiratory distress

ObjectiveBrain natriuretic peptide (BNP) is synthesized in the cardiac ventricles and released in response to volume or pressure load. The aim of the study was to determine whether plasma level of N-terminal pro BNP (NT-pro BNP) can distinguish between cardiac and pulmonary disease (PD) among neonates with respiratory distress (RD). Patients and methodsThe study included 48 term neonates in the first month of life with signs of RD. They were recruited from Neonatal Intensive Care Unit of Al-Galaa Teaching Hospital. Twenty-six healthy neonates were included as a control group. The degree of RD was assessed using Silverman–Anderson score. Chest X-ray, echocardiography, and laboratory measurement of NT-pro BNP were performed. ResultsAccording to the underlying disease, neonates with RD were divided into 28 neonates with PD and 20 neonates with congenital heart disease (CHD). Regardless the etiology of RD, NT-pro BNP was significantly higher in the RD group than in the control (p = 0.001). There was a significant difference between and within the three groups regarding NT-pro BNP (p = 0.001). NT-pro BNP was significantly higher in the CHD group than in the PD group (p = 0.001). There was a significant difference between and within RD subgroups. The NT-pro BNP is a very useful test for identification of CHD in neonates with RD. Area under the receiver operating characteristic curve for CHD was 0.857 (p = 0.01), sensitivity 66%, specificity 85%, and cutoff point was 24.5 pg/mL. The area under the curve for PD was 0.646 (p = 0.1) with poor sensitivity and specificity, indicating that NT-pro BNP is a poor test for identification of PD in neonates with RD. ConclusionTerm neonates with RD have increased plasma levels of NT-pro BNP. NT-pro BNP is a very good test for identification of CHD in neonates with RD, in comparison with PD. Therefore, plasma NT-pro BNP can be used to differentiate between cardiac and pulmonary cause of RD.

A clinical study of respiratory distress in neonates

Background: Respiratory distress is a medical emergency responsible for most of the admissions in NICUs during neonatal period. It is a major contributor to neonatal morbidity and mortality and results from a variety of respiratory and non-respiratory etiology. It occurs in 0.96 to 12% of live births and responsible for about 20% of neonatal mortality. Aim of study to find out the proportion of patients with different etiology of respiratory distress in neonates.Methods: The present study is a prospective, descriptive study which was carried out at neonatal units attached to SMS Medical College, Jaipur. All the neonates with respiratory distress admitted in NICU admitted from April 2012 to March 2013were selected for the present study. Detailed history including antenatal history, natal history, postnatal history with thorough clinical examinations and investigations done in each case and were recorded in the performa.Results: A total of 500 neonates were admitted and among them 375 were inborn (delivered in our hospitals) and 125 out-born (referred to our hospitals from outside). In inborn group hyaline membrane disease (HMD) was the most common cause (32%) of respiratory distress and in out-born congenital pneumonia/septicaemia (34.4%). There was male preponderance in both inborn and out-born groups with male: female ratio 1.45:1 and 1.6:1 respectively.Conclusions: Majority of cases in both inborn and out-born groups were preterm (56.8% and 54.4% respectively) which emphasises the need for care of mother during antenatal period for prevention of premature delivery.

Predictors of success of high flow nasal cannula (HFNC) therapy in children with respiratory distress in pediatric intensive care unit

Objective: To identify clinical and laboratory variables that predict success of High Flow Nasal Canula (HFNC) therapy in children presenting to Pediatric Intensive Care Unit (PICU) with respiratory distress of varied etiology. Methods: This was a prospective observational study conducted in PICU of St John’s medical college, Bengaluru over a period of one year from May 2016 to April 2017. All children 1 month to 2 years presenting with moderate/severe respiratory distress of varied etiology were included for the study. The standard exclusion criteria of noninvasive ventilation were used. They were started on HFNC and clinical and laboratory variables were monitored at regular intervals. The participants were categorized as responders and non-responders (defined by need for escalation of respiratory support to invasive ventilation while on HFNC therapy). Results: One hundred fourteen childrens participated in the study, 99 of them responded and 15 were non-responders. Fifty nine had pneumonia(51.7%), 14 had WALRI (12.2%),13 had bronchiolitis (11.4%), 12 had post extubation respiratory distress(10.5%), 8 had fluid overload with respiratory distress(7%), 4 had upper air way obstruction (1.7% ), 4 had respiratory distress due to other causes. No differences were noted between these two groups for age, sex, weight, comorbid conditions. Decreasing heart rate, decrease in the mean respiratory rate and improving distress score at the end of 1 hour and 6 hours strongly correlated with response to therapy. The PRISM III scores were significantly higher (p =0.004) in non-responders. Respiratory distress due to pneumonia as underlying etiology was another predictor of failure of HFNC (p=0.009). No differences were noted in arterial blood gas parameters between these two groups, however paO2 among responders was significantly higher compared to non-responders at the initiation of HFNC and at 1 hour. Conclusion: Improving trends of clinical vital signs like heart rate, respiratory rate and RDS while on HFNC therapy are the key to success. Majority of children who failed HFNC had pneumonia as the underlying etiology of respiratory distress.

The role of cardiovascular and inflammatory markers in elucidating the etiology of respiratory distress in the newborn

The role of cardiovascular and inflammatory markers in elucidating the etiology of respiratory distress in the newborn

Diagnostic Performance of Point of Care Ultrasonography in Identifying the Etiology of Respiratory Distress in Neonates

To determine the diagnostic test performance of Point of care ultrasonography (PoC-USG) for identifying the etiology of respiratory distress (RD) in neonates when combination of radiological and clinical criteria is considered as the gold standard. A neonate was included in the study if he/she had RD and underwent x-ray chest and ultrasound within 4h of admission and the age was less than 24h. The neonates admitted with non-respiratory illness were chosen as controls. A trained neonatologist took trans-thoracic and trans-abdominal views and a radiologist, as per the defined criteria, did the interpretation. During the study period, 63 neonates with RD and 31 control neonates were enrolled. Overall from the clinical-radiological findings, the final diagnosis was respiratory distress syndrome (RDS), transient tachypnea of newborn (TTNB) and pneumonia in 29, 33 and one infants respectively. The ultrasound diagnosis of respiratory distress was RDS in 30 infants and TTNB in 33 infants. Pneumonia was not a diagnosis in any of the infants on PoC-USG. The sensitivity and specificity of USG in the diagnosis of respiratory distress were 98.4% and 100% respectively. One infant with diagnosis of pneumonia on chest x-ray was interpreted as RDS on USG. PoC-USG can be used to diagnose different etiologies of RD in neonates.

A 14-Year-Old Boy with Unusual Presentation of Respiratory Distress

There are multiple cardiac etiologies for wheezing and respiratory distress which require a high degree of suspicion for the pediatrician to diagnose. We present a case of a patient with a history of long-standing mild persistent asthma with minimal improvement on controller and bronchodilator therapies who presented to the emergency room with acute respiratory distress. When he demonstrated a lack of improvement with traditional respiratory therapies, additional etiologies of respiratory distress were considered. Ultimately an echocardiogram was performed, which revealed the diagnosis of cor triatriatum. He underwent surgical resection of his accessory membrane and has had no additional symptoms of asthma since repair.

PS-204 The Utility Of N-terminal Pro-brain Natriuretic Peptide In Assessment Of Respiratory Distress In Term Neonates

Background and aims The N-terminal pro-brain natriuretic peptide (NTpro-BNP) is used to differentiate congestive heart failure and lung disease in children and adults. The aim of our study was to determine its utility in the assessment of respiratory distress (RD) in term neonates. We sought to find out whether it can distinguish cardiac from pulmonary aetiology of respiratory distress in term neonates. Methods The NT pro-BNP level was determined in 60 neonates admitted for RD. They were further divided in two subgroups: 37 with congenital heart disease (CHD) and 23 with pulmonary disease. The control group consisted of 30 neonates with no signs of RD. Findings of auscultation, chest radiography, Silverman score and echocardiography were recorded for each patient. Blood samples for determining NT pro-BNP levels were obtained on admission, when blood sampling was indicated for the clinical management of the newborn. Results The RD group, regardless of aetiology, showed significantly higher levels of NT- pro BNP than the control group (p Conclusions Term neonates with RD have significantly higher NT-pro BNP levels than healthy neonates. Higher level of NTpro-BNP indicates more severe RD. A single measurement of NT pro-BNP leve lcannot be used as the sole biomarker for distinguishing between cardiogenic and noncardiogenic aetiology of RD in term neonates.

Group B Streptococcus, phospholipids and pulmonary hypertension

Group B Streptococcus is the most common cause of bacterial infection in the newborn. Our aim was to purify and identify molecules produced by the bacterium, which cause pulmonary hypertension. Guided by bioassays performed in neonatal lambs, we utilized standard biochemical techniques for the purification of these bioactive compounds. The compounds were identified by mass spectrometry. Fully synthetic compounds were then tested using the bioassay to confirm their ability to induce pulmonary hypertension. The purified bacterial components causing pulmonary hypertension were the phospholipids cardiolipin and phosphatidylglycerol. Synthetic cardiolipin or phosphatidylglycerol also induced pulmonary hypertension in lambs. Bacterial phospholipids are capable of causing pulmonary hypertension. This finding opens new avenues for therapeutic intervention in persistent pulmonary hypertension of the newborn and generates hypotheses regarding the etiology of respiratory distress in the newborn and the possible effect of antibiotic therapy.

Détresse respiratoire aiguë révélant une leucémie aiguë myéloblastique. À propos d’un cas

We report on the case of a patient diagnosed with acute leukaemic transformation of chronic myelomonocytic leukaemia. Its development was characterised by blastic pulmonary localisation and response to corticosteroids. We discuss the etiologies of respiratory distress in acute myeloblastic leukaemia and the corticosteroid sensitivity of this myeloid disease.

Prevalence and etiology of respiratory distress in infants of diabetic mothers: Predictive value of fetal lung maturation tests

International Journal of Gynecology & ObstetricsVolume 35, Issue 3 p. 288-288 Citations from the literature perinatology Prevalence and etiology of respiratory distress in infants of diabetic mothers: Predictive value of fetal lung maturation tests SL Kjos, SL KjosSearch for more papers by this authorFJ Walther, FJ WaltherSearch for more papers by this authorM Montoro, M MontoroSearch for more papers by this authorRH Paul, RH PaulSearch for more papers by this authorF Diaz, F DiazSearch for more papers by this authorM Stabler, M StablerSearch for more papers by this author SL Kjos, SL KjosSearch for more papers by this authorFJ Walther, FJ WaltherSearch for more papers by this authorM Montoro, M MontoroSearch for more papers by this authorRH Paul, RH PaulSearch for more papers by this authorF Diaz, F DiazSearch for more papers by this authorM Stabler, M StablerSearch for more papers by this author First published: July 1991 https://doi.org/10.1016/0020-7292(91)90329-4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume35, Issue3July 1991Pages 288-288 RelatedInformation

Prevalence and etiology of respiratory distress in infants of diabetic mothers: Predictive value of fetal lung maturation tests

The purpose of this study was to investigate the prevalence of respiratory distress syndrome attributable to surfactant deficiency in infants of diabetic mothers tested for fetal lung maturation. Three tests were assessed: (1) lecithin/sphingomyelin ratio, (2) phosphatidylglycerol concentration, and (3) optical density at 650 nm. From January 1987 through June 1989, 526 diabetic gestations were delivered within 5 days of fetal lung maturation testing. Surfactant-deficient respiratory distress syndrome was present in five infants (0.95%); all were < 34 weeks' gestational age. Other causes of respiratory distress were transient tachypnea of the newborn (n = 5), hypertrophic cardiomyopathy (n = 4), pneumonia (n = 2), polycythemia (n = 1), and meconium aspiration syndrome (n = 1). The use of standard maturity values of lecithin/sphingomyelin ratio ≥ 2.0, phosphatidylglycerol > 2% to 5%, and optical density at 650 nm ≥ 0.150 were evaluated. Each test had a 100% sensitivity in identifying surfactant-deficient respiratory distress syndrome and a 100% negative predictive value in identifying the absence of disease. All three tests had a low positive predictive value: 15% for lecithin/sphingomyelin ratio, 9% for phosphatidylglycerol, and 3% for optical density at 650 nm. We concluded that most cases of respiratory distress in the infants of diabetic mothers were unrelated to surfactant deficiency. The standard maturity values used in fetal lung maturation tests were valid in the diabetic gestation. The optical density at 650 nm was useful as a first-line test to predict the absence of surfactant-deficient respiratory distress syndrome.