Prevention Of Respiratory Distress Syndrome Research Articles

Artificial intelligence in the prevention of respiratory distress syndrome

Malformations in fetal development affect the health of the product and the mother. Preventing illnesses during gestation, allows for a healthy and dignified life at birth. Data from INEGI in its report on Fetal Death Statistics (EFD) 2022, show that in Mexico there is an average of 72.2 fetal deaths per 100,000 women of childbearing age. Of these deaths, 25,041 deaths were registered during the year 2022. 5950 deaths correspond to gestational disorders, respiratory or cardiovascular disorders and congenital malformations. Lung defects result in induced abortion or Respiratory Distress Syndrome (RDS). RDS can be prevented by clinical studies and radiological criteria. Identification of abnormal developments using digital analysis of lung images during pregnancy can help identify a defect. We propose ONE classification tool using deep learning in a multiclass categorization of bronchopulmonary sequestration, cystic malformations and diaphragmatic hernia, where there is a risk of defect appreciation and thus misjudgment leading to complications or death. Resulting in a model accuracy of 88.88%, out of a set of 42 two-dimensional sonograms.

Current approaches to respiratory pathology in late preterm infants

Late preterm babies are those born between 340/7 and 366/7 weeks of gestation, constituting the largest subgroup of preterm infants. Despite the relative morphofunctional maturity, these children remain at a high risk of damage to various organs and systems, and there is also a high mortality rate. One of the top places in the structure of morbidity in late preterm is occupied by respiratory disorders. Quite often there is transient tachypnea, respiratory distress syndrome of the newborn, pulmonary hypertension, and congenital pneumonia. Currently, there are various approaches to prevention, treatment, and diagnosis of respiratory disorders in late preterm children. Until now, the issue of the advisability of prenatal prevention of respiratory distress syndrome with corticosteroids after the 34th week of gestation has not been resolved. Non-invasive methods of respiratory support are more popular along with minimally invasive administration of surfactant preparations when indicated. The trend towards an annual increase in late preterm births determines the need to improve the methods of their nursing. The control over respiratory disorders and hypoxia is crucial in the prevention of adverse outcomes in late preterm children.

A comparison of 2 doses of antenatal dexamethasone for the prevention of respiratory distress syndrome: an open-label, noninferiority, pragmatic randomized trial

Antenatal corticosteroids have been used for the prevention of respiratory complications, intraventricular hemorrhage, necrotizing enterocolitis, and other adverse neonatal outcomes for over 50 years, with limited evidence about their optimal doses. Higher steroid doses or frequencies of antenatal corticosteroids in preterm newborns pose adverse effects such as prolonged adrenal suppression, negative effects on fetal programming and metabolism, and increased risks of neurodevelopmental and neuropsychological impairments. Conversely, lower doses of antenatal corticosteroids may be an effective alternative to induce fetal lung maturation with less risk to the fetus. Late preterm births represent the largest population of all preterm neonates, with a respiratory distress syndrome risk of 8.83%. Therefore, determining the optimal antenatal corticosteroid dosage is of particular importance for this population. This study aimed to compare the efficacy of 5-mg and 6-mg dexamethasone in preventing neonatal respiratory distress syndrome in women with preterm births at 320 to 366 weeks of gestation. This was an open-label, randomized, controlled, noninferiority trial. Singleton pregnant women (n=370) at 320 to 366 weeks of gestation with spontaneous preterm labor or preterm premature rupture of membranes were enrolled. They were randomly assigned (1:1) to a 5-mg or 6-mg dexamethasone group. Dexamethasone was administered intramuscularly every 12 hours for 4 doses or until delivery. The primary outcome was the reduction in neonatal respiratory distress syndrome cases, whereas the secondary outcomes were any adverse maternal or neonatal events. Between December 2020 and April 2022, 370 eligible women, anticipating deliveries within the gestational range of 32 0/7 to 36 6/7 weeks, willingly participated in the study. They were evenly split, with 185 women assigned to the 5-mg group and 185 to the 6-mg group. The study revealed that the demographic profiles of the participants in the 2 groups were remarkably similar, with no statistically significant disparities (P>.05). It is noteworthy that most of these women gave birth after 34 weeks of gestation. Despite a substantial proportion not completing the full course of steroid treatment, the 5-mg dose exhibited noninferiority compared with the 6-mg dose of dexamethasone, as indicated by a modest proportional difference of 0.5% (95% confidence interval,-2.8 to 43.9). Neonatal respiratory distress syndrome occurred in a relatively low percentage of newborns in both groups, affecting 2.2% in the 5-mg group and 1.6% in the 6-mg group. Notably, the risk difference of 0.6% fell comfortably within the predefined noninferiority threshold of 10%. Our study suggests that a 5-mg dexamethasone dose is noninferior to a standard 6-mg dose in preventing neonatal respiratory distress syndrome in preterm births.

Features management of very early preterm birth

The objective: to determine features of tactics of very early preterm birth depending on the gestational age with the assessment of perinatal consequences. Materials and methods. The study involved 166 women of reproductive age with very early preterm birth (VEPB) at 22–27 weeks of gestation (the main criterion of inclusion). The patients were divided into two groups depending on the criteria of live birth: group 1 – 79 women, whose labor was regarded as late miscarriage (retrospective study); group 2 – 87 women, whose labor occurred as a very early premature (prospective study). Exclusion criteria: congenital malformations of the fetus. Patients of both groups had serious general and obstetric anamnesis, high frequency of inflammatory processes of the genitals, surgery and hormonal disorders with diseases caused by them. All women have got a comprehensive examination using clinical, instrumental and laboratory research methods. Results. The main complications of gestation in pregnant women of both groups in the second trimester were the threat of abortion and insufficiency of the fetoplacental (IFP), which caused fetal growth retardation syndrome (FGRS) in both groups – 66% and 63% of children, respectively. IFP in VEPB was confirmed histologically in 68% and 72% of cases in each group of mothers. Vaginal delivery occurred with 55 patients of group 1 and 26 women of group 2 (69,6% and 29,9%), among them in the period of 22–24 weeks – 100% and 57,1%, 25 weeks – 83,3% and 26,7%, 26–27 weeks – 57,7% and 24,1%, respectively, in each group. Indications for cesarean section (CS) in group 1 were mainly from the mother (75%), in group 2 – 27,8% from the mother, from the fetus – 4,9% (IFP), according to the combined indications – 65,6% (deep prematurity). Expansion of indications for CS in VEPB by 41% led to a decrease in perinatal mortality by 1,5 times (p<0,05). In the postpartum period, patients in both groups showed a decrease in purulent-septic complications on the background of preventive treatment from 13,9% (group 1) to 4,6% (group 2) (p<0,05). In the analysis of perinatal mortality, the highest rates were observed at 22–24 weeks of gestation, while they are 1,5 times lower at 25 weeks and 3,5 times lower at 26–27 weeks. The study found that the method of delivery did not affect perinatal outcomes at 22–25 weeks, but at 26–27 weeks, the survival of children born by CS surgery is higher than in spontaneous births, by 10% (p<0,05). Expansion of indications for the prevention of respiratory distress syndrome (RDS) of the fetus from 22 weeks in group 2 (in group 1 was not performed) by 10,7% led to an increase in survival of children with extremely low body weight (ELBW) by 11% (p<0,05). Conclusions. Under threat of VEPB the choice of delivery tactics is determined by the gestation period, the state of health of the mother and fetus, the degree of readiness of the birth canal for delivery. Premature pregnancy is not an indication for CS, except the specific obstetric indications, but abdominal delivery is possible for children in early pregnancy (22–25 weeks). The questions concerning the usage of instrumental care at birth, determination of gestational dates for the beginning of RDS prophylaxis with glucocorticoids, the necessity of using tocolysis remains ambiguous. Proper definition of management of women who give birth prematurely will allow timely implementation of measures aimed at improving the results for mother and newborn, and can be prognostic.

Перинатальні наслідки при передчасному розриві плодових оболонок до 36 тижнів вагітності

The purpose - to evaluate the clinical status of newborns in women with pregnancy complicated by preterm premature rupture of membranes (pPROM) and its relationship with the course of pregnancy and childbirth, the duration of the latency period between pPROM and delivery (LP), as well as with the levels of vitamin 25(OH)D and the expression of antimicrobial peptides (β-defensins 2) in the mother’s blood. Materials and methods. The condition and morbidity of newborns with preterm birth due to pPROM have been carefully studied. The levels of vitamin 25(OH)D and the expression of antimicrobial peptides (β-defensins 2) in the blood serum of 109 women with singleton pregnancy complicated by pPROM at 23-36 weeks of gestation and 20 pregnant women of the control group with intact membranes, who subsequently gave birth to full-term babies, were studied by enzyme-linked immunosorbent assay. Results. No significant relationship between the condition of newborns and the duration of LP was found. Medical tactics of pregnancy management with pPROM led to the presence of a direct relationship between the prolongation of LP and the prevention of respiratory distress syndrome with dexamethasone/betamethasone (r=+0.36; p<0.001), tocolytic therapy with nifedipine (r=+0.30; p<0.01) against the background of antibacterial therapy. Groups of pregnant women with different duration of LP were statistically comparable in terms of gestation at the time of delivery. The average content of vitamin 25(OH)D in the blood of pregnant women with pPROM was reduced by half (26.3±0.9 pg/ml vs. 52.9±2.4 pg/ml), and the expression level of β-defensins 2 - by 1.4 times compared to the control group (78.4±1.8 pg/ml vs. 107.4±2.6 pg/ml). It has been confirmed that the level of vitamin 25(OH)D in the blood of women with pregnancy complicated by pPROM is directly associated with the gestational age of the newborn (r=+0.22; p<0.05) and the corresponding assessments of its condition. Reliable associations of the expression level of β-defensins 2 in the mother's blood with the indicators of the course of pregnancy and perinatal period, as well as with certain characteristics of the condition of newborns were found. Conclusions. No reliable association between the condition of newborns and the LP was found, which can be explained by the adequate tactics of managing pregnant women with pPROM. A significant decrease in the levels of vitamin 25(OH)D and the expression of antimicrobial peptides (β-defensins 2) in blood serum of the examined pregnant women with pPROM compared to the control group was determined. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patients was obtained for conducting the studies. No conflict of interests was declared by the authors.

A Good Time to Be Born

A Good Time to Be Born

Effect of Antenatal Betamethasone on Respiratory Distress Syndrome in Preterm Neonates

Respiratory Distress Syndrome (RDS) is one of the most common complications that cause the death among pre-term neonates (PNs). Use of Antenatal betamethasone is the effective intervention for the prevention of RDS and reducing early neonatal mortality and morbidity. Although there is limited information as to how effective this practice in developing countries. Aim of this study is to evaluate the effectiveness of betamethasone on RDS in PNs. We conducted a prospective, observational multi-centered study at Gynecology and Obstetrics, Neonatal department of two teaching hospitals in South India over a period of 6 months. All babies born alive before 37 weeks of gestation were included in the study. The study population included 70 PNs and they were classified into three based on the consumption of betamethasone (no dose, single dose and double dose). Among them, 28(40%) belonged to no dose, 25(35.7%) in single dose and 17(24.2) in double dose. Neonates whose mothers received two doses of betamethasone had a significantly lower incidence of RDS (P=0.043) than neonates whose mothers received a single dose of betamethasone (P=0.343). We concluded that a single complete course of betamethasone (Two doses of betamethasone 12mg 24 hours apart) is efficacious than one dose of betamethasone in prevention of RDS.

Current strategies for the prevention of RDS in premature infants and possibilities of using them in the RT

Aim. To analyze modern strategies for the prevention of respiratory distress syndrome and the possibility of their use in RT.Material and methods. The analysis was carried out based on directives of the Government of the Republic of Tajikistan, regulations, and normative documents for obstetric institutions approved by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, and the data from annual reports of structural units.Results. The paper outlines an approach to monitoring a pregnant woman based on the 5th updated European Consensus Guidelines for the Management of Newborns with Respiratory Distress Syndrome. It presents positive and negative arguments for the effect of steroid drugs on the fetus and recommendations for their use at the stage of management of pregnant women with a high risk of preterm birth, depending on the gestation period. It also includes a brief comparative analysis with national clinical protocols for the management of preterm labor and tocolytic therapy.Conclusion. Early identification of pregnant women at high risk of termination and providing them with effective care following modern strategies, reduce the adverse perinatal outcomes.

The management of very early preterm birth

The objective: a determination of the management for very early preterm birth, depending on the gestational age, and an assessment of perinatal outcomes. Materials and methods. The study involved 166 women of reproductive age with very early preterm birth (VEPB) at 22–27 weeks of gestation. The patients were divided into two groups depending on the criteria of live birth: the 1st group – 79 women whose labor was as a late miscarriage (retrospective study); the 2nd group – 87 women with very early preterm birth (prospective study). Exclusion criteria: congenital malformations of the fetus. All women were examined using clinical, instrumental and laboratory research methods.Results. The main complications of gestation in pregnant women of both groups in the II trimester were the threat of pregnancy interruption and placental dysfunction (PD), which led to the development of fetal growth retardation in both groups (66% – in the 1st group, 63% – the 2nd group). The presence of PD by VEPB was confirmed histologically in 68% and 72% of cases in each group, respectively. 55 (69.6%) patients of the 1st group and in 26 (29.9%) women of the 2nd group had vaginal delivery. Indications for cesarean section (CR) in the 1st group were mainly from the mother (75%), in the 2d group 27.8% persons had indications from the mother, 4.9% (PD) – from the fetus, combined indications were determined in 65.6% (deep prematurity). The expansion of indications for CS by VEPD in 41% led to a 1.5-fold decrease in perinatal mortality (p<0.05). In the postpartum period, patients of both groups had a decrease frequency of purulent-septic complications after the preventive treatment from 13.9% (the 1st group) to 4.6% (the 2d group) (p<0.05). The analysis of perinatal mortality demonstrated a high rate at 22–24 weeks of gestation, while this indicator was in 1.5 times lower at 25 weeks and 3.5 times lower at 26–27 weeks. We found that the method of delivery did not affect perinatal results at 22–25 weeks, but at 26–27 weeks the survival rate of newborns born by CS is on 10% higher than by spontaneous delivery (p<0.05). The expansion of indications for the prevention of respiratory distress syndrome of the fetus from 22 weeks in the 2nd group (in the 1st group was not performed) by 10.7% led to an increase in the survival rate of children with extremely low body weight by 11% (p<0.05).Conclusions. In cases of threat of VTPB, the management is determined by the gestational age, the state of health of the mother and the fetus, the degree of readiness of the birth canal for delivery. Premature delivery is not an indication for CS, except for the presence of specific obstetric indications, but abdominal delivery is possible in early pregnancy (22–25 weeks). The questions about the operated vaginal delivery, the determination of the gestational age for the prevention of respiratory distress syndrome with glucocorticoids, the need to use tocolysis are controversial. The correct determination of the management of women with preterm birth will allow to apply timely measures to be taken to improve the results for the mother and the newborn and may have a prognostic character.

Efficacy of Antenatal Corticosteroid Injection in the Prevention of Neonatal Respiratory Distress Syndrome after C-Section

Aim: To determine the efficacy of antenatal corticosteroid in the prevention of respiratory distress syndrome of the neonates in women undergoing elective cesarean section at term pregnancy. Study design: Descriptive case series Place and duration of study: Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar from 6th December 2018 to 6th May 2019. Methodology: One hundred and seventy five women were enrolled. The women after taking complete history with obstetrical examination and antenatal corticosteroid administration i.e. 12 mg dexamethasone IM (two doses 12 hours apart) were observed. The caesarean section was performed by experienced obstetrician having minimum of five years of experience after 24 hours and within seven days of the second dose of dexamethasone. All the neonates were carefully examined in NICU for the detection of respiratory distress syndrome. All these observations were done under supervision of an expert pediatrician having minimum of five years of experience. Results: The mean age was 28±11.34 years. Thirty five percent patients had POG range 37+ weeks while 65% patients had POG range 38+ weeks. Mean POG was 37±1.12 weeks. More over antenatal corticosteroid was effective in 97% patients and was not effective in 3% patients. Conclusion: The antenatal corticosteroid was 97% effective in the prevention of respiratory distress syndrome of the neonates, in women undergoing ELSC at term after elective caesarean section for term pregnancy. Keywords: Efficacy, Antenatal corticosteroid, Respiratory distress syndrome, Neonates, Elective C- section,

Morphofunctional features of platelets in premature newborns with very low and extremely low body weight

Background. Currently, the development of medicine in the field of perinatology is aimed at improving the quality of medical care for newborns, especially those born prematurely. Premature newborns are most likely to develop hemorrhagic disorders, which often aggravates their condition and determines high morbidity and mortality. On modern hematological analyzers, it has become possible to evaluate a larger number of blood parameters, including platelet parameters, however, there are a small number of studies devoted to the study of platelet parameters in premature newborns. The aim was to study the morphofunctional features of platelets in premature newborns with very low and extremely low body weight. Materials and methods. The study included 78 newborns born at 2534 weeks of gestation, with a body weight of less than 1500 grams. On the 3rd5th day of life, a clinical blood test was performed on the Advia 2120i hematological analyzer (Siemens), with the determination of platelet parameters: PLT, 103 cells/l, PCT, %, PDW, %, Large Plt, 103 cells/l, MPC, g/dl, MRM, pg. Results. In newborns with ELBW, a decrease in the number and granularity of platelets in the blood, an increase in the average dry mass of platelets was found. Newborns with intrauterine growth retardation have a reduced platelet count and reduced thrombocrit. In premature newborns with a gestational age of 2527 weeks, blood circulation of platelets with a reduced volume was established, and in newborns who were born at a gestational age of 3234 weeks with increased granularity. In the absence of antenatal prevention of respiratory distress syndrome in newborns, there is a decrease in thrombocrit, the number of platelets, including large forms in the blood. In premature newborns born in a state of severe asphyxia, a decrease in platelet granularity was noted. The use of high concentrations of O2 in the oxygen-air mixture during respiratory therapy leads to a decrease in the number of platelets in the blood. Conclusions. Factors determining the morphofunctional state of platelets in premature newborns were established: the presence of a full course of antenatal prevention of respiratory distress syndrome of newborns, gestational age, the severity of asphyxia at birth, as well as the concentration of O2 in the oxygen-air mixture used in respiratory therapy. Newborns with ELBW have a reduced platelet count, low-granulated platelets, and an increased average dry platelet mass. Newborns with intrauterine growth retardation have a reduced number of platelets and thrombocrit in the blood. The revealed morphofunctional features of platelets allow us to clarify the nature of changes in the platelet link of hemostasis in premature newborns for the timely prevention of complications during the underlying disease.

Antenatal injection betamethasone- A fetal lung warrior

One of the most frequent causes of neonatal mortality or NICU admission of neonates especially in premature infants is Neonatal Respiratory Distress Syndrome (NRDS). Antenatal steroids are the most important and widely utilized interventions for improvement of neonatal outcomes like reducing incidence of respiratory distress syndrome (RDS), reducing neonatal NICU (neonatal intensive care unit) admission rates and also improve outcomes of pre-term infants. Antenatal steroids (ANS) like betamethasone 12 mg are given at 24 hourly IM at 28-34 weeks of gestation to mother. For administration of corticosteroids at less than 24 weeks of gestational age decision should be made at a senior level by taking all clinical aspects into consideration.To observe the effect of Betamethasone administration IM in pregnant women at risk of pre-term delivery and fetal outcomes in terms of development of Respiratory Distress Syndrome (RDS) and Neonatal Intensive Care Unit (NICU) admission rate by giving it between 28 to 34 weeks of gestation.Antenatal corticosteroids (betamethasone) play an important role for prevention of respiratory distress syndrome and reducing NICU admission rate of new borns and also reduce neonatal mortality and morbidity but benefits related to the time between administration of corticosteroid and delivery needed to be explored. Benefits of the injection betamethasone administration IM 12 mg between 24 hours and seven days on pre-term delivery has been established.,This was prospective study conducted in private setup from November 2020 to March 2021 in Scientific Research Institute, Surendranagar, Gujarat, India. Study comprised of 100 women with single tone pregnancies (28 – 36 weeks gestational age) in age group of 19 – 33 years not in labour, but at risk for pre-term delivery based on fetal or maternal indications. These pregnant women were treated with two doses of 12 mg Betamethasone Intramuscularly apart of 24 hourly for maturation of fetal lungs.Antenatal corticosteroids like betamethasone have a significant benefit on neonatal outcome even if used after 34 weeks of pregnancy. This was given prophylactically to those who are known to have increased risk of pre-term labour. Antenatal steroid like betamethasone 12 mg IM is also of benefit to reduce neonatal respiratory distress syndrome (NRDS) and NICU admission rates by giving it at 28-34 weeks of gestational age.

Modern concepts of low birth weight and fetal growth restriction

The aim of this work is to study the state of the problem of the development of small-for-gestational-age fetus and fetal growth restriction over the past 5 years. A review of randomized trials of the PubMed database for the period of 2015 to 2020 was carried out. Experts reached an agreement on the definition of diagnostic criteria for small-for-gestational-age fetus and fetal growth restriction, a clinically valid classification was created, and the main monitoring strategies were developed. Due to the different pathogenesis, fetal growth restriction is divided into early and late. The observation algorithm includes tests that have shown higher sensitivity and specificity. There is no single standard for the median weight and abdominal circumference of a fetus, indicators of the reference range for fetal Doppler. Smoking cessation and taking acetylsalicylic acid at a dose of 150 mg at high risk of preeclampsia is recommended to prevent the small-for-gestational-age fetus and fetal growth restriction. The pregnancy management algorithm includes Doppler ultrasound examination of the umbilical artery, cardiotocography. If this pathology occurs before 32 weeks of pregnancy, the blood flow in ductus venosus is additionally examined, and after 32 weeks of pregnancy, the middle cerebral artery blood velocities and cerebroplacental ratio are assessed. Indicators of Doppler velocimetry and cardiotocography, which serve as criteria for early termination of pregnancy, are developed, measures are proposed to improve neonatal outcomes prevention of respiratory distress syndrome at 2434 weeks of gestation, as well as magnesium therapy for fetal neuroprotection. The problems of preventing fetal growth restriction and the algorithm for monitoring pregnant women who do not have risk factors for small-for-gestational-age fetus, management tactics and indications for delivery while slowing fetal weight gain remain unresolved.

FETAL ALCOHOL SPECTRUM DISORDERS: LITERATURE DATA AND A CLINICAL CASE

According to statistical data, from 3 to 10% of women in many countries of the world abuse alcohol during pregnancy which results in the formation of fetal alcohol spectrum disorders (FASDs). The definition includes fetal alcohol syndrome (FAS); Partial Fetal Alcohol Syndrome (PFAS); Alcohol-related Neurodevelopmental Disorders (ARND) Alcohol-related Birth Defects (ARBD).
 According to the criteria of the Center for Disease Control and Prevention, (CDCP, USA) the major FASDs features are facial dysmorphology (smoothing of the nasolabial groove, flat upper lip, shortened eyelid openings); growth retardation (ante- or postnatal body weight or body length ≤ 10 percentiles); functional disorders of the nervous system (global cognitive deficiency, minor movement dysfunction, attention deficiency disorder and hyperactivity, sensor disorders, memory deficiency, social adaptation problems); structural disorders of the nervous system (head circumference ≤ 10 percentile (or ≤ 3 percentile for children with body weight ≤ 10 percentile) or clinically significant cerebral abnormalities found by neurovisualization). Combination of the above mentioned signs with maternal alcoholism during pregnancy in anamnesis underlies FASD diagnostics. 
 According to the findings of certain researchers the major pathogenic links of FASDs are associated with ethanol toxic effect on the fetal metabolism, that is, activation of oxidative stress processes and decreased intensity of antioxidant protection; reduced expression of genes essential for development; activation of nerve cells apoptosis; delay of the cellular neuron migration and disorders of their proliferation against insufficiently active enzymatic system of the liver participating in ethanol neutralization.
 The article presents a clinical case of FASDs in a newborn girl born from ХІ pregnancy; a pregnant woman who was not registered concerning pregnancy, did not undergo screening examinations, smoked and drank regularly. The girl was born after Х physiological labor in 34 weeks of gestation after preterm rupture of the amniotic sac and anhydrous period of 160 hours. Complete antenatal prevention of respiratory distress-syndrome was performed.
 The body weight of the girl at birth was 1600 g, the body length – 43 cm. The child’s condition at birth was assessed as compensated by vital functions, and Apgar score was 8/8. According to the assessment of the nervous-muscular and physical maturation by the New Ballard Score the girl was estimated 25 corresponding to 33 weeks of gestation. Assessment of physical development found the body mass value lower than 10 centile, the body length and head circumference – within the range of 10-90 centile. During physical examination dysmorphic signs were determined including smoothed nasolabial groove (5 points), thin flat upper lip, and shortened eyelid openings. The course of postnatal adaptation of the neonate was complicated by neurological symptoms manifested by the signs of inhibition syndrome. After comprehensive medical aid was provided, the girl was discharged from hospital in a satisfactory condition with recommendations about the necessity of including the child into the catamnestic follow-up with careful assessment of its physical and nervous-psychic development. 
 Diagnostics of FASDs is a complicated medical diagnostic process which is best ensured by means of a structural interdisciplinary approach of a strong clinical team consisting of specialists of various areas with mutually complementary experience, qualification and skills. An important role of a neonatologist in detection of children with FASDs is hardly overestimated concerning consistent provision of medical first aid and development of a professional diagnostic way, referral to catamnestic follow-up service and further rehabilitation.

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

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

A Randomised Controlled Trial of 12 Hours vs 24 Hours Betamethasone Dosing Interval in Preterm Premature Rupture of Membranes for Prevention of Respiratory Distress Syndrome (RDS) in Neonates

A Randomised Controlled Trial of 12 Hours vs 24 Hours Betamethasone Dosing Interval in Preterm Premature Rupture of Membranes for Prevention of Respiratory Distress Syndrome (RDS) in Neonates

TREATMENT OF RESPIRATORY DISTRESS-SYNDROME IN PRETERM NEWBORNS WITH THE USE OF EXOGENOUS SURFACTANT (PORACTANT ALFA): CLINLCAL GUIDLINES

Respiratory distress-syndrome (RDS) is an acute lung disease that occurs mainly in pretermnewborns due to deficiency of pulmonary surfactant and immaturity of the respiratory system. Its symptoms appear shortly after birth, and the clinical course in the absence of treatment is characterized by a worsening condition during the first 2 days of life.Despite the improvement and effectiveness of the prevention and treatment of RDS, this disease remains an important cause of death in newborns. According to European data, mortality associated with RDS can reach 10%, and according to the latest official statistical data from the United States, this disease ranks 8thamong the most important causes of death in infants.According to official statistical data from obstetrical hospitals, the incidence of RDS in Ukraine in 2016 was 194 cases per 1000 premature babies. The majority of patients in modern Ukrainianneonatal intensive care units die from the complications associated with this disease, especially intraventricular hemorrhages.The clinical recommendations contain sections on the etiology, pathogenesis, clinical presentation, antenatal prevention of RDS with recommendations for stabilizationafter birth and further,at the neonatal intensive care unit. Separately, the metabolism of surfactant, the importance of drug selection and the correct dose of surfactant use, practical recommendations on its use, indications, preparation for use and administration techniques are presented taking into account the international evidence-based data.Clinical guideline was elaborated for neonatologists, pediatric anesthesiologists and residents to improve the quality of medical care for preterm newborns at risk for developing or having RDS; the optimization of methods of medical care for preterm newborns to decrease the incidence of the disease, development of complications and mortality of premature babies at risk for or developing RDS.

Comparison between two doses of betamethasone administration with 12 hours vs. 24 hours intervals on prevention of respiratory distress syndrome: a randomised trial

The purpose of the present study was to compare the effect of a two-dose administration of betamethasone with 12 hours interval vs. 24 hours interval on neonatal respiratory distress syndrome (RDS). The study was performed as a randomised clinical trial on 201 pregnant women with a gestational age of 26–34 weeks. In one group 12 mg of betamethasone every 12 hours for two doses and in the other group 12 mg of betamethasone every 24 hours for two doses were prescribed intramuscularly. There were no significant differences between the two groups according to maternal age, parity, gravidity, BMI, neonatal sex, need to surfactant, NICU admission, NICU stay, neonatal death, neonatal sepsis and Apgar score at minutes 1 and 5, but the gestational age at the beginning of the study and delivery receiving complete course of betamethasone and neonatal weight were lower in 24 hours group. RDS, necrotising enterocolitis, intra-ventricular haemorrhage and chorioamnionitis were more in the 24 hours’ group. Multiple regression analysis showed that RDS and IVH (p = .022, RR = 0.07, CI95% 0.006–0.96 and p = .013; RR = 0.9, CI95% 0.1–0.89, respectively) were more in the 24 hours group and neonatal death (p = .034, RR = 4.7, CI95% 1.07–16.2) and NEC (p = 0.038, RR = 2.5, CI95% 1.7–3.7), were more in the 12 hours group. In conclusion, it seems that 12 hours interval betamethasone therapy may be considered as an alternative treatment in the case of preterm labour for acceleration of lung maturity; however, it is suggested that more studies should be performed on this issue and various morbidities.IMPACT STATEMENTWhat is already known on this subject: Administration of a single course of corticosteroids in all women with a gestational age of 24–34 weeks of pregnancy who are at risk for preterm labour and delivery has been recommended. The accepted regimen by National Institutes of Health (NIH) is an injection of betamethasone for two doses with 24 hours interval.What do the results of this study add: Twelve hours interval betamethasone therapy may be considered as an alternative treatment in the cases of preterm labour for acceleration of lung maturity.What are the implications of these findings for clinical practice and/or further research: Prescription of two doses (complete regimen) is more important than the interval between two doses for obtaining the maximum effect in a preterm birth.

Evaluation of the Need for Prophylactic Surfactant at 27-28 Weeks Gestation

Objective: Evaluate outcomes in 27-28 week gestation infants before and after a change in prophylactic surfactant guidelines. Materials and Methods: This retrospective chart review followed a change in NICU guidelines (January 2013) in which recommendations for prophylactic surfactant target population were changed from all infants under 29 weeks' to those under 27 weeks'. All 27-28 week infants born 24 months before (PRE) and 24 months after (POST) the guideline change were searched by database. Demographic data and outcomes were evaluated using non-parametric ANOVA and Dunn's multiple comparisons test. Results : In a NICU where 92% of its 27-28 week neonates receive at least one dose of prenatal steroids, the groups differed in only two outcome measures: surfactant doses and ventilator days after discontinuing prophylactic surfactant. Conclusions : This study suggests that there is no clear benefit and potential risk to prophylactic surfactant administration in 27-28 week gestation neonates. More studies may be useful to redefine criteria (or need) for prophylactic surfactant. Relevance: As prenatal steroids for prevention of respiratory distress syndrome has become more prevalent, we may need to reassess the routine use of surfactant in extremely and very low birthweight infants.

Antenatal Corticosteroids for the Prevention of Respiratory Distress Syndrome in Premature Twins.

To estimate whether antenatal corticosteroids before 34 weeks of gestation are associated with reduced incidence of respiratory distress syndrome (RDS) and composite neonatal morbidity in preterm twins. This was a secondary analysis of a multicenter randomized trial for the prevention of preterm birth in multiple gestations. All liveborn, nonanomalous twins delivered between 24 0/7 and 36 6/7 weeks of gestation were included. Neonatal outcomes were compared between women who received antenatal corticosteroids and those who did not. The primary outcome was the incidence of RDS. The secondary outcome was the incidence of serious composite neonatal morbidity. Multivariable log Poisson regression with correlation adjustment between twins born to the same mother was performed for confounder control. Adjusted relative risks (RRs) are reported for study outcomes. Based on a post hoc power analysis, this study was powered to detect an RR less than 0.63 for RDS and greater than 1.43 for composite neonatal morbidity outcomes. A total of 432 women (850 neonates) were included. Only 300 (35%) neonates were born to women receiving antenatal corticosteroids. After multivariable regression, antenatal corticosteroids were not associated with a reduced incidence of RDS (81 [27%] compared with 92 [17%] neonates, adjusted RR 1.28, 95% confidence interval [CI] 0.97-1.71) or composite neonatal morbidity (87 [29%] compared with 108 [20%] neonates, adjusted RR 1.21, 95% CI 0.93-1.56). However, antenatal corticosteroids were associated with increased rates of neonatal intensive care unit admissions (235 [78%] compared with 322 [59%] neonates, adjusted RR 1.22, 95% CI 1.09-1.36) and mechanical ventilation (70 [23%] compared with 66 [12%] neonates, adjusted RR 1.52, 95% CI 1.12-2.09). Focusing analysis to newborns delivered before 34 weeks of gestation (n=311), 161 (52%) received antenatal corticosteroids. Similarly, no differences in the rate of RDS (66 [41%] compared with 68 [45%] neonates, adjusted RR 1.01, 95% CI 0.76-1.34) or composite neonatal morbidity (72 [45%] compared with 81 [54%] neonates, adjusted RR 0.95, 95% CI 0.74-1.22) were noted. In this cohort of preterm twins, antenatal corticosteroid administration was not associated with a reduced incidence of RDS and composite neonatal morbidity.