Neonatal Respiratory Distress Syndrome Group Research Articles

Risk factors associated with respiratory distress syndrome in late preterm infants.

To investigate the risk factors for neonatal respiratory distress syndrome (NRDS) in late preterm infants. A retrospective analysis was performed on the clinical data of 86 late preterm infants with a gestational age of 34-36+6 weeks who were admitted to Maternity & Child Care Center of Qinhuangdao from June 2022 to June 2023 and with complete clinical records. All enrolled infants were divided into the non-NRDS group(n=51) and the NRDS group(n=35) according to the presence or absence of NRDS. No statistically significant differences were observed in birth weight, gestational age and gravidity between the two groups(p>0.05), while there were statistically significant differences in fetal gender, mode of delivery and presence or absence of asphyxia(p<0.05). Moreover, no statistically significant differences were found in advanced maternal age, anemia, multiple births, and gestational hypertension(p>0.05), while there were statistically significant differences in placental abnormalities, intrauterine distress, premature rupture of membranes, and gestational diabetes mellitus(p<0.05). Logistic regression analysis revealed that fetal gender(male), placental abnormalities, intrauterine distress, premature rupture of membranes, and gestational diabetes mellitus were risk factors for NRDS in late preterm infants(p<0.05). Late preterm infants suffer from NRDS due to a variety of complex pathogenic causes, with numerous complications. Factors such as male fetal gender, placental abnormalities, intrauterine distress, premature rupture of membranes, and gestational diabetes mellitus may increase the risk of NRDS in late preterm infants. In clinical observation, it is necessary to strengthen monitoring efforts and take timely measures to intervene in the course of NRDS.

Maternal prenatal systemic inflammation indexes predicts premature neonatal respiratory distress syndrome

Neonatal respiratory distress syndrome (NRDS) is one of the leading causes of neonatal mortality in low-income countries. It is caused by a lack of surface-active substances in the lungs, and the maternal inflammatory response plays an important role in the formation of surface-active substances in the fetal lungs. We aimed to investigate the correlation between maternal prenatal systemic inflammatory indices and respiratory distress syndrome in preterm neonates. This is a retrospective case–control study that collected data from all patients who delivered between 28 and 36 weeks of gestation at Longhua District People's Hospital in Shenzhen City and whose infants were admitted to the neonatal unit, newborns with respiratory distress syndrome were in the experimental group (NRDS group), and newborns without NRDS were in the control group (non-NRDS group). To minimize the effect of confounders on the results, propensity score matching was performed on baseline characteristics. Totally, 524 patients were included (93 in the NRDS group and 431 in the non-NRDS group), and 71 matched pairs (142 patients). The neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI) and neutrophil lymphocyte to platelet ratio (NLPR) were higher in the NRDS group than in the non-NRDS group (p < 0.05). The ROC curves of NLR, dNLR, SII, SIRI, AISI and NLPR for the diagnosis of NRDS were plotted, and it was found that the combined diagnostic efficacy of these six systemic inflammatory markers was better (AUC: 0.643, P = 0.003). Patients were divided into two groups based on the cut-off values determined from the ROC curves, and analysis using binary regression models revealed that SII ≥ 1199.94 (OR, 2.554; 95% CI 1.245–5.239, P = 0.011) and NLPR ≥ 0.0239 (OR, 2.175; 95% CI 1.061–4.459, P = 0.034) were independent risk factors predicting NRDS. Maternal prenatal SII ≥ 1199.94 and NLPR ≥ 0.0239 are independent risk factors for NRDS, and clinicians may be used to prevent neonatal respiratory distress in advance to reduce the incidence of NRDS.

Metabolic and Microbial Dysregulation in Preterm Infants with Neonatal Respiratory Distress Syndrome: An Early Developmental Perspective.

Neonatal respiratory distress syndrome (NRDS) is one of the most severe respiratory disorders in preterm infants (PTIs) due to immature lung development. To delineate the serum metabolic alterations and gut microbiota variations in NRDS and assess their implications on neonatal development, we enrolled 13 NRDS neonates and 12 PTIs and collected fecal and serum specimens after birth. Longitudinal fecal sampling was conducted weekly for a month in NRDS neonates. NRDS neonates were characterized by notably reduced gestational ages and birth weights and a higher rate of asphyxia at birth relative to PTIs. Early postnatal disturbances in tryptophan metabolism were evident in the NRDS group, concomitant with elevated relative abundance of Haemophilus, Fusicatenibacter, and Vibrio. Integrative multiomics analyses revealed an inverse relationship between tryptophan concentrations and Blautia abundance. At one-week old, NRDS neonates exhibited cortisol regulation anomalies and augmented hepatic catabolism. Sequential microbial profiling revealed distinct gut microbiota evolution in NRDS subjects, characterized by a general reduction in potentially pathogenic bacteria. The acute perinatal stress of NRDS leads to mitochondrial compromise, hormonal imbalance, and delayed gut microbiota evolution. Despite the short duration of NRDS, its impact on neonatal development is significant and requires extended attention.

Diagnostic value of bedside lung ultrasound and 12-zone score in the 65 cases of neonatal respiratory distress syndrome and its severity

ObjectiveTo explore the predictive value of bedside lung ultrasound score in the severity of neonatal respiratory distress syndrome (NRDS) and mechanical ventilation and extubation.MethodsThe clinical data of 65 neonates with NRDS and invasive mechanical ventilation diagnosed in the neonatal intensive care unit of our hospital from July 2021 to July 2022 were retrospectively analyzed. 65 neonates were included in the NRDS group, and 40 neonates with other common lung diseases were selected as the other lung disease groups. All neonates underwent lung ultrasound and X-ray examination. The correlation between lung ultrasound scores and arterial blood gas indexes was analyzed by Pearson. The efficacy of successful evacuation of mechanical ventilation was evaluated by lung ultrasound analysis by ROC curve analysis.ResultsThe positive rates of lung consolidation and white lung in NRDS group were higher than the other lung disease groups (P < 0.05). The positive rates of bronchial inflation sign and double lung points were lower than these in the other lung disease groups (P < 0.05). The ultrasound scores of both lungs, left lung, right lung, bilateral lung and double basal lung in the NRDS group were significantly higher than those in the other lung disease groups (P < 0.05). There was a significant positive correlation between lung ultrasound score and X-ray grade (r = 0.841, P < 0.001). The area under the curve (AUC) of lung ultrasound score for the differential diagnosis of NRDS and common lung diseases was 0.907. The AUC of lung ultrasound score in the differential diagnosis of mild and moderate, and moderate and severe NRDS were 0.914 and 0.933, respectively, which had high clinical value. The lung ultrasound score was positively correlated with the level of PaCO2 (r = 0.254, P = 0.041), and negatively correlated with the levels of SpO2 and PaO2 (r = − 0.459, − 0.362, P = 0.001, 0.003). The AUC of successful mechanical ventilation withdrawal predicted by the pulmonary ultrasound score before extubation was 0.954 (95% CI 0.907–1.000). The predictive value of successful extubation was 10 points of the pulmonary ultrasound score, with a sensitivity of 93.33% and a specificity of 88.00%.ConclusionThe bedside lung ultrasound score can intuitively reflect the respiratory status of neonates, which provides clinicians with an important basis for disease evaluation.

The association between sex and neonatal respiratory distress syndrome.

To investigate the association between sex and neonatal respiratory distress syndrome (NRDS). Neonates born at our hospital and transferred to the neonatal department within 1h were retrospectively analyzed. Depending on whether they developed NRDS during their hospital stay, the neonates was divided into NRDS and non-NRDS groups. There were 142 neonates in the NRDS group (95 males and 47 females) and 310 neonates in the non-NRDS group (180 males and 140 females). The neonates' data on gestational age(GA), sex, birth weight, white blood cell count (WBC), platelet count (PLT), C-reactive protein (CRP), total immunoglobulin M (total IgM), gestational diabetes mellitus(GDM), antenatal steroids use, meconium-stained amniotic fluid, and preterm premature rupture of membranes(PPROM) were gathered. 452 neonates (265 males and 187 females) were involved for the purpose of collecting basic characteristic. Multivariate analysis, males had a 1.87 times higher risk of NRDS than females (P < 0.05) after controlling for the confounding effects of GA, birth weight, WBC, PLT, CRP, total IgM, GDM, antenatal steroids use, meconium-stained amniotic fluid, and PPROM. Sex was associated with NRDS; males had a considerably higher risk of NRDS than females.

Decrease in lipid metabolic indexes in infants with neonatal respiratory distress syndrome.

Incomplete pulmonary function and insufficient production of pulmonary surfactant in premature infants may affect alveolar relaxation, inducing neonatal respiratory distress syndrome (NRDS). The present study was a retrospective comparison of lipid metabolism indexes and clinic information between NRDS and non-NRDS infants. Data on general information, pregnancy, clinical symptoms, family history as well as plasma biochemical and lipid metabolic indexes were retrospectively collected and statistically analyzed from 79 patients with NRDS and 44 non-NRDS infants. Infants in the NRDS group showed lower body weight (2,055 vs. 3,225 g) and gestation age (33.39 vs. 38.53 weeks) than those in the non-NRDS group (P<0.05). Baseline information was corrected by the inverse probability of treatment weighting (IPTW) analysis. The weighted adjusted median age was the same in both groups and there was no significant difference between two groups in birth weight. The IPTW analysis revealed that the levels of plasma triglyceride (TG), total cholesterol, low-density lipoprotein, free triiodothyronine, free thyroxine, glucose, calcium (Ca2+) and phosphorus in the NRDS infants were significantly lower compared with those in the non-NRDS infants. Additionally, NRDS infants had significantly higher incidence rates of pneumonia, sepsis, brain injury infection, preterm birth, patent foramen ovale, patent ductus arteriosus and premature rupture of membranes compared with the non-NRDS infants (P<0.05). Multivariate logistic analysis showed that TG and Ca2+ were risk factors associated with NRDS (P<0.05). Infants with NRDS have significantly lower levels of plasma lipid indexes. The results of the present study provide data to guide the clinical management of NRDS.

The Role and Clinical Value of Optimized Fetal Main Pulmonary Artery Doppler Parameters in the Diagnosis and Prognosis Monitoring of Neonatal Respiratory Distress Syndrome.

Objective A retrospective study was conducted to explore the role and clinical value of optimized fetal main pulmonary artery Doppler parameters in the diagnosis and prognosis monitoring of neonatal respiratory distress syndrome (NRDS). Methods Pregnant women admitted to our hospital for delivery from March 2019 to June 2021 were included in the study. There were 372 singleton pregnant women who voluntarily underwent ultrasound and Doppler examinations with informed consent for the study. The AT/ET ratio of the middle segment of the main pulmonary artery, the middle part of the left (or right) pulmonary artery, and the proximal segment of the intrapulmonary artery was measured by ultrasonic Doppler. According to the outcome of the newborn, it was divided into NRDS group (n =90) and non-NRDS group (n =282) to compare the differences of fetal AT/ET ratio at three Doppler sampling locations and the differences of fetal AT/ET ratio in different gestational weeks. Using Pearson's correlation analysis, the correlation among the Doppler parameters of fetal main pulmonary artery, the ratio of AT and AT/ET, gestational weeks, and the efficiency of prenatal prediction of NRDS was evaluated by receiver-operating characteristic (ROC). In addition, the diagnostic efficiency of fetal main pulmonary artery Doppler parameter AT/ET ratio and amniotic fluid method for prenatal prediction of NRDS was compared. Results Compared with the non-NRDS group, the gestational age, gestational age at delivery, and birth weight in the NRDS group were significantly lower than those in the non-NRDS group. The 1 min Apgar score of newborns was less than 7, and the proportion of newborns transferred to NICU was significantly higher than that in the control group. Compared with non-NRDS group, AT was significantly shortened, AT/ET ratio was significantly decreased, and ET was significantly prolonged in NRDS group. The fetal aortic blood flow parameters AT, ET, and AT/ET ratio in different gestational weeks were significantly different among the three groups. The AT/ET ratio in the middle segment of the aorta in NRDS group was lower than that in non-NRDS group. The ratio of AT/ET was still correlated with the occurrence of postpartum NRDS. The AUC value of NRDS predicted by AT/ET ratio was 0.984. In the combined determination of amniotic fluid Lh and S ratio and PG, the diagnostic accuracy of prenatal prediction of neonatal respiratory distress syndrome was 100.005%, 98.43%, and 95.56%, respectively. The accuracy of fetal aortic AT/ET ratio in prenatal prediction of neonatal respiratory distress syndrome was 100.005%, 95.28%, and 95.57%, respectively. The order of Kappa coefficient from high to low was amniotic fluid PG/L/S ratio, fetal main pulmonary artery blood flow parameter AT/ET ratio, amniotic fluid L/S ratio, OD650, amniotic fluid PG, and foam test. Conclusion Fetal main pulmonary artery Doppler AT/ET ratio may be a very potential parameter for prenatal noninvasive prediction of NRDS. The fetal main pulmonary artery Doppler flow spectrum may be a very potential alternative to amniocentesis to evaluate FLM.

A pilot study of plasma interleukin-6 and interleukin-27 in differential diagnosis of acute respiratory distress syndrome and neonatal respiratory distress syndrome in preterm infants

To study the significance of interleukin-6 (IL-6) and interleukin-27 (IL-27) in the differential diagnosis of acute respiratory distress syndrome (ARDS) and neonatal respiratory distress syndrome (NRDS) in preterm infants. The preterm infants with the manifestation of respiratory distress who were treated in the Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, from March to November 2021, were enrolled in this prospective study. According to the diagnosis results, they were divided into two groups: ARDS group (n=18) and NRDS group (n=20). ELISA was used to measure the plasma levels of IL-6 and IL-27. The receiver operating characteristic (ROC) curve was used to analyze the value of each index in the diagnosis of ARDS. The ARDS group had significantly higher plasma levels of IL-6 and IL-27 than the NRDS group (P<0.05). The ROC curve analysis showed that IL-6 had an area under the ROC curve (AUC) of 0.867 for the diagnosis of ARDS, with a sensitivity of 61.1% and a specificity of 95.0% at the cut-off value of 56.21 pg/mL. The ROC curve analysis also showed that IL-27 had an AUC of 0.881 for the diagnosis of ARDS, with a sensitivity of 83.3% and a specificity of 80.0% at the cut-off value of 135.8 pg/mL. Plasma IL-6 and IL-27 can be used as biological indicators for early differential diagnosis of ARDS and NRDS in preterm infants.

Ultrasound Lung Image under Artificial Intelligence Algorithm in Diagnosis of Neonatal Respiratory Distress Syndrome.

In order to analyze the application of ultrasonic lung imaging diagnosis model based on artificial intelligence algorithm in neonatal respiratory distress syndrome (NRDS), an ultrasonic lung imaging diagnosis model based on a deep residual network (DRN) was proposed. In this study, 90 premature infants in the hospital were selected as the research object and divided into the experimental group (45 cases) and control group (45 cases) according to whether or not they have NRDS. DRN was compared with the deep residual network (DRWSR) based on wavelet domain, deep residual network detection with normalization framework (Fisher-DRN), and distorted image edge detection preprocessor (DIEDP). Then, it was applied to the diagnosis of NRDS. The clinical data and ultrasound imaging results of infants with NRDS and ordinary premature infants were compared. The results showed that the gestational age, birth weight, and Apgar scores of the NRDS group were remarkably lower than those of ordinary children (P < 0.05). In addition, the segmentation accuracy, image feature extraction accuracy, algorithm convergence, and time loss of the DRN algorithm were better than the other three algorithms, and the differences were considerable (P < 0.05). In children with NRDS, the positive rate of abnormal pleural line, disappearance of A line, appearance of B line, and alveolar interstitial syndrome (AIS) test in the results of lung ultrasound examination in children with NRDS were all 100%. The lung consolidation became 70.8%, and the white lung-like change was 50.1%, both of which were higher than those of ordinary preterm infants, and the differences were considerable (P < 0.05). The diagnostic model of this study predicted that the AUC area of grade 1-2, grade 2-3, and grade 3-4 NRDS were 0.962, 0.881, and 0.902, respectively. To sum up, the ultrasound lung imaging diagnosis model based on the DRN algorithm had good diagnostic performance in children with NRDS and can provide useful information for clinical NRDS diagnosis and treatment.

Association Between Vitamin D Level and Neonatal Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

BackgroundIn recent years, vitamin D in the occurrence of lung diseases has gradually become a hot topic. Although the role of vitamin D in normal lung development has been confirmed, the correlation between vitamin D level and neonatal respiratory distress syndrome (NRDS) is not clear.ObjectiveTo evaluate the association between vitamin D level and NRDS.MethodsWe performed a comprehensive search of the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI). Literature screening and quality assessment were performed according to inclusion and exclusion criteria. The Newcastle–Ottawa Scale was used to assess the methodological components of each study, and Stata 15.1 software to perform the Meta-analysis.ResultsA total of nine case-control studies were included, with 653 infants with NRDS and 501 infants without NRDS. The Meta-analysis showed no heterogeneity across all studies(I2=0.0%, P=0.583). The fixed-effect model showed that 25 hydroxy vitamin D level of children in the NRDS group was significantly lower than that of the non-NRDS group(SMD = −0.51, 95%CI: −0.63 to −0.39, p ≤ 0.05).ConclusionThis systematic review and meta-analysis study suggests that vitamin D deficiency is very likely to be a high-risk factor of NRDS, and reasonable vitamin D supplementation during pregnancy and after birth is of great significance.

Efficacy analysis of different pulmonary surfactants in premature infants with respiratory distress syndrome

To explore high-risk factors of respiratory distress syndrome (RDS) and to compare the clinical efficacy of calf pulmonary surfactant (PS) combined with budesonide suspension and poractant alfa injection in the treatment of RDS in premature infants. A retrospective analysis was conducted. Preterm infants who were born in the obstetrics department of Liaocheng People's Hospital and admitted to the neonatal intensive care unit (NICU) within 24 hours from July 2016 to July 2020 were enrolled. The clinical data of these patients including perinatal conditions, clinical features, therapeutic regimens of PS and outcomes were collected and analyzed. According to the diagnostic criteria of neonatal respiratory distress syndrome (NRDS), premature infants were divided into NRDS group and non-NRDS group. First, the clinical data of the two groups were compared to analyze the related factors of NRDS. Then the related factors of NRDS were confirmed by Logistic regression analysis. In addition, according to the trapeutic regimens of PS, the children were divided into calf PS combined with budesonide suspension group and poractant alfa injection group, and the efficacy of the two PS was compared. (1) A total of 1 690 preterm infants were included, including 297 preterm infants were diagnosed with NRDS which accounted for 17.6% of live preterm infants. There were significant differences in gender, gestational age (GA), birth parity, birth weight (BW), asphyxia of newborn, caesarean section, premature rupture of membrane, placental abruption, gestational diabetes and father's smoking addiction (maternal exposure to smoke during pregnancy) between NRDS group and non-NRDS group (male: 71.0% vs. 59.0%; GA: < 28 weeks was 4.1% vs. 0.1%, 28 weeks ≤ GA < 34 weeks was 70.0% vs. 29.9%, 34 weeks ≤ GA < 37 weeks was 25.9% vs.70.0%; birth parity: 2 (1, 3) vs. 2 (1, 3); BW: < 1 000 g was 4.1% vs. 0.4%, 1 000 g ≤ BW < 1 500 g was 31.3% vs. 6.5%, 1 500 g ≤ BW < 2 500 g was 51.5% vs. 58.9%, 2 500 g ≤ BW < 4 000 g was 12.8% vs. 33.1%, BW ≥ 4 000 g was 0.3% vs. 1.1%; asphyxia of newborn: 50.8% vs. 14.6%; caesarean section: 71.7% vs. 65.0%; premature rupture of membrane: 66.7% vs. 42.2%; premature rupture of fetal membranes: 11.4% vs. 5.2%; gestational diabetes: 12.1% vs. 7.0%; father's smoking addiction: 80.8% vs. 71.5%, all P < 0.05), but there was no significant difference in prenatal use of dexamethasone (DEX) between NRDS group and non-NRDS group (80.1% vs. 84.1%, P > 0.05). Binary multivariate Logistic regression analysis showed that GA, gender, cesarean section, premature rupture of membranes, gestational diabetes, father's smoking addiction and neonatal asphyxia were the risk factors of RDS [odds ratio (OR) and 95% confidence interval (95%CI) were 0.621 (0.557-0.693), 2.043 (1.478-2.825), 1.365 (1.036-1.797), 0.697 (0.506-0.961), 3.223 (1.906-5.449), 1.836 (1.261-2.673), 3.596 (2.622-4.933), all P < 0.05]. (2) A total of 160 patients diagnosed with grade III/IV NRDS were included to analyze the efficacy of PS. Among them, 42 cases were treated with calf PS combined with budesonide suspension, and 118 cases were treated with poractant alfa injection. Compared with the poractant alfa injection group, the total oxygen consumption time of the calf PS group was shorter [days: 9.0 (5.0, 19.0) vs. 13.0 (6.0, 26.0)], the hospitalization expenses were lower [ten thousand Yuan: 3.46 (2.88, 5.18) vs. 4.58 (3.08, 6.06)], and the incidence of bronchopulmonary dysplasia (BPD) was lower (11.9% vs. 28.8%), with statistically significant differences (all P < 0.05). In addition to GA, gender, cesarean section, premature rupture of membranes, gestational diabetes, and neonatal asphyxia, the father's smoking addiction (maternal smoke exposure during pregnancy) is an important risk factor of RDS in premature infants. The efficacy of prenatal use of DEX for prevention of RDS in preterm infants is affected by many factors, such as prenatal smoke exposure, timing of use, multiple fetuses, etc. Calf PS combined with budesonide suspension is better than poractant alfa injection in reducing the incidence of BPD.

Increased Expression of IL-23 and IL-17 in Serum of Patients with Neonatal Respiratory Distress Syndrome and its Clinical Significance.

The present study focused on the potential clinical significance of Th-17 cell related inflammatory cytokines in the occurrence and development of neonatal respiratory distress syndrome (NRDS). We included 82 NRDS children and 82 healthy controls. NRDS children were divided into the mild and severe group based on the disease severity. The serum samples of the NRDS and non-NRDS children were collected, and the expression levels of IL-17, IL-22, and IL-23 were determined by ELISA method. Moreover, correlation between the levels of the cytokines and the disease severity were analyzed, and receiver operating characteristics curve (ROC) analysis was performed to determine the diagnostic value of the cytokines. Finally, correlation between the lung ultrasound score (LUS) of the NRDS patients and the levels of IL-17 and IL-23 were analyzed. IL-17 and IL-23 were dramatically increased in serum of the NRDS patients compared with the non-NRDS patients; moreover, IL-17 and IL-23 were significantly higher in the severe compared with the mild NRDS group, and the levels of both IL-17 and IL-23 were positively correlated with the disease severity. Furthermore, ROC analysis showed that both IL-17 and IL-23 can distinguish NRDS patient, especially the severe NRDS patients from the non-NRDS patients with high sensitivity and specificity; finally, the levels of IL-17 and IL-23 were positively correlated with the LUS in NRDS patients. IL-17 and IL-23 were up-regulated in NRDS and may serve as sensitive biomarkers for the diagnosis and treatment of the disease.

Budesonide and Poractant Alfa prevent bronchopulmonary dysplasia via triggering SIRT1 signaling pathway.

This study aimed to evaluate effect of budesonide combining Poractant Alfa on preventing bronchopulmonary dysplasia (BPD). A total of 120 preterm infants were involved. pH value, partial pressure of oxygen (PO2), and blood gas analysis were evaluated. Peripheral blood was collected and mononuclear cells were isolated. Reactive oxygen species (ROS) in peripheral blood mononuclear cells (PBMCs) were detected with laser confocal. Sirtuin 1 (SIRT1) in PBMCs was detected using immunofluorescence. SIRT1 and small ubiquitin-like modifier (SUMO)-specific protease 1 (SENP1) were detected with Western blot. Compared with group B, pH value and PO2 were improved significantly in group C and D (p<0.01). Compared with group B, oxygen inhalation duration, rate of having a respirator assisted ventilation, and using pulmonary surfactant (PS) again, and BPD incidence were significantly decreased in other groups (p<0.05). BPD incidence in group D was less than group C (χ2=4.00, p<0.05). Compared with control group, ROS level of neonatal respiratory distress syndrome (NRDS) group was significantly increased, SENP1 was increased, and SIRT1 was decreased in SIRT1 group. Compared with NRDS, when budesonide combined with Poractant Alfa, ROS decreased, SENP1 decreased, SIRT1 nuclear pulp shuttling rate reduced, nuclear SIRT1 increased (p<0.01). Compared with control, ROS level of NRDS group was significantly increased, SENP1 increased, and SIRT1 in nucleus decreased (p<0.05). Compared with NRDS group, when treated with budesonide and Poractant Alfa, ROS levels decreased, SENP1 decreased, nuclear SIRT1 increased (p<0.01). Budesonide combining Poractant Alfa can prevent BPD in preterm infants by activating the SIRT1 signaling pathway.

Rapid biophysical analyses of gastric aspirates from risk newborns for lung maturity assessment after corticosteroid therapy

BackgroundOne of the main causes for the higher mortality among risk newborn children (including preterm infants) is neonatal respiratory distress syndrome (NRDS), which develops as a result of primary deficiency or secondary inactivation of alveolar surfactant (AS). Therefore, fast and early diagnostics of risk newborns lung maturity is crucial for their prompt therapy. Materials and methodsGastric aspirates (GA) were collected from 77 infants divided into three groups: a control of 38 healthy full-term infants; 16 prematurely newborns with NRDS, and 23 prematurely born infants after in vitro fertilization and corticosteroid therapy (CST). Surface parameters: equilibrium (γeq), maximal (γmax) and minimal (γmin) surface tension, and the shape of hysteresis curves of GA monolayers were measured by axisymmetric drop shape analysis (ADSA) of a pending drop. In addition, the morphology of GA monolayers was studied by Brewster angle microscopy (BAM). ResultsOur results showed that only γmin values were reliable and were significantly lower in full-term infants, as compared to the risk neonates. The results obtained were proved by the shape of hysteresis curves of GA surface active films. BAM images of GA monolayers from NRDS group showed impaired surface morphology due to the surfactant insufficiency, as compared to the control group. Corticosteroid therapy improved both GA surface characteristics and monolayer morphology. ConclusionsGAs analyses by ADSA and BAM are fast and informative approaches for lung maturity assessment. In addition, the corticosteroid therapy applied improved all GAs surface parameters due to AS maturation.

Diagnostic value of lung ultrasound in evaluating the severity of neonatal respiratory distress syndrome

BackgroundIt is still unclear whether lung ultrasound (LUS) can be used to evaluate the severity of neonatal respiratory distress syndrome (NRDS). ObjectiveTo evaluate the role of LUS in assessing NRDS. MethodsFrom January 2017 to January 2018, newborns with suspected NRDS were enrolled. The LUS score and lung consolidation areas were determined. The receiver operative curve (ROC) was used to analyze the LUS score and lung consolidation to predict NRDS severity. ResultsNeonates with NRDS had higher LUS scores than those with non-NRDS (23.6 ± 3.6 vs. 16.2 ± 1.8, P < 0.05). Among neonates with NRDS, the LUS scores increased with NRDS severity (18.0 ± 2.7 vs. 24.0 ± 1.7 vs. 27.0 ± 1.7, all P < 0.05). There were almost no consolidation areas in non-NRDS, while 1.9 ± 1.7 consolidation areas were observed in the NRDS group (P < 0.05). The number of consolidation areas also increased with NRDS severity (0 vs. 1.5 ± 0.8 vs. 4.1 ± 1.3, all P < 0.05). The LUS score for NRDS vs. non-NRDS showed 80.2% sensitivity and 100% specificity using a cut-off of 21.5 (Area under the ROC curve, AUC = 0.938; P < 0.001). The LUS score for severe vs. mild/moderate NRDS showed 73.1% sensitivity and 95.7% specificity using a cut-off of 25.5 (AUC = 0.944; P < 0.001). The LUS score for predicting mechanical ventilation showed 81.3% sensitivity and 88.8% specificity using a cut-off of 25.5 (AUC = 0.912; P < 0.001). The AUCs of consolidation areas were similar to those of LUS score (all P > 0.05). ConclusionThe LUS score and consolidation areas can discriminate NRDS from non-NRDS and the different grades of NRDS, and predict the application of mechanical ventilation.

The anslysis of neonatal respiratory distress syndrome between the Han nationality and the Mongol nationality in Inner Mongolia

Objective To study the association between the SP-B gene polymorphisms and neonatal respiratory distress syndrome(NRDS) in infants of the Han nationality and the Mongol nationality. Methods One hundred and fifty-one infants with NRDS and another 151 infants without RDS (control group) were selected. PCR and RFLP were used to establish the genotype and allele frequencies of SP-B 1580 position. Results In the Inner Mongolia region, in both the Mongol nationality and the Han nationality, three genotypes namely TT, CT and CC could be can checked out from SP-B 1580 position . There were no significant differences in frequencies of TT genetype and CC genetype of SP-B 1580C/T between NRDS group and control group in Mongol nationality(χ2=0.021, P=0.886). On the contrary, there were statistical difference inthe frequencies of TT genetype and CC genetype of SP-B 1580C/T between NRDS group and control group in Mongol nationality(χ2=5.499, P=0.019). Conclusions The polymorphism of SP-B 1580 position in Inner Mongolia newborns displays no significant correlation with sex, birth weight or gestational age.The CC genetype of SP-B1580 might be the susceptibility genes of RDS in Han nationality in Inner Mongolia newborns. Key words: Respiratory distress syndrome; Surfactant protein B; Single nucleotide polymorphisms; Newborn

Relationship between ABCA3 gene polymorphisms and susceptibility with neonatal respiratory distress syndrome

Objective To investigate ABCA3 gene polymorphism and its relationship with neonatal respiratory distress syndrome (NRDS) in the Guangxi Zhuang Autonomous Region of China by genotyping and haplotype analysis. Methods Using a tagging single nucleotide polymorphism (tSNP) strategy and TaqMan (r) real-time PCR, we genotyped 4 tSNPs (rs4787273, rs150929, rs11867129, and rs17135889) and one additional coding SNP (rs13332514) of the ABCA3 gene in preterm infants with NRDS (NRDS group, n=45) and without NRDS (non-NRDS group, n=45) and subsequently predicted the haplotypes. The minor allele frequency and the haplotype `distribution were compared between the two groups. Results The minor allele A (0.14 vs.0.05, P=0.046) and genotype AG (0.289 vs.0.111, P=0.035) frequency of SNP rs17135889 in NRDS group were significantly higher than those in non-NRDS group. Totally 6 haplotypes occurred at a frequency ≥0.01, among which, the haplotype TGGAG, depended on rs17135889, was significantly higher in NRDS group than that in non-NRDS group (0.061 vs.0.000, P=0.014). Conclusion The results suggested that SNP rs17135889 of ABCA3 gene might be related to NRDS in preterm population of the Guangxi Zhuang Autonomous Region. Allele A contributes to NRDS susceptibility in preterm infants. Key words: Neonatal respiratory distress syndrome; ABCA3; Single nucleotide polymorphism

Correlation analysis of surfactant protein-C genetic polymorphisms and neonatal respiratory distress syndrome of the Mongol nationality in Inner Mongolia

Objective To investigate the distribution of surfactant protein-C (SP-C) gene single nucleotide polymorphisms and to study the association between the SP-C gene polymorphisms and neonatal respiratory distress syndrome (NRDS) in infants. Methods Fifty-one infants with NRDS (NRDS group) and 51 infants without RDS (control group) were selected. PCR gene analysis and polymerase chain reaction were used to establish the genotype and allele frequencies of SP-C exon 4(T138N) and exon 5(S186N), SP-C exon 4 and 5 for the mutation, and then the association between the polymorphisms and NRDS was analyzed. Results SP-C gene mutations were not found in exon 4 and 5. In the Mongol nationality of the Inner Mongolia region, SP-C exon 4(T138N) genotypes could check out three genotypes: namely AA, AC and CC. The frequencies of allele A and allele C of SP-C exon 4(T138N) were not statistically different between NRDS group and control group (χ2=0.454, P=0.797). In the Mongol nationality, SP-C exon 5(S186N) genotypes could check out three genotypes: namely AA, AG and GG. The frequencies of allele A and allele G of SP-C exon 5(S186N) were not statistically different between NRDS group and control group (χ2=0.493, P=0.782). Conclusion SP-C exon 4(T138N) and exon 5(S186N) gene polymorphism in Inner Mongolia newborns displays no significant correlation with sex, birth weight or gestational age. SP-C gene mutations are not found in exon 4 and 5. SP-C gene exon 4(T138N) and exon 5(S186N) polymorphisms are not found to be associated with NRDS in Mongol nationality of the Inner Mongolia. Key words: Respiratory distress syndrome; Surfactant protein C; Gene polymorphisms; Newborn

Nanostructure of Red Blood Cell Membranes in Premature Neonates with Respiratory Distress Syndrome

Objective: to study the nanostructure of red blood cell membranes in premature babies with neonatal respiratory distress syndrome (NRDS), by applying atomic force microscopy. Subjects and methods. The investigation included 27 newborn infants, of them 13 premature babies with NRDS formed a study group. The mean gestational age was 33.1±2.3 weeks; their birth weight was 1800±299.3 g. A comparison group consisted of 14 full-term babies with favorable pregnancy and term labor. The mean gestational age of the babies was 39.4±0.5 weeks; their birth weight was 3131.7±588.8 g; the infants had a one minute Apgar score of 8±0.4. Their red blood cells were examined using an atomic force microscope. The objects to be examined were residual umbilical cord blood (RUCB) from the premature infants; central venous blood after 7 hours of birth and neonatal venous blood taken on day 7 of life. Results. RUCB from full-term babies contained planocytes that were a major morphological type of red blood cells. In physiological pregnancy and acute fetal hypoxia, the morphological composition of red blood cells in premature neonates with NRDS was close to that in full-term babies. The planocytes are also a major morphological type of red blood cells in the premature infants; the frequency of their occurrence varies. Stomatocytes are typical of all the neonates in the NRDS group; their frequency levels vary greatly: from 8 to 65% of the total number of erythrocytes. The examination revealed that the premature infants of 31—36 weeks gestation were characterized by abnormal erythrocyte shapes that showed a high variability. At birth, the premature babies were found to have changes in the nanostructure of red blood cell membranes, which were influenced by intrauterine hypoxia. The first-order value reflecting flickering in the red blood cell membrane varies to the most extent. Conclusion. Atomic force microscopy showed that the greatest changes in the structure of red blood cell membranes were found in RUCB. The premature babies with NRDS had intrauterine poikilocytosis caused by unfavorable factors, as confirmed by the presence of multiple correlations. Analysis of the nanostructure of red blood cell membranes revealed that the first-order value reflecting flickering in the red blood cell membrane was most sensitive; this indicator showed a slow normalization. Correspondence to: Key words: red blood cell membrane, nanostructure, planocytes, stomatocytes, premature newborn infants, respiratory distress syndrome.