Respiratory Distress In Newborn Research Articles

Successful Nasal Continuous Positive Airway Pressure for Newborn Respiratory Distress in a Regional Centre

We wish to present our experience using nasal continuous positive airway pressure (nCPAP) in a regional town over a 5-year period. Kalgoorlie is located 595 km east of Perth in Western Australia, with a population of 31 107. With over 800 deliveries each year, around 100 infants require nursery care annually. The level 2 nursery caters for babies born 34 weeks and over with the intent to transfer those <34 weeks gestation in utero to the tertiary centre. Prior to 2008, most neonates presenting with respiratory distress were transferred to Perth. In 2008, the team of three paediatricians started offering nCPAP therapy for infant respiratory distress. The Western Australian Neonatal Network facilitated up-skilling of nurses with CPAP training as well as a 1–2 week rotation at the tertiary hospital. A process of ongoing training for nurses and junior doctors supervised by a paediatrician and neonatal nurse was commenced at Kalgoorlie. Bubble CPAP was commenced using Hudson prongs and Fisher and Paykel Healthcare Bubble CPAP System. We adhered to the King Edward Memorial Hospital Neonatal guidelines for CPAP.1 A paediatrician was available on site during working hours and as Kalgoorlie is a small town geographically could attend to emergencies out of hours within10 min. Fifty-five babies were treated with CPAP when they developed respiratory distress. Of these, over half were term gestation, 14 (25%) 35–37 weeks gestation and 11 (20%) 32–34 weeks. The conditions requiring nCPAP were transient tachypnoea of the newborn, hyaline membrane disease, meconium aspiration syndrome, sepsis and birth asphyxia. None of the babies developed nasal trauma or pneumothorax while on CPAP. The majority 37 (67%) were discharged home without needing transfer to a tertiary centre (Fig. 1). Eighteen babies (33%) were transferred to the tertiary hospital. In eight instances, there was shortage of nursing staff; seven were sent for further investigations and management of complex conditions. Disposition of babies treated with nCPAP. Nasal CPAP is safe and effective therapy for infant respiratory distress even in a regional hospital.2 With adequate training of the staff and availability of paediatrician cover, nCPAP therapy reduces the number of transfers to tertiary facility. Although we acknowledge there was a small number treated over 5 years, our experience suggests that nCPAP is a feasible treatment option for late preterm and term infants even in regional centres.

Congenital Saccular Cyst of the Larynx: A Rare Cause of Stridor in Neonates And Infants

Stridor is a noise caused by the passage of turbulent air through a diminished airway caliber. Laryngomalacia is the most common congenital anomaly of the larynx and the principal cause of stridor in children under 6 months.A less common aetiology of stridor and respiratory distress in newborns and infants is congenital laryngeal saccular cyst. This entity should be considered in the differential diagnosis of stridor. Early recognition and proper treatment are essential because it can cause life-threatening airway obstruction.We describe our experience with 4 patients with this disease, 3 of them were successfully treated with microsurgical resection of the cyst, and we emphasise the importance of considering the endoscopic evaluation of the airway in every child exhibiting stridor with an unexpected evolution to determine the causal lesion.

Quiste sacular congénito de laringe: una causa rara de estridor en neonatos y lactantes

Stridor is a noise caused by the passage of turbulent air through a diminished airway caliber. Laryngomalacia is the most common congenital anomaly of the larynx and the principal cause of stridor in children under 6 months.A less common etiology of stridor and respiratory distress in newborns and infants is congenital laryngeal saccular cyst. This entity should be considered in the differential diagnosis of stridor. Early recognition and proper treatment are essential because it can cause life-threatening airway obstruction.We describe our experience with 4 patients with this disease, 3 of them successfully treated with microsurgical resection of the cyst, and we emphasize the importance of considering the endoscopic evaluation of the airway in every child exhibiting stridor with an unexpected evolution to determine the causal lesion.

Low Apgar scores at 5 minutes in a low risk population: Maternal and obstetrical factors and postnatal outcome

To evaluate the association between Apgar scores of less than seven at five minutes (AS5min < 7) and antenatal factors and postnatal outcomes. A retrospective cohort and case-control study of 27,252 consecutive term newborns in a low risk obstetrical population between January 2003 and December 2010. Maternal and infant databases were reviewed from all cases with AS5min < 7 (n = 121; 0.4%) and 363 cases with AS5min > 7 at 5 minutes who were randomly selected by a computer program. The main outcomes were neonatal death, newborn respiratory distress, need for orotracheal intubation and neonatal intensive care unit (NICU), and hypoxic-ischemic-encephalopathy. After multiple regression analysis, repeated late decelerations on cardiotocography (OR: 2.4; 95% CI: 1.4-4.1) and prolonged second stage of labor (OR: 3.3; 95% CI: 1.3-8.3) were associated with AS5min < 7, as well as neonatal respiratory distress (OR: 3.0; 95% CI: 1.3-6.9), orotracheal intubation (OR: 2.5; 95% CI: 1.2-4.8), need for NICU (OR: 9.5; 95% CI: 6.7-16.8), and hypoxic-ischemic-encephalopathy (OR: 14.1; 95% CI: 3.6-54.7). No other antenatal factors were associated with AS5min < 7 (p > 0.05). Repeated late decelerations and prolonged second stage of labor in the low-risk population are predictors of AS5min < 7, a situation associated with increased risk of neonatal respiratory distress, need for mechanical ventilatory support and NICU, and hypoxic-ischemic-encephalopathy.

Respiratory Distress and the Bacteria Causing Infection in the Neonates

An analysis of 64 samples of (blood, vagina, anaus) from pregnant mothers and their neonates, only 58 samples showed these types of bacteria Streptococcus agalactiae(GBS), Staphylococcus aureus and Escherichia coli, distributed as: 16 blood isolates from mothers and 25 from neonates, while 13 vaginal isolates from mothers and 4 anal isolates from neonates. Bacterial components (phospholipids-PL) purified by High Performance Liquid Chromatography (HPLC), and identified as Cardiolipin (CL) with retention time (10.76 min.), Phosphatidylserine (PS) (8.1min.), and Phosphatidyl ethanolamine (PE) (5.9 min.) compared with standard PL. GBS isolates produced more extracellular phospholipids than other types in thisstudy.&#x0D; The three types of bacteria differed in their levels of virulence when injected intratracheally in to a neonatal rabbit model to determine whether they induced pulmonary hypertension in it. After 8 days the rates of surviving neonatal rabbits were 2/15 (13.33%) to GBS, 5/15 to E.coli (33.33%), and 7/15 (46.66%) to S.aureus. The recognition that bacterial phospholipids may cause respiratory distress in newborns with these kinds of bacteria opens new avenues for therapeutic intervention.

Respiratory syncytial virus potentiates ABCA3 mutation-induced loss of lung epithelial cell differentiation

ATP-binding cassette transporter A3 (ABCA3) is a lipid transporter active in lung alveolar epithelial type II cells (ATII) and is essential for their function as surfactant-producing cells. ABCA3 mutational defects cause respiratory distress in newborns and interstitial lung disease (ILD) in children. The molecular pathomechanisms are largely unknown; however, viral infections may initiate or aggravate ILDs. Here, we investigated the impact of the clinically relevant ABCA3 mutations, p.Q215K and p.E292V, by stable transfection of A549 lung epithelial cells. ABCA3 mutations strongly impaired expression of the ATII differentiation marker SP-C and the key epithelial cell adhesion proteins E-cadherin and zonula occludens-1. Concurrently, cells expressing ABCA3 mutation acquired mesenchymal features as observed by increased expression of SNAI1, MMP-2 and TGF-β1, and elevated phosphorylation of Src. Infection with respiratory syncytial virus (RSV), the most common viral respiratory pathogen in small children, potentiated the observed mutational effects on loss of epithelial and acquisition of mesenchymal characteristics. In addition, RSV infection of cells harboring ABCA3 mutations resulted in a morphologic shift to a mesenchymal phenotype. We conclude that ABCA3 mutations, potentiated by RSV infection, induce loss of epithelial cell differentiation in ATII. Loss of key epithelial features may disturb the integrity of the alveolar epithelium, thereby comprising its functionality. We suggest the impairment of epithelial function as a mechanism by which ABCA3 mutations cause ILD.

Phrenic nerve palsy: A rare cause of respiratory distress in newborn

Birth injury is defined as an impairment of a newborn's body function or structure due to adverse influences that occurred at birth. Phrenic nerve palsy may result from birth trauma during a traumatic neonatal delivery from a stretch injury due to lateral hyperextension of the neck at birth. This could be a rare cause of respiratory distress in the newborn period with irregular respiration. Respiratory distress due to phrenic nerve damage leading to paralysis of the ipsilateral diaphragm may require continuous positive airway pressure or mechanical ventilation and if unresponsive, surgical plication of diaphragm. Herein, we report a case of phrenic nerve palsy in a newborn presenting with respiratory distress.

Correlation between transient tachypnea of the newborn and wheezing attack

Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns. Although associated with some morbidity, it is generally believed that once TTN resolves, there is no further increased risk for respiratory disease. However, in limited studies frequency of wheezing attacks is found to be increased in patients who had TTN diagnosis during the newborn period, in comparison to patients who had no respiratory problem. Thus, the question arises as to whether TTN is an innocent disease. This study was done retrospectively. We recorded the demographic characteristics of 103 infants born between 17 October 2003 and 17 October 2004 at Zeynep Kamil Hospital and hospitalized because of TTN in the neonatal intensive care unit. In the second phase, we telephoned the parents of the 103 infants and asked about wheezing attacks. A total of 103 other infants, born during the same period, with no health problems during the newborn period, were included in the study as the control group and the same procedures were applied to them. The rate of wheezing attack among patients with TTN diagnosis was found to be significantly higher than that in patients who had no TTN diagnosis (P < 0.01). TTN was found to be an independent risk factor for wheezing attack (OR, 2.378; 95% CI, 1.20-4.70). In conclusion, we established that TTN is an independent risk factor for wheezing. In addition we also hypothesized that genetic and environmental interactions synergistically predisposed these children for future wheezing.

Progress on vitamin A for newborn respiratory distress

Chronic lung disease (CLD) of prematurity is the major cause of long-term disability of extremely low birth weight ( ELBW ) premature infants, and it is the most cost consumptive disease in neonatal intensive care unit graduates. Vitamin A plays an important role in the development of premature lung. Nevertheless, premature infants are prone to vitamin A deficiency. Oral supplementation of vitamin A does not alter the incidence of CLD in ELBW infants. Intramuscular administration of vitamin A reduced the incidence of CLD. The treatment is considered painful and this way is not routinely practiced. Vitamin A is systemically bioavailable after intratracheal administration with surfactant in an animal model of newborn respiratory distress. Key words: Newborn ; Chronic lung disease; Vitamin A; lntratracheal administration

In vitro activity of the clinical pulmonary surfactant Surfacen® against Leishmania amazonensis

Surfacen® is an exogenous natural lung surfactant, composed by phospholipids and hydrophobic proteins, which is applied successfully in Newborn Respiratory Distress Syndrome. In this paper, in vitro activity of Surfacen® against Leishmania amazonensis is described. The product showed activity against the amastigote form found in peritoneal macrophages from BALB/c mice, with an IC50 value of 17.9 ± 3.0 µg/mL; while no toxic effect on host cell was observed up to 200 µg/mL. This is the first report about the antileishmanial activity of Surfacen®.

Newborn Respiratory Disorders

Newborn Respiratory Disorders

Impact of introducing binasal continuous positive airway pressure for acute respiratory distress in newborns during retrieval: Experience from Western Australia

We aimed to review the impact of introducing binasal continuous positive airway pressure (CPAP) for acute respiratory distress in newborns ≥32 weeks gestation during retrieval in Western Australia. Retrospective review of newborns ≥32 weeks gestation with acute respiratory distress, transported by the Western Australian Neonatal Transport Service between February 2002 and December 2004. Respiratory management of 369 newborns was examined. CPAP use increased significantly during the study period from 33% in 2002 to 59% in 2004. Overall, endotracheal tube (ETT) ventilation was required in 108 (29%), nasal CPAP in 166 (45%) and cot oxygen in 95 (26%) patients. Twenty-two (13%) newborns in the CPAP group subsequently required ETT ventilation within 24 h: these babies had higher initial oxygen requirements than those successfully transported on CPAP alone. There was no significant morbidity or mortality in patients retrieved on CPAP. CPAP was increasingly utilised as an alternative to ETT ventilation for the management of most cases of less severe acute respiratory distress in near-term neonates on retrieval. This review demonstrated that newborns requiring more than 45-50% oxygen at the time of retrieval were more likely to require intubation at a later time, and hence may benefit from intubation at the time of retrieval. A prospective randomised trial would assist in ascertaining the true benefit of CPAP during retrieval in the newborn period.

Summaries of Nursing Care-Related Systematic Reviews from the Cochrane Library : Intra-amniotic surfactant for preventing respiratory distress in newborns

Summaries of Nursing Care-Related Systematic Reviews from the Cochrane Library : Intra-amniotic surfactant for preventing respiratory distress in newborns

Vitamin A Is Systemically Bioavailable After Intratracheal Administration With Surfactant in an Animal Model of Newborn Respiratory Distress

Chronic lung disease (CLD) is a major cause of long-term morbidity in extremely LBW infants with respiratory distress syndrome. Parenteral vitamin A administration decreases the risk of CLD. We tested the hypothesis that intratracheal vitamin A administration with surfactant is systemically bioavailable without interfering with the functional properties of exogenous surfactant. Newborn piglets were ventilated with 100% FiO2 and sequential saline lavage induced respiratory distress syndrome. During lung injury induction, ventilator changes were allowed, but none were made following treatment allocation. Animals were assigned by chance in a blinded control trial to three groups: I=control; II=surfactant; III=surfactant+vitamin A. Hemodynamics, lung mechanics, and blood gases were measured following instrumentation, pre- and posttreatment for 4 h, at which time the liver was sampled for retinol determination. All parameters improved in animals receiving surfactant. A significant interaction existed between time and group for PaO2 and alveolar-arterial oxygen difference (A-aDO2). Hepatic levels of retinol were higher (p<0.001) in animals receiving retinyl acetate. Intratracheal administration of surfactant+vitamin A did not alter the beneficial effects of surfactant on lung compliance and gas exchange. Intratracheal Vitamin A was associated with rapid hepatic uptake. Further studies are warranted.

Intra-amniotic surfactant for women at risk of preterm birth for preventing respiratory distress in newborns.

Early surfactant reduces mortality and pulmonary complications in preterm infants with respiratory distress syndrome. However, current surfactant administration strategies require endotracheal intubation with or without continued mechanical ventilation. Bronchopulmonary dysplasia and chronic lung disease (CLD) are associated with mechanical ventilation and potentially life-long effects. Non-invasive methods of surfactant administration including intra-amniotic surfactant may avoid endotracheal intubation and mechanical ventilation, potentially preventing development of CLD. To determine if intra-amniotic instillation of surfactant for women at risk of preterm birth, compared to placebo or no treatment or post-delivery tracheal surfactant instillation, reduces morbidity or mortality, or both, in preterm infants. If intra-amniotic instillation is effective, in subgroup analysis to determine the effect of 1) gestational age; 2) type of surfactant; 3) dose; 4) timing; 5) indication; and 6) multiple pregnancy. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2009), MEDLINE (1950-August 2009), handsearched the Proceedings of Pediatric Academic Societies (American Pediatric Society, Society for Pediatric Research and European Society for Pediatric Research) from 1990-2009 in Pediatric Research Journal and Abstracts online and the Proceedings of Perinatal Society of Australia and New Zealand (PSANZ) (1996-2009). We also searched the Science Citation Index (Web of Science) (August 2009) and checked reference lists of identified studies. We contacted Abbott Laboratories, Inc for unpublished studies. Published, unpublished and ongoing randomised controlled, cluster-randomised or quasi-randomised trials of intra-amniotic instillation of surfactant for women at risk of preterm birth, compared to placebo or no treatment or post-delivery tracheal surfactant instillation. Three review authors independently assessed study eligibility and quality. We found no trials were found met the inclusion criteria for this review. We identified no randomised trials that evaluated the effect of intra-amniotic instillation of surfactant for women at risk of preterm birth. Evidence from animal and observational human studies suggest that intra-amniotic surfactant administration is potentially safe, feasible and effective. Well designed trials of intra-amniotic instillation of surfactant for women at risk of preterm birth are needed.

Emerging roles for transthoracic ultrasonography in pulmonary diseases

As a result of many advantages such as the absence of radiation exposure, non-invasiveness, low cost, safety, and ready availability, transthoracic ultrasonography (TUS) represents an emerging and useful technique in the management of pleural and pulmonary diseases. In this second part of a comprehensive review that deals with the role of TUS in pleuropulmonary pathology, the normal findings, sonographic artifacts and morphology of the most important and frequent pulmonary diseases are described. In particular, the usefulness of TUS in diagnosing or raising suspicion of pneumonia, pulmonary embolism, atelectasis, diffuse parenchymal diseases, adult and newborn respiratory distress syndrome, lung cancer and lung metastases are discussed, as well as its role in guidance for diagnostic and therapeutic interventional procedures. Moreover, the preliminary data about the role of contrast enhanced ultrasonography in the study of pulmonary pleural-based lesions are also reported. Finally, the limits of TUS when compared with chest computed tomography are described, highlighting the inability of TUS to depict lesions that are not in contact with the pleura or are located under bony structures, poor visualization of the mediastinum, and the need for very experienced examiners to obtain reliable results.

A Difficult Emergency Surgical Diagnosis: Atresia of the Common Pulmonary Vein

A newborn female experienced severe respiratory distress immediately after delivery. She presented with intense cyanosis, refractory hypoxemia, and acidosis. The deterioration was rapidly progressive, leading to the child's demise. The autopsy showed common pulmonary vein atresia, the most severe form of pulmonary venous drainage obstruction. Subpleural and interstitial pulmonary lymphagiectasias also were present as well as evidence of pulmonary hypertension. The lung pathology probably resulted from pulmonary venous atresia during prenatal development.

In vitro and in vivo analysis of high flow nasal cannulae compared with nasal CPAP for newborns

Nasal continuous positive airway pressure (CPAP) has been shown to be effective in the treatment of newborn respiratory distress syndrome. However, there can be mechanical difficulties in maintaining a seal with the small newborn nose. Humidified high flow nasal cannulae have been introduced as an alternative method for positive distending pressure. In this issue of The Journal, Lampland et al from Children's Hospital of Minnesota have compared the two approaches both in vitro and in vivo. In vitro they showed that the high flow nasal cannulae system did not tolerate leaks as small as 30%, resulting in a loss of positive pressure.

Congenital Chylothorax

Although pleural effusion is a rare cause of respiratory distress in newborns, being familiar with this disease is very important because of the generally favorable prognosis when the diagnosis is done early and therapy is prompt. We report a case of a full-term baby diagnosed with respiratory distress after 1 week of life. An X-ray of his chest showed a left pleural effusion. Moreover, a thoracentesis combined with a biochemical study of the pleural fluid confirmed the diagnosis of chylothorax. In our case, the conservative therapy was successful. The baby was followed up for a period of 6 months, with no evidence of recurrence. We have concluded, therefore, that conservative management should be the first line of treatment in chylothorax cases. If it does not work, a surgical approach might be considered.

Impact of timing of antenatal corticosteroid exposure on neonatal outcomes

Objective. To evaluate morbidities among neonates with a history of remote antenatal corticosteroid (ACS) exposure compared to those with recent exposure.Study Design. This is a retrospective-cohort study of neonates born at 30–33 6/7 weeks gestational age. The primary outcome was newborn respiratory distress syndrome (RDS) defined by the persistent need for oxygen at 24 h of life. Maternal chart review established timing of ACS exposure. Data were stratified by the time interval of ACS administration to delivery: none or <48 h (Incomplete/Unexposed), 48 h to 7 days (Recent) and >7 days (Remote). Perinatal outcomes were compared between groups.Resuts. Five hundred and twenty-four infants were included: 273 Incomplete/Unexposed, 120 Recent and 131 with Remote ACS exposure. RDS was significantly less frequent with Recent vs. Remote exposure (RR: 1.73 [1.01–3.02]p = 0.04). This finding persisted in a logistic regression model.Conclusions. Infants delivering more than 1 week after ACS exposure have a higher frequency of RDS than those who deliver within 1 week.