Treatment Of Neonatal Respiratory Distress Syndrome Research Articles

Progress in the Application of Lung Ultrasound for the Evaluation of Neonates with Respiratory Distress Syndrome.

Neonatal respiratory distress syndrome (NRDS) is a common critical disease in neonates. Early diagnosis and timely treatment are crucial. Historically, X-ray imaging was the primary method for diagnosing NRDS. However, this method carries radiation exposure risks, making it unsuitable for dynamic lung condition monitoring. In addition, neonates who are critically ill require bedside imaging, but diagnostic delays are often unavoidable due to equipment transportation and positioning limitations. These challenges have been resolved with the introduction of lung ultrasound (LUS) in neonatal intensive care. The diagnostic efficacy and specificity of LUS for NRDS is superior to that of X-ray. The non-invasive, dynamic, and real-time benefits of LUS also allow for real-time monitoring of lung changes throughout treatment for NRDS, yielding important insights for guiding therapy. In this paper, we examine the ultrasonographic characteristics of NRDS and the recent progress in the application of ultrasound in the diagnosis and treatment of NRDS while aiming to promote wider adoption of this method.

Effect of different ventilation methods combined with pulmonary surfactant on neonatal acute respiratory distress syndrome.

Acute respiratory distress syndrome precipitates is widespread pulmonary injury in impacted individuals, the neonatal respiratory distress syndrome (NRDS), primarily observed in preterm infants, represents a prevalent critical condition in neonatal clinical settings. To investigate the clinical efficacy of various ventilation strategies combined with pulmonary surfactant (PS) therapy in the treatment of NRDS. A total of 20 neonates diagnosed with respiratory distress syndrome, admitted between May 2021 and June 2022, were randomly assigned to either a research group or a control group. Neonates in the research group received treatment involving high-frequency oscillatory ventilation (HFOV) in conjunction with PS. In contrast, neonates in the control group were administered either controlled mechanical ventilation or synchronous intermittent mandatory ventilation, combined with PS. Arterial blood samples from the neonates in both groups were collected before treatment, as well as 6 h, 12 h, 24 h, and 48 h post-treatment. These samples underwent blood gas analysis, with measurements taken for pH value, partial pressures of oxygen (O2) and carbon dioxide. Concurrently, data was collected on the duration of ventilator use, length of hospitalization time, O2 treatment time, treatment outcomes, and complications of the ventilator. From 6-48 h post-treatment, both groups demonstrated significant improvements in arterial blood pH and oxygen partial pressure, along with a significant decrease in carbon dioxide partial pressure compared to pre-treatment values (P < 0.05). Although these changes progressed over time, there were no significant differences between the two groups (P > 0.05). However, the research group had significantly lower X-ray scores, shorter hospitalization time, and less time on O2 therapy compared to the control group (P < 0.05). Mortality rates were similar between the two groups (P > 0.05), but the research group had a significantly lower incidence of complications (P < 0.05). The integration of HFOV combine with PS has proven to effectively expedite the treatment duration, decrease the occurrence of complications, and secure the therapeutic efficacy in managing NRDS.

A systematic review and meta-analysis of pulmonary surfactant combined with budesonide in the treatment of neonatal respiratory distress syndrome.

Neonatal respiratory distress syndrome (NRDS), if caused by a lack of pulmonary surfactant (PS), leads to progressive alveolar collapse. Glucocorticoids have anti-inflammatory and anti-allergic effects and can reduce bronchial and pulmonary edema. This research hopes to systematically evaluate the efficacy and safety of animal-derived PS combined with the glucocorticoid drug budesonide in the treatment of NRDS. Electronic databases (i.e., Wanfang, Weipu, CNKI, PubMed, Embase, Cochrane Library) were searched from inception until May 30th, 2021. Studies relevant to the treatment of pulmonary surfactant combined with budesonide in the treatment of neonatal respiratory distress syndrome were identified. Consequently, all the studies that met the inclusion criteria were considered qualified for screening. For the meta-analysis, all data were analyzed using RevMan 5.3 software. Furthermore, subgroup analysis was performed to evaluate the administration method of budesonide (nebulized inhalation, intratracheal instillation) combined with intratracheal instillation of pulmonary surfactant. A total of 10 articles were included in this study, involving 527 children. This meta-analysis suggests that the treatment of intratracheal infusion of pulmonary surfactant combined with budesonide therapy can effectively (I) reduce the time of mechanical ventilation (OR =-1.72,95% CI: -2.44 to -1.01, P<0.00001); (II) reduce the length of stay (OR =-5.17, 95% CI: -9.35 to -0.99, P=0.02); (III) reduce the incidence of bronchopulmonary dysplasia (BPD) (OR =0.52, 95% CI: 0.39-0.68, P<0.00001); and (IV) reduce the incidence of BPD (RR =0.73, 95% CI: 0.40-1.35, P=0.32). There was no significant difference in the incidence of retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), or sepsis between the experimental group and the control group. The treatment of animal-derived pulmonary surfactant combined with budesonide can effectively shorten the hospital stay and reduce the time of invasive mechanical ventilation and the incidence of BPD. Meanwhile, it does not increase the risk of related complications or death. This approach can be applied clinically.

Evaluation of the Efficacy of Budesonide Combined with Pulmonary Surfactants on the Neonatal Respiratory Distress Syndrome by Pulmonary Ultrasonography

Objective. This study aimed to investigate the value of lung ultrasound images in evaluating the efficacy of budesonide combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS) in premature infants. Methods. 76 NRDS premature infants admitted to the hospital were randomly divided into experimental group and control group, with 38 children in each group. The premature infants in control group underwent PS, and those in experimental group underwent budesonide combined with PS. After treatment, lung ultrasound imaging was used to evaluate the curative effect, and X-ray results were used as a reference. The changes in clinical signs of two groups were detected, and the pulmonary ultrasound was used to evaluate the clinical efficacy of two groups. The changes in the lung ultrasound score (LUS) and arterial blood gas (ABG) indexes of two groups were compared before and after treatment. Results. LUS and improvement of patients of experimental group were obviously higher than those of the control group after treatment. LUS of experimental group was 12.1 ± 3.7, and that of control group was 18.2 ± 2.3, respectively. The differences were statistically significant ( P &lt; 0.05). The arterial partial oxygen pressure (PaO2) and oxygenation index (PaO2/FiO2) levels of two groups of patients increased dramatically after treatment. PaO2 and PaO2/FiO2 levels of experimental group were 65.59 ± 12.46 mmHg and 112.57 ± 19.3 mmHg, and those of control group were 45.12 ± 11.21 mmHg and 101.28 ± 21.36 mmHg, respectively. However, arterial partial pressure of carbon dioxide (PaCO2) level was significantly decreased in two groups after treatment. PaCO2 level of experimental group was 40.24 ± 8.92 mmHg, and that of control group was 41.22 ± 9.24 mmHg, respectively ( P &lt; 0.05). The diagnostic accuracy of lung ultrasound images in two groups was 95.3% and 96.2%, respectively. Conclusion. Pulmonary ultrasonography showed a high diagnostic accuracy in evaluating the efficacy of budesonide combined with PS in the treatment of NRDS in premature infants. It can evaluate the cardiopulmonary function of premature infants with NRDS and effectively improve the respiratory status of premature infants. In conclusion, this study provided some reference value for upgrading the clinical treatment of NRDS in premature infants.

The safety and effectiveness of heated humidified high-flow nasal cannula as an initial ventilation method in the treatment of neonatal respiratory distress syndrome: A protocol for systematic review and meta-analysis.

Background:This study uses a method of systematic evaluation to evaluate the safety and effectiveness of heated humidified high-flow nasal cannula (HHHFNC) as an initial ventilation method in the treatment of neonatal respiratory distress syndrome (NRDS) scientifically. In the field of evidence-based medicine, this study provides a theoretical reference and basis for choosing appropriate initial non-invasive ventilation methods in the treatment of NRDS, thereby providing assistance for clinical treatment.Methods:The main electronic network databases were searched by computer, including 4 Chinese databases: CNKI, WangFang Data, CQVIP, SinoMed and 3 English databases: PubMed, The Cochrane Library and EMBASE, the time range of retrieval from the beginning of each database to September 1, 2020. The content involves all the published randomized controlled trials on the effectiveness of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. Using a search method that combines medical subject words and free words. Based on the Cochrane risk bias assessment tool, 2 researchers independently screen the literature, and then extract the data we needed in the literature, and cross-check. If it is difficult to decide whether to include literature, then turning to a third researcher for help and making a final decision after discussion, and using RevMan 5.3 and STATA 13.0 to analyze the relative data.Results:Based on the method of meta-analysis, this study analyzes the pre-determined outcome indicators through scientific statistical analysis, and compares the effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. All results will be published in peer-reviewed high-quality professional academic journals.Conclusion:Based on evidence-based medicine, this study will obtain the establishing evidence of comparison that the clinical effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS through the existing data and data, which provides the evidence support of evidence-based medicine in the treatment of NRDS.OSF registration number:September 17, 2020. osf.io/f6at4 (https://osf.io/f6at4).

Influenced CD cells and ICAM-1 by pulmonary surfactant combined with high-frequency oscillatory ventilation and its effects on immune function in children with neonatal respiratory distress syndrome

This study aimed to explore the clinical efficacy of pulmonary surfactant combined with high-frequency oscillatory ventilation (HFOV) on neonatal respiratory distress syndrome (NRDS) and its influence on immune function in children. Children admitted to our hospital from March 2017 to March 2019 who received HFOV combined with pulmonary surfactant therapy as a research group. Sixty-two children received conventional nasal continuous positive pressure combined with pulmonary surfactant therapy as a control group. Clinical efficacy, blood gas and immune function of patients were compared between the two groups. The clinical efficacy of the research group was better than that of the control group (P&lt; 0.050). PaO2 and PaO2/FiO2 were both higher after treatment (P&lt; 0.050). CD3+ and NK cells in the research group were higher than those in the control group, while CD8+ cells and ICAM-1 were lower than those in the control group (P&lt; 0.050). CD3+, CD4+ and NK cells decreased in both groups after treatment, while CD8+ cells and ICAM-1 increased (P&lt; 0.050). HFOV combined with pulmonary surfactant has significant clinical efficacy and high safety on NRDS, and has a certain protective effect on children's immune function. Hence, it is worthy of being the first choice for the clinical treatment of NRDS in the future.

Melatonin supplementation as an adjuvant therapy in neonatal respiratory distress syndrome

Background: Neonatal respiratory distress syndrome (RDS) is a common serious chest disease that is caused by a deficiency of alveolar surfactant. Aim: Detection of the effect of melatonin supplementation in cases of neonatal RDS. Patients and Methods: A prospective randomized clinical trial study which was done at Tanta University Hospital from July 2016 to March 2018 on 100 neonates suffering from respiratory distress which was diagnosed as RDS. The studied neonates were divided into two groups: group 1, which had supplied with melatonin, and group 2, which had not supplied with melatonin. Grades of RDS, down score, malondialdehyde (MDA), superoxide dismutase (SOD), and interleukin-8 (IL-8) were measured on the 1st day and the 5th day of admission in the incubator. The duration of the presence of neonates in the incubator was determined, and the number of cases who needed mechanical ventilation (MV) was calculated. Results: There were significant differences in grades of RDS, Down score, MDA, SOD, IL-8 on the 5th day of admission between Group 1 and 2 (P = 0.001), and between 1st and 5th day of admission in Group 1 (P = 0.001). There was a significant difference between Groups 1 and 2 in the duration of the presence of neonates in the incubator (P = 0.001) and the number of cases who needed MV (P = 0.046). Conclusion: Melatonin supplementation could be used as adjuvant therapy for the treatment of RDS in neonates, but further studies involving a larger number of neonates must be performed on this topic. Recommendation: Melatonin supplementation for RDS neonates.

Efficacy of pulmonary surfactant combined with caffeine citrate on neonatal respiratory distress syndrome treated with synchronized nasal intermittent positive pressure ventilation

Objective To investigate the clinical effects of pulmonary surfactant(PS) combined with caffeine citrate on neonatal respiratory distress syndrome(NRDS) treated with synchronized nasal intermittent positive pressure ventilation(SNIPPV). Methods We collected and analyzed 99 neonates who were diagnosed with NRDS and required SNIPPV treatment from January 2016 to June 2019 in NICU of Shengjing Hospital of China Medical University.According to the different treatment, they were divided into PS+ citrate caffeine combination group and control group.The control group(53 neonates)was treated by PS alone.The combination group(46 neonates)was treated with PS combined with caffeine citrate.The indexes of ventilator time, the time of using oxygen, length of hospital stay and complications were compared between the two groups. Results The indexes of ventilator time, the time of using oxygen and length of hospital stay of combination group were significantly shorter than those of the control group.The differences were statistically significant(P 0.05). Conclusion PS combined with caffeine citrate in the treatment of NRDS with SNIPPV could effectively improve the pulmonary function of infants.It could improve the neonatal survival rate and reduce complications.It is worth to be recommended. Key words: Neonatal respiratory distress syndrome; Synchronized nasal intermittent positive pressure ventilation; Pulmonary surfactant; Caffeine citrate

Efficacy of pulmonary surfactant combined with high-dose ambroxol hydrochloride in the treatment of neonatal respiratory distress syndrome.

Clinical efficacy of pulmonary surfactant combined with high-dose ambroxol hydrochloride in the treatment of neonatal respiratory distress syndrome (NRDS) was investigated. One hundred child patients with NRDS in Linyi Central Hospital were collected according to the diagnostic criteria for RDS in the Pediatrics, and randomly divided into the treatment group (n=50) and the control group (n=50) based on different therapeutic methods. Patients in the control group were treated with basic treatment and high-dose ambroxol hydrochloride injection, while those in the treatment group were additionally administered with pulmonary surfactant Curosurf based on conventional therapy in the control group. The chest X-rays were collected before the treatment and at 12 h after the drug administration, the degree of respiratory distress in child patients was observed and evaluated via Silverman grading, and changes in blood gas indexes were recorded before treatment and at 2, 6 and 12 h after the drug administration. The chest X-ray grade, Silverman grade and blood gas analysis results had no differences between the two groups before the treatment (P>0.05). In the treatment group, partial pressure of oxygen (PaO2) and PH were increased and partial pressure of carbon dioxide (PaCO2) was decreased compared with those in the control group at 2, 6 and 12 h after the drug administration (P<0.05). At 12 h after the drug administration, chest X-ray grade and Silverman grade in both groups were improved, which were significantly superior in the treatment group to those in the control group (P<0.01). Moreover, the efficacy in the treatment group was remarkably better than that in the control group at 12 h after drug administration (P<0.01). Pulmonary surfactant combined with high-dose ambroxol hydrochloride has definite efficacy in the treatment of NRDS, which can significantly improve the pulmonary infection, respiratory distress and blood gas indexes of child patients.

Multicenter investigation and analysis of neonatal respiratory distress syndrome in parts of Inner Mongolia

Objective To investigate the diagnosis and treatment status of neonatal respiratory distress syndrome (NRDS) in Inner Mongolia and explore the problems and countermeasures for NRDS diagnosis and treatment. Methods Data of infants with NRDS in 4 hospitals(3 hospitals were in the west, which were the Affiliated Hospital of Inner Mongolia Medical University, Baotou Steel Three Hospital and Ordos Central Hospital, 1 hospital was in the east, which was the Affiliated Hospital of Chifeng Institute) participating in the study during the period from 1th January, 2016 to 30th June, 2018 were investigated retrospectively with descriptive epidemiological survey, including basic situation, perinatal period, clinical manifestations, treatment, complications and prognosis. Results Among 11 406 newborns admitted in 4 hospitals during the study period, 748 infants were diagnosed with NRDS, accounting for 6.56%.In the eastern region, 279 infants were diagnosed with NRDS, the rate was 9.30%, and in the western region were 469(5.58%). The average hospitalization time in the eastern region was longer than that in the western region, and the age of mothers was higher than that in the western region.There were significant differences between the two groups(P<0.05). The antenatal hormone use, cesarean delivery, multiple gestation, low Apgar score, premature rupture of membrane in the western region were higher than those in the eastern region(P<0.05). The proportion of NRDS grade Ⅰ and gradeⅢ, pulmonary surfactant(PS) utilization ratio and INSURE technology usage in the eastern region were higher than those in the western region.The ratio of NRDS(grade Ⅱ) and the first dose of PS in the western region were higher than those in the eastern region(P<0.05). The total mortality of neonates with NRDS was 6.15%(46/748). The incidence rates of patent ductus arteriosus, bronchopulmonary dysplasia, necrotizing enterocolitis, ventilator-associated pneumonia in the western region were higher than those in the eastern region(P<0.05). Conclusion The level of diagnosis and treatment of NRDS in four hospitals in two districts of Inner Mongolia varies widely.But overall compared with other areas, the treatment of NRDS in Inner Mongolia has the problems of low antenatal hormone use, insufficient use of PS and INSURE technology, and late use of PS.The treatment of NRDS should continue to standardize antenatal hormone use, early and sufficient use of PS, the promotion of the use of INSURE technology. Key words: Neonates; Respiratory distress syndrome; Epidemiology

A Comparative Study of the Efficacy of Surfactant Administration through a Thin Intratracheal Catheter and its Administration via an Endotracheal Tube in Neonatal Respiratory Distress Syndrome

Background: The cornerstone of the treatment of respiratory distress syndrome (RDS) is respiratory support and surfactant replacement therapy. The administration of surfactant through a thin intratracheal catheter is one of the methods used to reduce one of the standard technique complications of a surfactant injection (Intubation-Surfactant-Extubation method [INSURE]). The aim of this study was to compare the effectiveness of this method on the treatment of RDS in neonates with one of the INSURE technique. Methods: In this double blind clinical trial, 104 neonates with RDS were randomly allocated to two groups, one group received surfactant via an endotracheal tube (INSURE) and the other received surfactant without intubation (SWI) via a thin intratracheal catheter. Subsequently the outcomes of the two groups were compared. Results: The incidence of hypoxemia during surfactant administration was significantly lower in the SWI group (11.5%) than in the INSURE group (28.8% , P< 0.05). no significant difference was observed in the need for intubation and mechanical ventilation during the first 72 hours of life, the duration of mechanical ventilation, the need for nasal continuous positive airway pressure (NCPAP), the need for oxygen, the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, pulmonary hemorrhage ,and death in the two groups. Conclusion: Administration of surfactant through a thin intratracheal catheter is a safe and easy technique. This method is as effective as the INSURE method in improving the outcomes of RDS treatment.

Efficacy of volume target pressure control and synchronized intermittent mandatory ventilation in treating neonatal respiratory distress syndrome

Objective To investigate the efficacy of volume target pressure control(VTPC) and synchronized intermittent mandatory ventilation (SIMV)in treating severe neonatal respiratory distress syndrome (NRDS). Methods Fifty-six admitted cases with severe NRDS hospitalized in Jiangmen Central Hospital from October 2012 to March 2015 were randomly divided into 2 groups: 28 cases in VTPC group were treated by VTPC and SIMV, and 28 cases in pressure control ventilation (PCV)group were treated by PCV and SIMV.There was no significant difference between 2 groups in terms of gender, gestational age, and birth weight (all P>0.05). Artery blood gas analysis was performed at 6 hours, 12 hours, 24 hours, and 48 hours respectively after ventilation.The following parameters were observed: the time of invasive mechanical ventilation, duration of oxygen therapy, mortality and the incidence rates of hypocapnia, pneumothorax, ventilator associated pneumonia (VAP), grade Ⅲ-Ⅳ periventricular intraventricular hemorrhage (PVH-IVH), periventricular leukomalacia (PVL)and bronchopulmonary dysplasia (BPD). Results No case in 2 groups withdrew from the test.There was no significant difference between 2 groups in terms of the first treatment time and total doses of poractant alfa injection (all P>0.05). The time of invasive mechanical ventilation in VTPC group[(71.75±9.82) h] was shorter than that in PVC group[(97.89±16.88) h] (t=7.083, P=0.000). Hypocapnia incidence of four blood gas analysis in VTPC group[(19.64±14.20)%] was lower than that in PCV group[(47.32±18.43)%] (t=6.294, P=0.000). Incidence rates of VAP and PVL in VTPC group were lower than those in PCV group (χ2=5.197, P=0.023; χ2=4.766, P=0.029). However, duration of oxygen therapy, mortality and the incidence rates of pneumothorax, Ⅲ-Ⅳ PVH-IVH and BPD were not significantly different between 2 groups (all P>0.05). Conclusion VTPC+ SIMV has a better efficacy than PCV+ SIMV in the treatment of NRDS. Key words: Mechanical ventilation; Respiratory distress syndrome; Treatment; Infant, premature

Neonatal Respiratory Distress Syndrome: Early Diagnosis, Prevention, and Treatment

to improve treatment results in premature infants with neonatal respiratory distress syndrome (NRDS), by establishing developmental mechanisms and elaborating methods for its early diagnosis, treatment, and prevention. Material and methods . The paper analyzes the results of a clinical observation and laboratory, instrumental, immunological, morphological, and radiological studies of 320 premature neonates at 26—35 weeks gestational age. The following groups of neonates were identified: 1) 40 premature neonatal infants without NRDS and with the physiological course of an early neonatal period (a comparison group); 2) 190 premature neonates with severe NRDS in whom the efficiency of therapy with exogenous surfactants, such as surfactant BL versus curosurf, was evaluated; 3) 90 premature newborn infants who had died from NRDS at its different stages. Results . The poor maternal somatic, obstetric, and gynecological histories in the early periods of the current pregnancy create prerequisites for its termination, favor the development of severe acute gestosis, and cause abnormal placental changes. Each gestational age is marked by certain placental changes that promote impaired uterineplacentalfetal blood flow and premature birth. Alveolar and bronchial epithelial damages, including those ante and intranatally, microcircula tory disorders play a leading role in the tanatogenesis of NRDS. Intranatal hypoxia and amniotic fluid aspiration are one of the important factors contributing to alveolar epithelial damage and NRDS in premature neonates. Exogenous surfactants prevent the development of hyaline membranes and are useful in the normalization of ventilation-perfusion relationships and lung biomechanical properties. Conclusion. This study could improve the diagnosis and treatment of NRDS, which assisted in reducing the duration of mechanical ventilation from 130±7.6 to 65±11.6 hours, the number of complications (the incidence of intragastric hemorrhages decreased from 28.8 to 9%), the stay length of the neonates in an intensive care unit, and early neonatal mortality rates from 9.3 to 0.9‰ and in improving demographic indicators.

Clinical analysis of pulmonary surfactant in treatment of 30 cases with neonatal respiratory distress syndrome

Objective To explore the effect of pulmonary surfactant(PS) in the treatment of neonatal respiratory distress syndrome(NRDS).Methods According to whether using the PS,60 NRDS patients were divided into treatment group and control group.The blood-gas analysis index,oxygen time,mechanical ventilation time,hospitalization time and other indicators were analyzed.Results After 6h treatment,blood pH value (7.41 ± 0.11),PaO2 (69.8 ± 11.9) mm Hg and PaCO2 (48.7 ± 11.1)mm Hg in the treatment group were higher than those of the control group (7.24 ±0.13),(53.3 ±9.8)mm Hg,(59.1 ± 12.7)mm Hg(t =3.35,2.88,3.24,all P ＜0.05).In the treatment group,oxygen time (98.2 ± 29.2) h,the time of mechanical ventilation (77.6 ± 30.4) h and hospitalization time (12.9 ± 1.7)d,were also shorter than those of the control group (143.9 ± 26.5) h,(121.4 ± 22.9) h,(17.6 ±2.1) d (t =4.56,5.32,4.86,all P ＜ 0.05).Conclusion The application of PS in the treatment of NRDS can improve the lung function and lung aeration and reduce the time of mechanical ventilation. Key words: Pulmonary surfactants ; Respiratory distress syndrome; Infant, neonate

A multi-center randomized controlled clinical trial of surfactant (Calsurf) therapy for neonatal respiratory distress syndrome

Objective To study the relative efficacy and safety of Calsurf (surfactant extracted from calf lung lavage,Beijing Double Crane Pharmaceutical Co. Ltd. ) in treatment of neonatal respiratory distress syndrome (RDS). Methods Multi-center randomized controlled clinical trial was organized in 7 children's hospitals nation wide. Criteria for enrollment were clinical diagnosis of RDS, birth weight ＜ 2 500 g, FiO2 ＞0. 5 for maintaining PaO2＞50 mm Hg, a/APO2＜0. 22 and less than 36 h post partum. Patients were randomized to either surfactant treatment or control group. Randomization were stratified by birth weight (≥ 1500 gor ＜ 1 500 g) for each hospital. All patients were intubated and received mechanical ventilation. In surfactant treatment group 70 mg/kg Calsurf suspension was instilled into endotracheal tube. 12-24 h after first dose a second dose can be given if the need arises. For the control group an equal amount of air was instilled. Changes of oxygenation and ventilation were measured by comparing pre-treatment and post-treatment values at 2 h,8 h,24 h,48 h,3 days and 5 days. PaO2 and PaCO2 were measured,a/APO2 were calculated,ventilator settings (FiO2 ,PIP,MAP,PEEP) were recorded. Chest X-ray was finished 0. 5 h before treatment,8 h and 24 h after treatment. Results Surfactant treatment group received Calsurf at 14 h of mean age. Four patients received a second dose. In 3 days after treatment oxygenation and ventilation improved, a/APO2 values were higher and showed significant improvement at 2 h,8 h ,24 h after treatment compared with control group. After treatment ventilator parameters (FiO2 ,PIP,MAP,PEEP) improved within 2 days in all time points. According to changes of a/APO2 after initial dose of surfactant totally 84.2% of patients had good response. Chest X-ray results showed,after treatment 8 h and 24 h there were significant improvement in lung aeration. Temporary partial airway obstruction was found in 1/3 patients when received surfactant. No other side effects were found after Calsurf instillation. There were no significant differences in the incidence of complications in surfactant treatment and control group. Conclusion Calsurf is effective and safe for treatment of neonatal RDS. Key words: Surfactant; Neonatal respiratory distress syndrome; Multi-center clinical trial

Effect of indomethacin on complications of preterm neonatal respiratory distress syndrome after pulmonary surfactant treatment or prevention

目的 探讨预防性应用吲哚美辛减少肺表面活性物质治疗或预防新生儿呼吸窘迫综合征的合并症.方法临床诊断为新生儿呼吸窘迫综合征的早产儿40例,用肺表面活性物质(固尔苏)治疗,按有无用吲哚美辛预防分为A1组22例与B1组18例.胎龄＜32周未发生新生儿呼吸窘迫综合征的早产儿37例,用肺表面活性物质预防,按有无用吲哚美辛预防分为A2组24例与B2组13例.分别比较A1与B1组、A2与B2组的辅助通气(含鼻塞CPAP和机械通气)时间和发生动脉导管未闭、肺出血、脑室内出血及死亡情况分布并做统计学分析.结果A1与B1两组辅助通气时间分别为(94.9±61.5)h、(105.8±103.0)h,差异无统计学意义(P＞0.05);发生动脉导管未闭例数分别为8、14例,差异有统计学意义(P＜0.05);发生肺出血、脑室内出血例数的差异无统计学意义(P＞0.05);死亡例数≤3 d分别为0和3例,差异有统计学意义(P＜0.05),＞3 d各为3例,差异无统计学意义(P＞0.05).A2与B2两组辅助通气时间分别为(24.0±20.8)h、(44.0±25.9)h,发生动脉导管未闭例数分别为2和5例,差异均有统计学意义(P＜0.05);发生肺出血例数的差异无统计学意义(P＞0.05);发生脑室内出血例数较少,死亡例数≤3 d分别为0和1例,＞3 d各为1例,未做统计学分析.结论肺表面活性物质治疗或预防新生儿呼吸窘迫综合征时,用吲哚美辛预防可减少合并动脉导管未闭、肺出血和早期死亡。