Infant Respiratory Distress Research Articles

A rare cause of respiratory distress in preterm infants: a case report of acquired subglottic cysts

BackgroundThe Subglottic Cysts (SGCs) are a rare cause of respiratory distress in infants. Typical risk factors include male gender, extreme prematurity, gastro-oesophageal reflux and invasive ventilation, the latter being associated with mucosal damage and blockage of the subglottic cysts’ ducts. We describe a case of acquired subglottic cysts in a premature infants presented with respiratory distress.Case presentationA premature male infant was born at 25 weeks + 2 days with a history of monochorionic diamniotic twin pregnancy with twin-to-twin transfusion syndrome. During hospitalization, invasive mechanical ventilation was necessary for a total of 18 days; the patient was discharged at postmenstrual age of 40 weeks + 1 day in good condition. At 43 weeks post-menstrual age, he presented to our department with mixed stridor and worsening of respiratory dynamics. A laryngotracheoscopy evaluation was performed. The exam showed the presence of multiple SGCs causing an almost complete obstruction of the airway. Because of the significant reduction of the airway’s patency, the child underwent a tracheotomy and thereafter cysts’ removal using cold steel microinstruments. A better airway patency was restored although a slight glottic edema persisted. The histopathology confirmed the benign nature of the lesions. Successive controls showed a completely patent airway and absence of SGCs.ConclusionIn conclusion, SGCs should be considered in preterm infants with respiratory distress previously intubated, which cannot be explained by the most common causes. Early diagnosis and treatment are fundamental to reducing the morbidity and mortality associated with this disease.

Neonatal morbidity in the 2011 JAKIDS Jamaican birth cohort

ABSTRACT This study reports the spectrum of discharge diagnoses in a national cohort of newborns admitted during a 3-month period to hospitals across Jamaica. The data were analyzed using measures of central tendency and risk assessed using odds ratio. Data on 1607 admissions were used to describe the spectrum of morbidity in hospitalized infants. Eight hundred and seven (50%) male and 754 (48%) female neonates were admitted. There was a 15% (240) readmission rate during the neonatal period. Infants of diabetic mothers were almost three times as likely to be admitted as infants whose mothers were not diabetic OR 2.89 (CI 1.96 − 4.13). Infants of women who were hypertensive were 1.5 times more likely to be admitted than infants of non-hypertensive women OR 1.56 (CI 1.56–1.9). The odds ratio for admission of an infant born to a woman delivered by caesarean section was 2.1 (CI: 1.67–2.38). Premature infants constituted 50% of admissions. The most prevalent discharge diagnosis included presumed sepsis, respiratory distress and neonatal jaundice in both preterm and term neonates. In the extreme preterm infant respiratory distress syndrome was the most predominant discharge diagnosis. Multiple gestation was a significant risk for admission OR 2.7 (CI 1.8 to 3.9). Prematurity, multiple gestation, macrosomia, maternal diabetes, maternal hypertension and low 5 minute Apgar score < 7 were all found to be independent predictors of neonatal admission in a logistic regression model (p < 0.001). The recognition of the discharge morbidity is useful for future health planning for the most vulnerable in our population.

Safety of bubble nasal intermittent positive pressure ventilation (NIPPV) versus bubble nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress.

Nasal Intermittent Positive Pressure Ventilation (NIPPV) is an effective therapy for infants in respiratory distress. We here report the safety of a novel, low-cost, non-electric bubble NIPPV device in comparison with bubble NCPAP. At Paramitha Children's Hospital (Hyderabad, India), preterm (n = 60) neonates with moderate respiratory distress were pragmatically allocated to bubble NCPAP (5-8 cm H2O) or bubble NIPPV (Phigh 8-12 cm H2O/Plow 5-8 cm H2O) based on staff and equipment availability. Primary outcomes to assess safety included clinically relevant pneumothorax, nasal septal necrosis, or abdominal distention. One patient in each arm developed minor nasal septal injury (grade 3 on NCPAP, grade 2 on NIPPV); no patients in either arm developed a clinically significant pneumothorax or abdominal distention. The similar rates of nasal septal injury, pneumothorax and abdominal distention suggest that bubble NIPPV has a similar safety profile as bubble NCPAP for preterm infants in respiratory distress.

Respiratory distress in SARS-CoV-2 exposed uninfected neonates followed in the COVID Outcomes in Mother-Infant Pairs (COMP) Study

Respiratory distress (RD) has been reported in SARS-CoV-2 exposed uninfected (SEU) term neonates. Prior studies suggest that prenatal exposure to Coronavirus Disease 19 (COVID-19) may activate an inflammatory cascade in the newborn airway. In this study, we examine the relationship between maternal COVID-19 vaccination and neonatal RD using a longitudinal cohort of mother-infant pairs in Los Angeles, CA. Two-hundred and twenty-one mothers with laboratory confirmed SARS-CoV-2 during pregnancy and 227 exposed fetuses are enrolled in our study. Maternal disease severity and neonatal RD variables were defined based on current accepted clinical criteria. To explore the multifactorial associations between maternal COVID-19 parameters and infant RD, we utilize a multivariable logistic regression model and a proteomic sub-analysis to propose a pathway for the development of RD following in utero exposure to SARS-CoV-2. Unusually high rates of RD are observed in SEU infants (17%). The odds ratio of RD is 3.06 (95% CI:1.08-10.21) in term neonates born to unvaccinated individuals versus those born to individuals vaccinated prior to maternal infection. Proteomic analysis reveals a robust inflammatory response associated with ciliary dysregulation and enhanced IgE production among SEU neonates with RD. Maternal vaccination against COVID-19 reduces the frequency of neonatal RD.

A Retrospective Analysis of Ultrasonic Diagnosis of Neonatal Respiratory Distress Syndrome.

The aim of the study was to investigate ultrasound's diagnostic capabilities for infant respiratory distress syndrome. Retrospective analysis was performed on the clinical information of 96 newborns with respiratory distress syndrome who were treated at our hospital between July 2015 and October 2017. The patients were split into the mild group (n = 55) and the severe group based on the findings of the chest x-ray examinations (n = 41). All neonates underwent an ultrasound examination at baseline, 12 hours after treatment and 24 hours after treatment of pulmonary surfactant (PS). Between the 2 groups, ultrasonographic characteristics and imaging scores were compared between infants with and without PS treatment. When compared with the severe group, the ultrasound score in the mild group was lower ( P < 0.05). Before treatment, there was no statistically significant difference in ultrasound score between the PS treatment group and the non-PS treatment group ( P > 0.05). At each time point after treatment, the ultrasonography score of the non-PS treatment group was greater than that of the PS treatment group ( P < 0.05). Neonatal respiratory distress syndrome severity may be accurately assessed using ultrasound technology. Furthermore, the results of ultrasonography examinations may serve as a significant marker for assessing and measuring the severity of newborn respiratory distress syndrome.

A Narrative Review on Management of Cyanosis in Neonates

A bluish coloring of the skin or mucous membrane that is characteristic of the medical condition cyanosis can be visible around the lips, fingers, and toes. It is one of the indications of respiratory distress in infants that can be brought on by inadequate circulation and low levels of oxygenated blood. There are two basic causes of cyanosis, cardiac and pulmonary. Medical professionals are constantly very concerned about accurately diagnosing and treating newborns with congenital heart disease (CHD), despite the fact that prenatal diagnostic methods have significantly improved. Although they are physiologically entirely different from one another, ductus dependent congenital cardiac abnormalities can be divided into the ductus dependent systemic or pulmonary sickness. When developing the treatment plan, the clinical state and cardiac abnormalities must be taken into consideration. Many life-threatening conditions may not show signs right away after delivery, and the majority of clinical and physical symptoms are ambiguous, which makes a diagnosis difficult. Careful evaluation is required, and when clinical data, electrocardiograms, and chest X-rays are used. The newborn must be identified as being at such high risk right once, and prompt medical attention is essential to reducing mortality and morbidity

Association Between Airway Stenosis Degree and Respiratory Distress in Infants With a Vascular Ring.

Background Although the number of cases of prenatally diagnosed vascular rings is increasing, some cases may remain asymptomatic, and no indicator of the appearance of dyspnea has been established. Thus, we aimed to determine the relationship between the degree of airway compression by the vascular ring on contrast-enhanced computed tomography (CT) and respiratory distress. Methods This is a retrospective study of nine patients diagnosed with vascular rings at a single hospital from July 2010 to December 2019. Data regarding the patient's clinical characteristics, such as prenatal diagnosis, vascular ring type, complicated cardiac disease, and presence or absence of surgery, were recorded. Airway assessment on contrast-enhanced CT was measured in the axial cross-section. Statistical analysis was performed using Statistical Product and Service Solutions (SPSS) (version 25.0; IBM SPSS Statistics for Windows, Armonk, NY). Results Five of the eight patients had respiratory distress. Patients with respiratory distress were less likely to have been diagnosed prenatally (p = 0.04) and had smaller stenosis degree of anteroposterior diameter (p = 0.03). Conclusion Contrast-enhanced CT is useful in patients with vascular rings. Our study suggests that the stenosis degree of the anterior-posterior diameter of the airway is related to dyspnea.

Safety evaluation of the use of calcineurin inhibitor to prenatal and postpartum women in Japan from a health administrative database.

To investigate the use of calcineurin inhibitors (CNIs) in pregnant Japanese women and to evaluate their safety in infants. Data were extracted from the claims database of the Japan Medical Data Center. The prevalence of CNIs was evaluated 180 days before pregnancy onset, during pregnancy, and within180-days post partum. We investigated the characteristics of the infants, including the presence of major malformations and their diagnoses, for 1 year after birth. A total of 91,865 pregnancies in 80,049 women were included. Fifty-three women were prescribed CNIs between 180-day before pregnancy onset and 180-day postpartum; 35 of the 53 women were prescribed the drugs during pregnancy, and 10 of their infants were born preterm. Three were diagnosed with major congenital malformations, such as patent ductus arteriosus. Six preterm infants presented with infant respiratory distress syndrome. No congenital anomalies were clearly attributable to the use of CNIs during pregnancy.

Preterm Labor with Side Effects: Compare the Effectiveness of Magnesium Sulfate (MgSO4) with Isoxsuprine

Background: In India, 25% of pregnancies develop preterm labor (PTL), resulting in 10 to 69% cases of preterm birth. Medical intervention to stop labor, reduce infection rate, and avoid infant respiratory distress has been the subject of studies for a long time. PTL patients usually get tocolytics, corticosteroids, antibiotics, and other clinically symptomatic and supportive therapy to accomplish this goal. Studies further showed that these tocolytic drugs lower intracellular calcium bioavailability via biochemical pathways, hindering the interaction of actin-myosin. Due to the poor success rate of labor arrest, researchers concluded from their studies that widespread adoption of medical management for PTL has been hampered. The high rate of major side effects of tocolytic drugs, particularly beta-mimetic ones, exacerbated this. We know of no clinical evidence on PTL management in India. Objective: The effectiveness and maternal side effects of MgSO4 and isoxsuprine in PTL arrest. Methods: In our study, we included a total of 82 pregnant women who had PTL discomfort and were admitted to the labor department. Both groups were randomly assigned patients. “Group 1 patients received isoxsuprine hydrochloride, whereas group 2 patients received MgSO4”. After that, a comprehensive clinical examination included vital signs, general, systemic, external genitalia, and PV (per vaginal) results. Investigations include CBC, BT, CT, urine full examination, ABO, RH group, serum electrolytes, RBS, vaginal swab, and Renal function test (RFT). Result: Significant difference (p &lt;0.05) indicated that MgSO4 was more effective. Conclusion: MgSO4 can be used as a tocolytic agent in PTL as it shows better tolerance capacity when compared to isoxsuprine.

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

Background: Bronchiolitis is an acute respiratory illness which is the leading cause of respiratory distress in infancy and early childhood with its greatest morbidity in infants. Although zinc supplementation is effective in both preventing and treating pneumonia but its role in acute bronchiolitis has rarely been examined.&#x0D; Objective: To assess the effect of zinc sulfate to improve the clinical manifestations of acute bronchiolitis (Severe cases) in children less than 2 years of age.&#x0D; Materials and Methods: This was a double blind randomized clinical trial on 70 patients aged 2 to 23 months admitted in the Pediatric ward of Khwaja Yunus Ali Medical College and Hospital from September 2019 to September 2020 with the diagnosis of acute bronchiolitis. Patients were randomly divided equally into 2 groups: a case group was assigned oral zinc sulfate and the control group received placebo.&#x0D; Results: Mean age of case group was 174.63±98.7 days and control group 176.86±97.43 days ( p=0.924) with male predominance in both groups. Symptoms and signs of acute bronchiolitis (Severe cases) were compared between the 2 groups during admission and then at 24, 48 and 72 hours after initiation of treatment. No statistically significant differences were observed between the 2 groups in improvement of symptoms and signs including fever, fast breathing, chest indrawing and wheezing on 48 and 72 hours after treatment with zinc sulfate ( p&gt;0.05). The duration of hospitalization was 4.2±2.6 days in the case group and 4.4±2.2 days in the control group and this difference was not significant.&#x0D; Conclusion: The present study showed that zinc sulfate has no benefit in improving the clinical manifestations of acute bronchiolitis.&#x0D; Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 535-538

High flow nasal cannula for respiratory support in term infants.

High flow nasal cannula for respiratory support in term infants.

Why is This Infant in Respiratory Distress?

Why is This Infant in Respiratory Distress?

Thyroid Dysfunction in Pregnancy: A Literature Review

Due to structural similarities between HCG and thyroid-stimulating hormone, thyroid stimulation during pregnancy starts in the first trimester (TSH). The volume of thyroid hormone distribution increases along with placental metabolism, maternal thyroxine transport, and estrogen-mediated changes in thyroxine-binding globulin (TBG), all of which cause a 20–40% rise in early pregnancy thyroid hormone demand. Due to the human chorionic gonadotropin alpha subunit's cross-reactivity with the TSH receptor, the reference range of laboratory values for TSH is lower. High serum protein levels may alter estimates rather than direct measurements of free thyroxine (FT4), leading to reported results that are inaccurate. The clinical range of thyroid dysfunction during pregnancy can include both hyperthyroidism (Graves' disease and transitory gestational thyrotoxicosis) and hypothyroidism (overt hypothyroidism, subclinical hypothyroidism, and autoimmune thyroid disease). The risk of preterm and infant respiratory distress syndrome is increased by this malfunction.

Pierre Robin Sequence and Respiratory Distress: Long-Term Evolution in Patients Submitted to the Conservative Treatment.

Pierre Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, cleft palate, and airway distress. The aims of initial treatment are the improvement of airway and feeding. There are many therapeutic options, including conservative techniques (prone positioning and nasopharyngeal tube) and invasive procedures (mandibular distraction and tracheostomy). In our center, initially conservative treatment is the rule and many patients have been treated with nasopharyngeal tube. The aim was to analyze of the clinical evolution of respiratory distress in infants with PRS submitted to nonsurgical treatment. A retrospective and observational descriptive evaluation was carried out with 56 patients with the PRS at Centro de Atendimento Integral ao Fissurado Labiopalatal (CAIF). 21 patients were selected to a transversal phase. The treatment has started in an average age of 1.5 months (±2.09) and 17 (94.4%) had respiratory distress at birth. Polysomnographic exams showed an average apnea/hypopnea index of 0.93, an average number of central apnea/hour of 0.3, an average number of obstructive apnea of 0.6 and an average oxygen saturation of 92%. There was the predominance of esthetic profile in class II with 16 (88.9%) patients in this group, and orthodontic profile in class II with 15 (83.3%) patients. The conservative treatment has presented remarkable results in the treatment of respiratory distress in bearers of PRS with a decrease of obstructive sleep events considering the growth of patient and the development of mandibular growth as well.

Evaluation of thalamus echogenicity via ultrasonography as a marker of fetal lung maturity

Background: Fetal lung immaturity is a major problem in the management of elective birth with respect to predicting the development of infant respiratory distress syndrome (IRDS) in the neonate after birth.Aim and Objectives: The aim of this study was to evaluate the validity of measuring fetal thalamic echogenicity by ultrasound as a marker of fetal lung maturity.Subjects and Methods: This was a prospective observational study that was being carried out on 80 pregnant patients. They were recruited from Obstetrics and Gynaecology clinics at Tanta University Hospitals during the period of research from March 2021 till the end of the study.Results: There was statistically significant difference between RDS group and those without RDS regarding thalamic echogenicity, 1 and 5- min APGAR score, NICU admission and neonatal mortality.Conclusion: Evaluation of echogenic thalamus by ultrasound at the level of the BPD is of value, and can be considered as a new marker of fetal lung maturity; however, further studies are required to strengthen such idea.

Evaluation of thalamus echogenicity via ultrasonography as a marker of fetal lung maturity

Background: Fetal lung immaturity is a major problem in the management of elective birth with respect to predicting the development of infant respiratory distress syndrome (IRDS) in the neonate after birth.Aim and Objectives: The aim of this study was to evaluate the validity of measuring fetal thalamic echogenicity by ultrasound as a marker of fetal lung maturity.Subjects and Methods: This was a prospective observational study that was being carried out on 80 pregnant patients. They were recruited from Obstetrics and Gynaecology clinics at Tanta University Hospitals during the period of research from March 2021 till the end of the study.Results: There was statistically significant difference between RDS group and those without RDS regarding thalamic echogenicity, 1 and 5- min APGAR score, NICU admission and neonatal mortality.Conclusion: Evaluation of echogenic thalamus by ultrasound at the level of the BPD is of value, and can be considered as a new marker of fetal lung maturity; however, further studies are required to strengthen such idea.

The Effect of Maternal Vitamin D Intake on the Incidence of Nonspecific Respiratory Distress in Infants: A Randomized Clinical Trial

The Effect of Maternal Vitamin D Intake on the Incidence of Nonspecific Respiratory Distress in Infants: A Randomized Clinical Trial

Maternal opioids age-dependently impair neonatal respiratory control networks.

Infants exposed to opioids in utero are an increasing clinical population and these infants are often diagnosed with Neonatal Abstinence Syndrome (NAS). Infants with NAS have diverse negative health consequences, including respiratory distress. However, many factors contribute to NAS, confounding the ability to understand how maternal opioids directly impact the neonatal respiratory system. Breathing is controlled centrally by respiratory networks in the brainstem and spinal cord, but the impact of maternal opioids on developing perinatal respiratory networks has not been studied. Using progressively more isolated respiratory network circuitry, we tested the hypothesis that maternal opioids directly impair neonatal central respiratory control networks. Fictive respiratory-related motor activity from isolated central respiratory networks was age-dependently impaired in neonates after maternal opioids within more complete respiratory networks (brainstem and spinal cords), but unaffected in more isolated networks (medullary slices containing the preBötzinger Complex). These deficits were due, in part, to lingering opioids within neonatal respiratory control networks immediately after birth and involved lasting impairments to respiratory pattern. Since opioids are routinely given to infants with NAS to curb withdrawal symptoms and our previous work demonstrated acute blunting of opioid-induced respiratory depression in neonatal breathing, we further tested the responses of isolated networks to exogenous opioids. Isolated respiratory control networks also demonstrated age-dependent blunted responses to exogenous opioids that correlated with changes in opioid receptor expression within a primary respiratory rhythm generating region, the preBötzinger Complex. Thus, maternal opioids age-dependently impair neonatal central respiratory control and responses to exogenous opioids, suggesting central respiratory impairments contribute to neonatal breathing destabilization after maternal opioids and likely contribute to respiratory distress in infants with NAS. These studies represent a significant advancement of our understanding of the complex effects of maternal opioids, even late in gestation, contributing to neonatal breathing deficits, necessary first steps in developing novel therapeutics to support breathing in infants with NAS.

Surgical Etiology of Respiratory Distress in Infant and Short Term Outcome at Benghazi Children Hospital (2017-2018)

Background: Respiratory distress (RD) is a common problem in newborns immediately following birth. It is often seen during the transition from fetal to neonatal life. Aims: This study was conducted to demonstrate the surgical causes of respiratory distress in infants admitted to paediatric surgical department of Benghazi Children Hospital and to describe the short term outcome of the sample. Methodology: A retrospective observational descriptive cross section study was done to achieve the aims of this study. Results: A sample of (50) children admitted with respiratory distress due to congenital anomalies, the age range of the sample was from one day to one year, male were (70%) and females and (30%). Residency (20%) from Benghazi and (80%) from outside Benghazi. Normal delivery was reported in52% of the cases and (48%) C/S, (86%) were born at term and (14%) preterm. The mean weight of the cases was (3.38) (±1.91) kg with minimum of (2) kg and maximum (10) kg. TOF in (52%), diaphragmatic hernia in (40%) and lung emphysema in (8%). Clinical presentation of the cases was mainly with respiratory distress in (84%), while (16%) presented with frothy secretion, ultrasound scan was done to (88%) and was normal. Echocardiogram was normal, atrial septal defect in (16%), ventricular septal defect in (14%), patent ductus arteriosus in (8%). (80%) were operated. Death was recorded in half of the cases. Cases with TOF were in total (26) cases of them (17) died and (9) survived, diaphragmatic hernia cases were (20), of them (12) discharged and (8) died, all cases of congenital lobar emphysema discharged. This association was highly significant Fisher`s (exact=6.9 P=0.005). all preterm neonate died (seven cases) and those who were term were in total (43) of them (25) survived and (18) died, Fisher`s (exact=10.85 P=0.005). Cases who were presented with respiratory distress were in total (42) of them (18) died and (25) discharged, while cases who presented with frothy secretions ....

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.