Respiratory Distress Syndrome Of Prematurity Research Articles

Management of neonates with respiratory distress syndrome in resource-limited settings.

In South Africa, prematurity stands as one of the foremost causes of neonatal mortality. A significant proportion of these deaths occur because of respiratory distress syndrome of prematurity. The implementation of non-invasive respiratory support, such as continuous positive airway pressure (CPAP), has demonstrated both safety and efficacy in reducing mortality rates and decreasing the need for mechanical ventilation. Given the absence of blood gas analysers and limited radiological services in many district hospitals, the severity of respiratory distress is often assessed through observation of the infant's work of breathing and the utilisation of bedside scoring systems. Based on the work of breathing, non-invasive therapy can be commenced timeously. While evidence supporting the use of high-flow nasal cannula as a primary treatment for respiratory distress syndrome remains limited, it may be considered as an alternative, provided that CPAP machines are available. The purpose of this article is to advocate the use of non-invasive therapy in low resource-limited settings and describe the indications, contraindications, complications, and application of CPAP therapy. This would benefit healthcare workers, especially in low-care settings and district hospitals.

Anesthesia Management in A Newborn Baby with Tracheoesophageal Fistula: A Case Report

Background: In infants with esophageal atresia/tracheoesophageal fistula, excessive salivation, coughing, choking, cyanosis, and regurgitation associated with attempts to eat may be seen, as well as aspiration of gastric contents. Thus difficulties encountered during anesthetic management include ineffective ventilation due to an endotracheal tube placed in the fistula, massive gastric dilatation, preexisting severe lung disease from aspiration of gastric contents and/or respiratory distress syndrome of prematurity, and associated anomalies, especially cardiac. This study aimed to discuss the anesthetic management of neonates with tracheoesophageal fistula.
 Case presentation: The patient was a 12-day-old baby girl with type C tracheoesophageal fistula. Anesthesia was performed using general anesthesia. The procedure lasts 3 hours 15 minutes. The patient underwent closure of the esophageal fistula, repair of the trachea in the distal part of the tracheoesophageal fistula, and performed end-to-end anastomosis proximal and distal esophagus. Postoperatively the patient was treated at the neonatal intensive care unit on a ventilator and given a combination of opioid and non-opioid analgesics.
 Conclusion: The key to successful anesthetic management in the operation of a patient with a tracheoesophageal fistula is airway management, where the ETT must be properly placed on the trachea and try not to get the ETT into the fistula.

A Good Time to Be Born

A Good Time to Be Born

Natural Versus Synthetic Surfactant Therapy in Respiratory Distress Syndrome of Prematurity.

To compare the clinical efficacy and the cost of treatment between the newborns who received either a natural or a protein-free synthetic surfactant for respiratory distress syndrome (RDS) of prematurity. This is a retrospective analytical study incorporating comparisons of clinical parameters and cost in newborns having RDS of prematurity who received either Survanta (bovine lung extract), a natural surfactant or Surfact (protein-free colfosceril palmitate), a synthetic surfactant. There were 100 newborns who received either of the natural (n = 52) or synthetic (n = 48) surfactant with mean (SD) gestational age and mean (SD) birth weight of 31.5 (2.6) wk, 1425 (461) g and 32.2 (2.2) wk, 1519 (413) g, respectively. Majority of the newborns (> 90%) received endotracheal surfactant within the first 24h of life and had similar baseline characteristics in either group. No differences were noted in ventilator settings on admission and 24h after surfactant/admission. Oxygen requirement, extubation age, complications, hospital stay, and mortality were similar across groups, except that the necrotizing enterocolitis was noted only in natural surfactant group. There was a significant pharmacy cost savings in synthetic surfactant group. Synthetic surfactant was comparable to natural surfactant with regard to outcomes, like ventilator settings, hospital stay, and mortality. Pharmacy cost was less in synthetic surfactant group.

Concept and clinical management of neonatal acute respiratory distress syndrome

In 2017, the Montreux diagnostic criteria for neonatal acute respiratory distress syndrome(ARDS) were released, which helps to decrease neonatal mortality and morbidity and the incidence of sequelae.However, how to use the diagnostic criteria remains confused for the neonatologists for its ambiguity of definition in clinical risk factors, differentiating from premature respiratory distress syndrome, and relationship between surfactant and neonatal ARDS.In the present review, these issues will be focused to better interpret and use the definition in dealing with neonatal ARDS. Key words: Acute respiratory distress syndrome; Pulmonary surfactant; Infant, newborn; Infant, preterm

Heated, Humidified High-Flow Nasal Cannula vs Nasal Continuous Positive Airway Pressure for Respiratory Distress Syndrome of Prematurity: A Randomized Clinical Noninferiority Trial.

Heated, humidified high-flow nasal cannula (HHHFNC) has gained increasing popularity as respiratory support for newborn infants thanks to ease of use and improved patient comfort. However, its role as primary therapy for respiratory distress syndrome (RDS) of prematurity needs to be further elucidated by large, randomized clinical trials. To determine whether HHHFNC provides respiratory support noninferior to nasal continuous positive airway pressure (nCPAP) or bilevel nCPAP (BiPAP) as a primary approach to RDS in infants older than 28 weeks' gestational age (GA). An unblinded, monocentric, randomized clinical noninferiority trial at a tertiary neonatal intensive care unit. Inborn infants at 29 weeks 0 days to 36 weeks 6 days of GA were eligible if presenting with mild to moderate RDS requiring noninvasive respiratory support. Criteria for starting noninvasive respiratory support were a Silverman score of 5 or higher or a fraction of inspired oxygen higher than 0.3 for a target saturation of peripheral oxygen of 88% to 93%. Infants were ineligible if they had major congenital anomalies or severe RDS requiring early intubation. Infants were enrolled between January 5, 2012, and June 28, 2014. Randomization to either HHHFNC at 4 to 6 L/min or nCPAP/BiPAP at 4 to 6 cm H2O. Need for mechanical ventilation within 72 hours from the beginning of respiratory support. The absolute risk difference in the primary outcome and its 95% confidence interval were calculated to determine noninferiority (noninferiority margin, 10%). An intention-to-treat analysis was performed. A total of 316 infants were enrolled in the study: 158 in the HHHFNC group (mean [SD] GA, 33.1 [1.9] weeks; 52.5% female) and 158 in the nCPAP/BiPAP group (mean [SD] GA, 33.0 [2.1] weeks; 47.5% female). The use of HHHFNC was noninferior to nCPAP with regard to the primary outcome: failure occurred in 10.8% vs 9.5% of infants, respectively (95% CI of risk difference, -6.0% to 8.6% [within the noninferiority margin]; P = .71). Significant between-group differences in secondary outcomes were not found between the HHHFNC and nCPAP/BiPAP groups, including duration of respiratory support (median [interquartile range], 4.0 [2.0 to 6.0] vs 4.0 [2.0 to 7.0] days; 95% CI of difference in medians, -1.0 to 0.5; P = .45), need for surfactant (44.3% vs 46.2%; 95% CI of risk difference, -9.8 to 13.5; P = .73), air leaks (1.9% vs 2.5%; 95% CI of risk difference, -3.3 to 4.5; P = .70), and bronchopulmonary dysplasia (4.4% vs 5.1%; 95% CI of risk difference, -3.9 to 7.2; P = .79). In this study, HHHFNC showed efficacy and safety similar to those of nCPAP/BiPAP when applied as a primary approach to mild to moderate RDS in preterm infants older than 28 weeks' GA. clinicaltrials.gov Identifier: NCT02570217.

ABCA3, a key player in neonatal respiratory transition and genetic disorders of the surfactant system.

Genetic disorders of the surfactant system are rare diseases with a broad range of clinical manifestations, from fatal respiratory distress syndrome (RDS) in neonates to chronic interstitial lung disease (ILD) in children and adults. ABCA3 [ATP-binding cassette (ABC), subfamily A, member 3] is a lung-specific phospholipid transporter critical for intracellular surfactant synthesis and storage in lamellar bodies (LBs). Its expression is developmentally regulated, peaking prior to birth under the influence of steroids and transcription factors. Bi-allelic mutations of the ABCA3 gene represent the most frequent cause of congenital surfactant deficiency, indicating its critical role in lung function. Mutations affect surfactant lipid and protein processing and LBs' morphology, leading to partial or total surfactant deficiency. Approximately 200 mutations have been reported, most of which are unique to individuals and families, which makes diagnosis and prognosis challenging. Various typesof mutations, affecting different domains of the protein, account in part for phenotype diversity. Disease-causing mutations have been reported in most coding and some non-coding regions of the gene, but tend to cluster in the first extracellular loop and the second nucleotide-binding domain (NBD), leading to defective glycosylation and trafficking defects and interfering with ATP binding and hydrolysis respectively. Mono-allelic damaging and benign variants are often subclinical but may act as disease modifiers in lung diseases such as RDS of prematurity or associate with mutations in other surfactant-related genes. Diagnosis is complex but essential and should combine pathology and ultrastructure studies on lung biopsy with broad-spectrum genetic testing of surfactant-related genes, made possible by recent technology advances in the massive parallel sequencing technology.

Trends in Neonatal Mortality at a Tertiary Level Teaching Hospital

Introduction: Neonatal services at Tribhuvan University Teaching hospital (TUTH) was essentially up to level II till year 2008 and upgraded to level III care in later years. A 4 years retrospective study was carried out at TUTH, Kathmandu, Nepal to determine any change in the trend of neonatal mortality after the improvement in its services. Materials and Methods: Labor room record book, neonatal record book, perinatal audit data and neonatal record charts were used to collect the data. Results: During the study period, there were total of 15063 live births. The neonatal mortality ranges from 9.46 to 14.88 per 1000 live births per year. There was no significant fall in trend of neonatal mortality (x2 for linear trend=1.40, p=0.23). There was also no significant fall in trend in perinatal mortality rates over this period (x2 for linear trend=1.92, p=0.16).The number of neonates referred to other hospitals has been significantly reduced by 61%.(x2 for linear trend=33.18, p<0.001). Majority of the neonatal deaths (72%) occurred within first 7 days of life and more than a third (39%) died within the first 24 hours of life. Respiratory distress syndrome, perinatal asphyxia and neonatal sepsis were three major causes of death. Deaths due to respiratory distress and perinatal asphyxia has not changed significantly over the years (p=0.4 and 0.25 respectively). Incidence of low birth weight ranges from 10.8 – 16.1% of total live births. 63% of neonatal mortality occurred in low birth weight babies. This trend has not changed in over the years (x2=1.03, p=0.31). Conclusion: With the improvement in the services, though neonatal mortality remained unchanged, referral rates and mortality due to respiratory distress syndrome of prematurity has decreased. DOI: http://dx.doi.org/10.3126/jnps.v33i3.8957 J. Nepal Paediatr. Soc. 2013;33(3):213-217

Comparative trial of artificial and natural surfactants in the treatment of respiratory distress syndrome of prematurity: Experiences in a developing country

We conducted a randomized clinical trial to compare the effects of a synthetic (Exosurf®) and natural (Survanta®) surfactant in infants with neonatal respiratory distress syndrome. Eighty-nine patients were randomly allocated to receive one of the two surfactants. Primary outcome variables were the acute and long-term effects of the surfactant preparations, i.e., ventilatory requirements at 24 h of age as judged by the oxygenation index (OI), and the combined incidence of chronic lung disease or death at 28 days. The OIs in the Exosurf® and Survanta® groups at 24 h were the same (10.1 and 7, respectively; P > 0.05). The magnitude and rapidity of response, however, were greater for Survanta® than for Exosurf®. When arterial/alveolar oxygen tension ratios (a/A) were compared, the Exosurf® group had a significantly worse a/A ratio at 24 h than the Survanta® group (0.21 Exosurf® vs. 0.37 Survanta®; P < 0.05). The long-term outcome as judged by the combined incidence of death or chronic lung disease was not different in the two groups (18.6% Exosurf® vs. 15.2% Survanta®; P > 0.05). When the complications of prematurity were compared, there were no statistically significant differences between the two groups. We conclude that both preparations are reasonable choices for the treatment of respiratory distress syndrome of prematurity. Pediatr Pulmonol. 1999;27:312–317. © 1999 Wiley-Liss, Inc.

Exogenous surfactant enhances the delivery of recombinant adenoviral vectors to the lung.

Somatic gene therapy for pulmonary diseases must be accomplished in vivo, requiring the spread of a gene transfer vector across a vast expanse of respiratory epithelium. Surfactant, a naturally occurring protein and lipid mixture used to treat the respiratory distress syndrome of prematurity, disperses rapidly and evenly throughout the lung. We employed exogenous bovine surfactant (Survanta beractant) as a carrier vehicle for pulmonary delivery of a recombinant adenovirus expressing beta-galactosidase (beta-Gal). Rats treated with an adenovirus-beractant mixture demonstrated more uniform lobar distribution of transgene expression than rats treated with the same amount of virus in saline. Tissue homogenates were examined for quantitative beta-Gal expression by reaction with o-nitrophenol beta-n-galactopyranoside (ONPG). The degree of beta-Gal activity was affected by both the volume and type of carrier used to deliver the virus. At low volumes (0.5 ml, 1.3 ml/kg), beractant-treated animals demonstrated significantly greater pulmonary beta-Gal activity than saline-treated animals (p < 0.002) and untreated controls. At high volume (1.2 ml, 4 ml/kg), average beta-Gal activity was similar between groups treated with beractant or saline, but was more variable within the saline treated group. Higher volumes of delivery medium were associated with increased levels of beta-Gal expression regardless of the carrier used. Survanta was well tolerated by the animals and did not affect the duration of transgene expression. Exogenous beractant provides a useful medium for delivering recombinant adenoviruses to the lung when diffuse distribution of transgene expression is desired.

Effects of progressive intratracheal administration of perflubron during conventional gas ventilation in anesthetized dogs with oleic acid lung injury.

The respiratory distress syndrome of prematurity (RDS) is due to immaturity of alveolar type II cells which fail to produce adequate surfactant. The resultant increase in alveolar surface tension leads to both alveolar flooding and alveolar collapse, decreased compliance, and increased shunt with hypoxemia. Exogenous replacement of surfactant has reduced morbidity and mortality from RDS, though the most premature infants often fail to respond. Another possible therapy for RDS is liquid breathing (LB). Introduced by Kylstra et al. (1962), LB refers to a ventilatory mode in which the lungs are filled with a liquid perfluorocarbon (PFC) or hyperbarically oxygenated saline to functional residual capacity (FRC) followed by tidal ventilation with additional liquid. Using PFC’s with surface tensions of ≈ 15 dynes/cm, Shaffer et al. (1983a, 1983b) showed markedly improved arterial oxygenation during LB compared to gas ventilation in surfactant-deficient, very premature lambs. Interestingly, even after drainage of PFC from the lungs of these lambs, persistent improvements in FRC, compliance, and gas exchange were seen, suggesting that residual PFC coating the alveoli improved alveolar surface tension.KeywordsOleic AcidPulmonary Capillary Wedge PressureFunctional Residual CapacityPulmonary Blood FlowLung LavageThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Chlamydia trachomatis in neonatal respiratory distress of very preterm babies: biphasic clinical picture.

We observed 12 very preterm infants (10 males) with a peculiar respiratory syndrome characterized by early onset soon after birth and by a biphasic course. The severe first phase was characterized by a clinical pattern mimicking the idiopathic respiratory distress syndrome of prematurity. Gradually, respiratory symptoms decreased and assisted ventilation with oxygen therapy was reduced. In the second phase, a significant worsening of respiratory signs and the appearance of apneic spells were observed. Chest X-ray showed hypoexpansion of the lungs and the prevalence of a fine reticular pattern. Chlamydia trachomatis was identified in this second phase in conjunctival and pharyngeal swabs and/or on tracheal aspirates. Our data suggest that in the very preterm infants, chlamydial infection shows different clinical and laboratory features if compared with Chlamydia trachomatis pneumonia of infants born at term.

Pulmonary Single Circulation Dilution Curves of T-1824, Sodium, and Tritiated Water in Intact Piglets

In order to assess pulmonary endothelial permeability to sodium in the immature lung, 15 multiple indicator dilution curves were done in eight intact piglets. An indicator bolus consisting of T-1824, 22Na, and tritiated water (THO) was delivered into the right atrium and blood was sampled from the aorta. The concentration of sodium, expressed as a fraction of the quantity injected and of the corresponding fractional concentration of T-1824, was averaged for the samples prior to recirculation. The permeability-surface area product calculated from these data is 2.0 X 10(-5) cm sec-1, and is virtually identical with the value reported elsewhere for adult dogs. Extravascular lung water obtained from the triated water and T-1824 curves averaged 64%, whereas that obtained from the 22Na and T-1824 curves averaged 23% of blood-free lung water.

Left heart failure from patent ductus arteriosis following respiratory distress syndrome of prematurity

Left heart failure from patent ductus arteriosis following respiratory distress syndrome of prematurity

THE MANAGEMENT OF RESPIRATORY FAILURE IN THE IDIOPATHIC RESPIRATORY DISTRESS SYNDROME OF PREMATURITY.

Annals of the New York Academy of SciencesVolume 121, Issue 3 p. 930-941 THE MANAGEMENT OF RESPIRATORY FAILURE IN THE IDIOPATHIC RESPIRATORY DISTRESS SYNDROME OF PREMATURITY* Mildred T. Stahlman, Mildred T. Stahlman Vanderbilt University School of Medicine, Nashville, Tenn.Search for more papers by this authorWilliam C. Young, William C. Young Vanderbilt University School of Medicine, Nashville, Tenn. U.S. Public Health Service Fellow.Search for more papers by this authorJames Gray, James Gray Vanderbilt University School of Medicine, Nashville, Tenn. Dept. of Pediatrics.Search for more papers by this authorFrank M. Shepard, Frank M. Shepard Vanderbilt University School of Medicine, Nashville, Tenn. U.S. Public Health Service Fellow.Search for more papers by this author Mildred T. Stahlman, Mildred T. Stahlman Vanderbilt University School of Medicine, Nashville, Tenn.Search for more papers by this authorWilliam C. Young, William C. Young Vanderbilt University School of Medicine, Nashville, Tenn. U.S. Public Health Service Fellow.Search for more papers by this authorJames Gray, James Gray Vanderbilt University School of Medicine, Nashville, Tenn. Dept. of Pediatrics.Search for more papers by this authorFrank M. Shepard, Frank M. Shepard Vanderbilt University School of Medicine, Nashville, Tenn. U.S. Public Health Service Fellow.Search for more papers by this author First published: March 1965 https://doi.org/10.1111/j.1749-6632.1965.tb14263.xCitations: 16 * Aided by U.S. Public Health Service Grants No. H-4632 and No. HE-0895-01 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume121, Issue3Respiratory FailureMarch 1965Pages 930-941 RelatedInformation

Reduction of Mortality From Respiratory Distress Syndrome of Prematurity With Early Administration of Intravenous Glucose and Sodium Bicarbonate

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The Respiratory Distress Syndrome of Prematurity: Clinical and Therapeutic Aspects

The Respiratory Distress Syndrome of Prematurity: Clinical and Therapeutic Aspects