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Petrovic M, Savvoulidou E, Johnson S, Battaglino C, Bourne I, Whitten M, Siassakos D. Relation between possible under-diagnosed/treated glucose dysmetabolism, delayed villous maturation, and lethal fetal pneumonia. Placenta 2024; 154:220-223. [PMID: 39106563 DOI: 10.1016/j.placenta.2024.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 07/12/2024] [Accepted: 07/18/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a known risk factor for stillbirth (Rosenstein et al., 2012) [1]. Delayed villous maturation (DVM), predominantly seen in term placentas in pregnancies complicated with glucose dysmetabolism, may in part be a consequence of excessive maternal glucose leading to release of fetal insulin and other growth factors that promote excessive placental growth at the expense of villous maturation (Redline, 2012) [2]. CASES We present three cases of under-diagnosed/treated glucose dysmetabolism in women in their first pregnancies cared for in other hospitals in the United Kingdom (UK) with the fatal fetal/neonatal outcomes and confirmed DVM in the placenta and congenital pneumonia on post-mortem examination in all three cases. CONCLUSION This cluster supports a hypothesis that DVM and glucose dysmentabolism may make babies more susceptible to severe perinatal infection. All three cases received the antenatal care in their subsequent pregnancies in our unit and had confirmed glucose dysmetabolism which was treated and resulted in healthy babies.
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Affiliation(s)
- M Petrovic
- Obstetrics and Gynaecology Specialist, Senior Clinical fellow at Obstetrics and Gynaecology Department, University College London Hospital, 25 Grafton Way, London, WC1E 6DB, UK.
| | - E Savvoulidou
- Obstetrics and Gynaecology Department, University College London Hospital, 25 Grafton Way, London, WC1E 6DB, UK.
| | - S Johnson
- Queen Mary University, Barts and the London Medical School, UK
| | - C Battaglino
- Specialist Midwife in Fetal Medicine, University College London Hospital (UCLH), UK
| | - I Bourne
- Institute for Women's Health, University College London (UCL), UK
| | - M Whitten
- Governance Lead, Women's health Division University College London Hospital (UCLH), Consultant in Obstetrics and Fetal Medicine UCLH, UCL MBBS Year 5 Module B & Year 3 IBSc Women's Health Lead, UK
| | - D Siassakos
- Professor in Obstetrics and Gynaecology, University College London, Honorary Consultant in Obstetrics, University College London Hospital, UK
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Lee S, Kim SH, Kim HD, Lee JS, Ko A, Kang HC. Genetic Diagnosis in Neonatal Encephalopathy With Hypoxic Brain Damage Using Targeted Gene Panel Sequencing. J Clin Neurol 2024; 20:519-528. [PMID: 39227335 PMCID: PMC11372210 DOI: 10.3988/jcn.2023.0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/28/2024] [Accepted: 03/26/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND AND PURPOSE Neonatal encephalopathy (NE) is a neurological syndrome that presents with severe neurological impairments and complications. Hypoxic-ischemic encephalopathy is a major contributor to poor outcomes, being responsible for 50%-80% of admissions to neonatal intensive care units. However, some cases of NE accompanied by hypoxic brain damage cannot be solely attributed to hypoxia-ischemia. We aimed to identify diverse pathogenic genetic variations that may be associated with cases of NE accompanied by hypoxic brain damage rather than hypoxia-ischemia. METHODS We collected data from 34 patients diagnosed with NE accompanied by hypoxic brain damage over a 10-year period. Patients with the following specific conditions were excluded: 1) premature birth (<32 weeks), 2) no history of hypoxic events, 3) related anomalies, 4) neonatal infections, 5) antenatal or perinatal obstetrical complications, 6) severe hypoxia due to other medical conditions, and 7) early death (within 1 week). A comprehensive review of clinical and radiological features was conducted. RESULTS A genetic diagnosis was made in 11 (32.4%) patients, with pathogenic variants being identified in the following 9 genes: CACNA1A (n=2), KCNQ2 (n=2), SCN2A (n=1), SCN8A (n=1), STXBP1 (n=1), NSD1 (n=1), PURA (n=1), ZBTB20 (n=1), and ENG (n=1). No specific treatment outcomes or clinical features other than preterm birth were associated with the results of the genetic analyses. Personalized treatments based on the results of genetic tests were attempted, such as the administration of sodium-channel blockers in patients with KCNQ2 or SCN8A variants and the implementation of a ketogenic diet in patients with STXBP1 or SCN2A mutations, which demonstrated some degree of effectiveness in these patients. CONCLUSIONS Genetic analyses may help in diagnosing the underlying etiology of NE and concurrent hypoxic brain damage, irrespective of the initial clinical features.
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Affiliation(s)
- Sangbo Lee
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hee Kim
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ara Ko
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
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Marinonio ASS, Costa-Nobre DT, Sanudo A, Miyoshi MH, Areco KCN, Kawakami MD, Xavier RDC, Konstantyner T, Bandiera-Paiva P, Freitas RMVD, Morais LCC, Teixeira MLP, Waldvogel BC, Kiffer CRV, Almeida MFBD, Guinsburg R. Temporal Trend and Risk Factors for Respiratory Distress Syndrome-Associated Neonatal Mortality in Preterm Infants: A Population-Based Study in a Middle-Income Country. Am J Perinatol 2024; 41:e298-e304. [PMID: 35973740 PMCID: PMC11093649 DOI: 10.1055/s-0042-1754410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/01/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This article aimed to report a temporal series of respiratory distress syndrome (RDS)-associated neonatal mortality rates in preterm live births in São Paulo state, Brazil, and to identify social, maternal, and neonatal characteristics associated with these deaths. STUDY DESIGN This is a population-based study of all live births with gestational age (GA) between 22 and 36 weeks, birth weight ≥400 g, without congenital anomalies from mothers living in São Paulo state during 2004 to 2015. RDS-associated neonatal mortality was defined as death up to 27 days after birth with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality rate (annual percent change [APC] with 95% confidence intervals [95% CIs]) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that the RDS-associated neonatal death occurred. Poisson's regression model compared social maternal and neonatal characteristics between preterm live births that survived the neonatal period and those with RDS-associated neonatal deaths, with results expressed in incidence rate ratio and 95% CI. RESULTS A total of 645,276 preterm live births were included in the study, of which 612,110 survived and 11,078 had RDS-associated neonatal deaths. RDS-associated neonatal mortality rate was 17.17 per thousand preterm live births, with a decreasing annual trend (APC: -6.50%; 95% CI: -9.11 to -3.82%). The median time of these deaths was 48 hours after birth. The following risk factors for RDS-associated neonatal death were identified: maternal schooling ≤7 years (1.18; 1.09-1.29), zero to three prenatal care visits (1.25; 1.18-1.32), multiple pregnancy (1.24; 1.16-1.33), vaginal delivery (1.29; 1.22-1.36), GA 22 to 27 weeks (106.35; 98.36-114.98), GA 28 to 31 weeks (20.12; 18.62-21.73), male sex (1.16; 1.10-1.22), and 5-minute Apgar scores of 0 to 3 (6.74; 6.08-7.47) and 4 to 6 (3.97; 3.72-4.23). CONCLUSION During the study period, RDS-associated neonatal mortality rates showed significant reduction. The relationship between RDS-associated neonatal deaths and social, maternal, and neonatal factors suggests the need for perinatal strategies to reduce prematurity and to improve the initial management of preterm infants. KEY POINTS · RDS is associated with preterm live births.. · Impact of RDS-associated neonatal mortality in middle-income countries is scarce.. · Qualified perinatal care can reduce RDS-associated neonatal mortality..
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Affiliation(s)
| | - Daniela Testoni Costa-Nobre
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Milton Harumi Miyoshi
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Kelsy Catherina Nema Areco
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Mandira Daripa Kawakami
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Rita de Cassia Xavier
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | | | | | | | | | - Carlos Roberto Veiga Kiffer
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
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Sabzevari F, Eslamian M, Karami Robati F, Bahmanbijari B, Daei Parizi Z, Jamali Z. Comparison of the efficacy of two natural surfactants (BERAKSURF and BLES) in the treatment of respiratory distress syndrome among preterm neonates. BMC Pediatr 2023; 23:608. [PMID: 38036980 PMCID: PMC10691073 DOI: 10.1186/s12887-023-04406-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The benefit of surfactant replacement therapy for respiratory distress syndrome (RDS) has been demonstrated. However, some surfactants are expensive and usually inaccessible. Consequently, the Iranian Survanta was produced, but its effect on complications and mortality of RDS is unknown. This study aimed to compare the therapeutic outcomes of Iranian surfactant (beraksurf) and BLES (bovine lipid extract surfactant) on RDS treatment among preterm neonates. METHODS This triple blinded randomized controlled trial study was performed on 128 eligible neonates diagnosed with RDS in Afzalipour hospital in Kerman, Iran. Diagnosis of RDS, gestational age of 28-34 weeks and weight ≥ 1 kg were considered as inclusion criteria. Congenital anomalies such as congenital cyanotic heart diseases, digestive system anomalies and chromosome abnormalities were the exclusion criteria Neonates were randomly assigned into two equal groups: (1) those treated with BLES (n = 64) and (2) those treated with beraksurf (n = 64). Complications including patent ductus arteriosus (PDA), sepsis, intraventricular hemorrhage (IVH), pneumothorax, pulmonary hemorrhage, mortality, and also, the number of days required for invasive mechanical ventilation (using ventilator) and non-invasive continuous positive airway pressure (CPAP) were evaluated for all neonates. The risk ratio (RR) was calculated at 95% of confidence intervals (CI). RESULTS Compared with BLES group, the RR estimate among neonates in beraksurf group was 0.89 (0.66-1.20) for PDA, 0.71 (0.23-2.13) for IVH, 0.44 (0.14-1.36) for sepsis, 0.35 (0.13-0.93) for pneumothorax, 0.33 (0.12-0.86) for pulmonary hemorrhage, and 0.55 (0.28-1.05) for mortality. CONCLUSIONS Despite advances in the use of exogenous surfactants for the treatment of neonatal respiratory distress syndrome; There are still some controversial topics in this field. The results obtained in the present study showed that the two types of surfactant (BERAKSURF and BLES) have similar efficacy for the treatment and short-term outcomes in preterm infants with respiratory distress syndrome. Therefore, due to the cost-effectiveness of BRAKSURF compared to BLES, We recommend choosing BERAKSURF in terms of treatment.
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Affiliation(s)
- Fatemeh Sabzevari
- Department of Pediatrics, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahdie Eslamian
- Department of Pediatrics, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.
| | - Fatemeh Karami Robati
- Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Bahareh Bahmanbijari
- Department of Pediatrics, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Daei Parizi
- Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Jamali
- Department of Pediatrics, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Wondie WT, Legesse BT, Mekonnen GB, Degaga GT, Zemariam AB, Gedefaw GD, Abebe DE, Kassie YT, Gonete AT, Belay AE, Wubneh CA. Incidence and predictors of respiratory distress syndrome among low birth weight neonates in the first seven days in Northwest Ethiopia Comprehensive Specialized Hospitals, 2023: A retrospective follow-up study. BMJ Open 2023; 13:e079063. [PMID: 37984945 PMCID: PMC10660425 DOI: 10.1136/bmjopen-2023-079063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Respiratory distress syndrome is a catastrophic respiratory problem among low birth weight neonates. It increases the suffering of neonates and the economic expenditure of the countries. Notably, it is a major public health issue in low-income and middle-income countries such as Ethiopia. Despite this, studies regarding respiratory distress syndrome among low birth weight neonates were limited in Ethiopia. OBJECTIVE To assess the incidence and predictors of respiratory distress syndrome among low birth weight neonates in the first 7 days in Northwest Ethiopia Comprehensive Specialized Hospitals. METHOD Multicentred institution-based retrospective follow-up study was conducted from 19 September 2021 to 1 January 2023, among 423 low birthweight neonates. A simple random sampling technique was used. The data were collected using a data extraction checklist from the medical registry of neonates. The collected data were entered into EPI-DATA V.4.6.0.6. and analysed using STATA V.14. The Kaplan-Meier failure curve and log-rank test were employed. Bivariable and multivariable Weibull regression was carried out to identify predictors of respiratory distress syndrome. Statistical significance was declared at a p≤0.05. RESULT The incidence rate of respiratory distress syndrome was found to be 10.78 (95% CI 9.35 to 12.42) per 100 neonate days. Fifth minute Appearance, Pulse, Grimace, Activity, Respiration (APGAR score) <7 (AHR 1.86; 95% CI 1.18 to 2.92), multiple pregnancy (AHR 1.43; 95% CI 1.04 to 1.96), caesarean section delivery (AHR 0.62; 95% CI 0.41 to 0.93), prematurity (AHR 1.56; 95% CI 1.06 to 2.30) and birth weight <1000 g (AHR 3.14; 95% CI 1.81 to 5.40) and 1000-1499 g (AHR 2.06; 95% CI 1.42 to 2.83) were significant predictors. CONCLUSION The incidence of respiratory distress syndrome was higher than other studies conducted on other groups of neonates. Multiple pregnancy, fifth minute APGAR score, caesarean section, prematurity, extremely low birth weight and very low birth weight were predictors of respiratory distress syndrome. However, it needs further prospective study. Therefore, the concerned stakeholders should give due attention and appropriate intervention for these predictors.
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Affiliation(s)
- Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Bruck Tesfaye Legesse
- Department of Pediatrics and Neonatal Nursing, Wollega University, Nekemte, Ethiopia
| | - Gebrehiwot Berie Mekonnen
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gosa Tesfaye Degaga
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Alemu Birara Zemariam
- Department of Pediatrics and Child Health Nursing, Woldia University, Woldia, Ethiopia
| | - Gezahagn Demsu Gedefaw
- Department of Neonatal Health Nursing, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Dereje Esubalew Abebe
- Department of Medical Physiology College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Yohannes Tesfahun Kassie
- Department of Emergency and Critical Care Nursing,College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Almaz Tefera Gonete
- Pediatrics and Child Health Nursing, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | | | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Gould AJ, Ding JJ, Recabo O, Has P, Savitz DA, Danilack VA, Lewkowitz AK. Risk factors for respiratory distress syndrome among high-risk early-term and full-term deliveries. J Matern Fetal Neonatal Med 2022; 35:10401-10405. [PMID: 36210090 PMCID: PMC9851950 DOI: 10.1080/14767058.2022.2128657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To identify whether risk factors for respiratory distress syndrome (RDS) differ between early-term and full-term births. STUDY DESIGN This is a secondary analysis of a large NIH-funded retrospective cohort study including patients who delivered at a tertiary-care obstetric hospital between January 2002 and March 2013 with comorbid diabetes, hypertensive disorders, and/or fetal growth restriction (FGR). Pregnancies complicated by severe preeclampsia and multifetal gestations were excluded. Maternal characteristics, delivery information, and neonatal information were abstracted by trained clinicians blinded to the comorbidity leading to study inclusion. In this secondary analysis of the infant health outcomes of pregnancies with one or more of the qualifying conditions, risk factors for RDS among neonates born early term (37w0d-38w6d gestation) were compared to risk factors for RDS among full-term neonates (39w0d-40w6d). RESULTS Among 10,532 singleton newborns, there were 99 cases of early-term RDS (0.94%) and 95 cases of full-term RDS (0.90%). Maternal demographics were similar between those with and without RDS in both groups. Among early-term infants, lower gestational age, presence of meconium, non-spontaneous labor, and cesarean delivery were positively associated with RDS, whereas hypertensive disorders, diabetes, FGR, and many other comorbid delivery conditions were not. The strongest risk factor for RDS among early-term infants was delivery via cesarean (RR 1.98, 95% CI 1.31, 3.01). Among full-term neonates, cesarean delivery was also positively associated with RDS, although presence of meconium, chorioamnionitis, and endometritis were all stronger risk factors with RRs >2.0. CONCLUSIONS In this cohort of high-risk term deliveries, maternal demographics and comorbidities were found not to be associated with increased risk for RDS, but novel risk factors for RDS after 37 weeks' gestation - chorioamnionitis and endometritis - were identified. A focus on preventing infectious comorbidities may help reduce incidence of RDS at full-term.Key PointsRDS risk factors vary by gestational age.Novel risk factors for RDS at full-term identified.Intrauterine inflammation associated with RDS at term.
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Affiliation(s)
- Alexander J Gould
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905
| | - Jia Jennifer Ding
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905
| | - Olivia Recabo
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905
| | - Phinnara Has
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905
| | - David A Savitz
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905
- Departments of Epidemiology, Obstetrics and Gynecology, and Pediatrics, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903
| | - Valery A Danilack
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905
- Departments of Epidemiology, Obstetrics and Gynecology, and Pediatrics, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903
| | - Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905
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Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, Boyle E, Roehr CC. Surfactant therapy in late preterm and term neonates with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:393-397. [PMID: 34686533 DOI: 10.1136/archdischild-2021-322890] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/06/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There are no evidence-based recommendations for surfactant use in late preterm (LPT) and term infants with respiratory distress syndrome (RDS). OBJECTIVE To investigate the safety and efficacy of surfactant in LPT and term infants with RDS. METHODS Systematic review, meta-analysis and evidence grading. INTERVENTIONS Surfactant therapy versus standard of care. MAIN OUTCOME MEASURES Mortality and requirement for invasive mechanical ventilation (IMV). RESULTS Of the 7970 titles and abstracts screened, 17 studies (16 observational studies and 1 randomised controlled trial (RCT)) were included. Of the LPT and term neonates with RDS, 46% (95% CI 40% to 51%) were treated with surfactant. We found moderate certainty of evidence (CoE) from observational studies evaluating infants supported with non-invasive respiratory support (NRS) or IMV that surfactant use may be associated with a decreased risk of mortality (OR 0.45, 95% CI 0.32 to 0.64). Very low CoE from observational trials in which surfactant was administered at FiO2 >0.30-0.40 to infants on Continuous Positive Airway Pressure (CPAP) indicated that surfactant did not decrease the risk of IMV (OR 1.20, 95% CI 0.40 to 3.56). Very low to low CoE from the RCT and observational trials showed that surfactant use was associated with a significant decrease in risk of air leak, persistent pulmonary hypertension of the newborn (PPHN), duration of IMV, NRS and hospital stay. CONCLUSIONS Current evidence base on surfactant therapy in LPT and term infants with RDS indicates a potentially decreased risk of mortality, air leak, PPHN and duration of respiratory support. In view of the low to very low CoE and widely varying thresholds for deciding on surfactant replacement in the included studies, further trials are needed.
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Affiliation(s)
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, Delhi, India
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Charles Christoph Roehr
- Nuffield Department of Population Health, Medical Sciences Division, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK .,Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, UK.,Faculty of Health Sciences, University of Bristol, Bristol, UK
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Hoong MF, Chao AS, Chang SD, Lien R, Chang YL. Association between Respiratory Distress Syndrome of Newborns and Fetal Growth Restriction Evaluated Using a Dichorionic Twin Pregnancy Model. J Gynecol Obstet Hum Reprod 2022; 51:102383. [PMID: 35447371 DOI: 10.1016/j.jogoh.2022.102383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/22/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022]
Abstract
AIMS To evaluate the association between respiratory distress syndrome (RDS) and intrauterine fetal growth restriction (IUGR) by using a dichorionic twin model. METHODS We retrospectively analyzed twins delivered between September 2012 and December 2018. A dichorionic (DC) twin pregnancy with selective IUGR (sIUGR) was defined as the presence of (i) a birthweight discordance of ≥25% and (ii) a smaller twin with birth weight below the 10th percentile. Pregnancies with major fetal anomalies, delivery at gestational age below 23 weeks, and intrauterine fetal demise were excluded. RESULTS We included 53 DC twins with sIUGR. The sIUGR twin had a higher risk of RDS than did his appropriate for gestational age (AGA) cotwin (32.1% vs. 11.3%, p = 0.001); however, the risk of severe RDS did not significantly differ between the twins (17.0% vs 9.4%, p = 0.125). The findings of logistic regression analysis indicated that younger gestational age (weeks) at delivery (odds ratio = 0.48, p < 0.001) and IUGR (odds ratio = 13.87, p = 0.009) were significant risk factors for RDS in newborns in DC twin pregnancies with selective sIUGR. CONCLUSIONS IUGR was identified as a risk factor for newborn RDS. However, the association between IUGR and severe newborn RDS was not significant possibly due to the small sample size of this study.
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Affiliation(s)
- Michael Fw Hoong
- Department of Obstetrics and Gynaecology, Sabah Women and Children's Hospital, Kota Kinabalu, Malaysia
| | - An-Shine Chao
- Department of Obstetrics and Gynaecology, Linkou Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Shin Street, Kweishan, Taoyuan ROC 333, Taiwan
| | - Shuenn-Dyh Chang
- Department of Obstetrics and Gynaecology, Linkou Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Shin Street, Kweishan, Taoyuan ROC 333, Taiwan
| | - Reyin Lien
- Department of Paediatrics, Linkou Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Shin Street, Kweishan, Taoyuan ROC 333, Taiwan
| | - Yao-Lung Chang
- Department of Obstetrics and Gynaecology, Linkou Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Shin Street, Kweishan, Taoyuan ROC 333, Taiwan.
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Li C, Du Y, Yang K, Cao H, Yang H, Zhang C, Li X, Deng X, Shi Y. Safety and efficacy of a novel double-lumen tracheal tube in neonates with RDS: A prospective cohort study. Front Pediatr 2022; 10:1032044. [PMID: 36545664 PMCID: PMC9760922 DOI: 10.3389/fped.2022.1032044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the safety and efficacy of a new double-lumen tracheal tube for neonates, with a conventional tracheal tube as a control. METHOD Newborns with respiratory distress syndrome (RDS) requiring endotracheal intubation admitted to the tertiary neonatal intensive care unit (NICU) of Qujing Maternal and Child Healthcare Hospital in Yunnan Province between March 2021 and May 2022 were enrolled in this prospective cohort study. Outcome indicators related to effectiveness included mainly the number of intubations, duration of ventilation, duration of oxygenation, and length of stay; safety indicators included any clinical adverse effects during and after intubation. Appropriate stratified and subgroup analyses were performed according to the purpose of intubation, gestational age, and whether the drug was administered via endotracheal tube. RESULT A total of 101 neonates were included and divided into two groups based on the choice of tracheal tube: the conventional (n = 50) and new (n = 51) tracheal tube groups. There was no statistical difference between the two groups in terms of adverse effects during and after intubation (p > 0.05). In neonates who were mechanically ventilated without endotracheal surfactant therapy or newborns receiving InSurE technique followed by non-invasive ventilation, no significant differences were found between the two groups regarding any of the efficacy indicators (p > 0.05). However, for neonates on invasive mechanical ventilation, the new tracheal tube allowed for a significant reduction in the duration of mechanical ventilation (96.50[74.00, 144.00] vs. 121.00[96.00, 196.50] hours, p = 0.037) and total ventilation (205.71 ± 80.24 vs. 277.56 ± 117.84 h, p = 0.027), when used as a route for endotracheal drug delivery. Further analysis was performed according to gestational age for newborns requiring intratracheal surfactant administration during mechanical ventilation, and the data showed that for preterm infants, the new tracheal tube not only shortened the duration of mechanical ventilation (101.75 ± 39.72 vs. 155.50 ± 51.49 h, p = 0.026) and total ventilation (216.00 ± 81.60 vs. 351.50 ± 113.79 h, p = 0.010), but also demonstrated significant advantages in reducing the duration of oxygen therapy (9.75 ± 6.02 vs. 17.33 ± 8.43 days, p = 0.042); however, there was no statistical difference in efficacy outcomes between the two groups in full-term infants (p > 0.05). CONCLUSION The efficacy and safety of this new tracheal tube are promising in neonates with RDS, especially those requiring surfactant administration via a tracheal tube during mechanical ventilation. Given the limitations of this study, however, the clinical feasibility of this catheter needs to be further confirmed in prospective randomized trials with larger sample sizes. CLINICAL TRIAL REGISTRATION http://www.chictr.org.cn/showproj.aspx?proj=122073.
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Affiliation(s)
- Chuanfeng Li
- Department of Neonatology, Qujing Maternity and Child Healthcare Hospital, Yunnan, China
| | - Yuxuan Du
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Kaiting Yang
- Department of Neonatology, Qujing Maternity and Child Healthcare Hospital, Yunnan, China
| | - Huiling Cao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hong Yang
- Department of Neonatology, Qujing Maternity and Child Healthcare Hospital, Yunnan, China
| | - ChunXiu Zhang
- Department of Neonatology, Qujing Maternity and Child Healthcare Hospital, Yunnan, China
| | - Xiongbin Li
- Department of Neonatology, Qujing Maternity and Child Healthcare Hospital, Yunnan, China
| | - Xingmei Deng
- Department of Neonatology, Qujing Maternity and Child Healthcare Hospital, Yunnan, China
| | - Yuan Shi
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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10
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Debillon T, Tourneux P, Guellec I, Jarreau PH, Flamant C. Respiratory distress management in moderate and late preterm infants: The NEOBS Study. Arch Pediatr 2021; 28:392-397. [PMID: 33934933 DOI: 10.1016/j.arcped.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/22/2021] [Accepted: 03/16/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the characteristics and management of respiratory failure (RF) in moderate-to-late preterm infants. METHODS NEOBS was a prospective, multicenter, observational study conducted in 46 neonatal intensive care units caring for preterm infants (30+0/7 to 36+6/7 weeks of gestation [WG]) in France in 2018. The cohort was stratified into two groups: 30-33 WG (group 1) and 34-36 WG (group 2). Infants with early neonatal RF were included and the outcomes assessed were maternal, pregnancy, and delivery characteristics and how RF was managed. RESULTS Of the 560 infants analyzed, 279 were in group 1 and 281 were in group 2. Most pregnancies were singleton (64.1%), and 67.4% of women received prenatal corticosteroids (mostly two doses). Infants were delivered by cesarean section in 59.6% of cases; 91.7% of the infants had an Apgar score ≥7 at 5min. More than 90% of infants were hospitalized post-birth (median duration, 36 and 15 days for groups 1 and 2, respectively). Medical intervention was required for 95.7% and 90.4% of the infants in group 1 and group 2, respectively, and included noninvasive ventilation (continuous positive airway pressure [CPAP]: 88.5% and 82.9%; high-flow nasal cannula: 55.0% and 44.7%, or other) and invasive ventilation (19.7% and 13.2%). The two main diagnoses of RF were respiratory distress syndrome (39.8%) and transient tachypnea of the newborn (57.3%). Surfactant was administered to 22.5% of the infants, using the less invasive surfactant administration (LISA) method for 34.4% of the patients. In the overall population, 8.6% of the infants had respiratory and/or hemodynamic complications. CONCLUSIONS The NEOBS study demonstrated that CPAP was widely used in the delivery room and the LISA method was chosen for 34.4% of the surfactant administrations for the management of RF in moderate-to-late preterm infants. The incidence of RF-related complications was low.
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Affiliation(s)
- T Debillon
- Neonatology Intensive Care Unit, University Hospital of Grenoble, CS 10217, 38043 Grenoble Cedex 9, France.
| | - P Tourneux
- Neonatal Intensive Care Unit, University Hospital of Amiens, France-PériTox UMR_I 01, University of Picardy Jules Verne, 1, rond point du Professeur Christian Cabrol, 80054 Amiens, France
| | - I Guellec
- Neonatal and Pediatric Intensive Care Unit, University Hospital of Trousseau, AP-HP, 26, avenue du Dr Arnold Netter, 75012 Paris, France
| | - P-H Jarreau
- NICU of Port-Royal, AP-HP Centre-Université de Paris, Cochin Hospital, 123, boulevard de Port-Royal, 75014 Paris, France
| | - C Flamant
- Neonatal Intensive Care Unit, University Hospital of Nantes, 38, boulevard Jean Monnet, 44000 Nantes, France
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11
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Smyrni N, Koutsaki M, Petra M, Nikaina E, Gontika M, Strataki H, Davora F, Bouza H, Damianos G, Skouteli H, Mastroyianni S, Dalivigka Z, Dinopoulos A, Tzaki M, Papavasiliou A. Moderately and Late Preterm Infants: Short- and Long-Term Outcomes From a Registry-Based Cohort. Front Neurol 2021; 12:628066. [PMID: 33643206 PMCID: PMC7907517 DOI: 10.3389/fneur.2021.628066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background: While most studies on the association of preterm birth and cerebral palsy (CP) have focused on very preterm infants, lately, attention has been paid to moderately preterm [32 to <34 weeks gestational age (GA)] and late preterm infants (34 to <37 weeks GA). Methods: In order to report on the outcomes of a cohort of moderately and late preterm infants, derived from a population-based CP Registry, a comparative analysis of data on 95 moderately preterm infants and 96 late preterm infants out of 1,016 with CP, was performed. Results: Moderately preterm neonates with CP were more likely to have a history of N-ICU admission (p = 0.001) and require respiratory support (p < 0.001) than late preterm neonates. Birth weight was significantly related to early neonatal outcome with children with lower birth weight being more likely to have a history of N-ICU admission [moderately preterm infants (p = 0.006)/late preterm infants (p < 0.001)], to require ventilator support [moderately preterm infants (p = 0.025)/late preterm infants (p = 0.014)] and not to have neonatal seizures [moderately preterm infants (p = 0.044)/late preterm infants (p = 0.263)]. In both subgroups, the majority of children had bilateral spastic CP with moderately preterm infants being more likely to have bilateral spastic CP and less likely to have ataxic CP as compared to late preterm infants (p = 0.006). The prevailing imaging findings were white matter lesions in both subgroups, with statistically significant difference between moderately preterm infants who required ventilator support and mainly presented with this type of lesion vs. those who did not and presented with gray matter lesions, maldevelopments or miscellaneous findings. Gross motor function was also assessed in both subgroups without significant difference. Among late preterm infants, those who needed N-ICU admission and ventilator support as neonates achieved worse fine motor outcomes than those who did not. Conclusions: Low birth weight is associated with early neonatal problems in both moderately and late preterm infants with CP. The majority of children had bilateral spastic CP and white matter lesions in neuroimaging. GMFCS levels were comparable in both subgroups while BFMF was worse in late preterm infants with a history of N-ICU admission and ventilator support.
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Affiliation(s)
- Nikoletta Smyrni
- Second Department of Neurology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Maria Koutsaki
- Third Pediatric Department, University General Hospital Attikon, Athens, Greece
| | - Marianna Petra
- Department of Orthopedics, Penteli Children's Hospital, Athens, Greece
| | - Eirini Nikaina
- Department of Pediatrics, Agia Sophia Children's Hospital, Athens, Greece
| | - Maria Gontika
- Department of Neurology, Evaggelismos General Hospital, Athens, Greece
| | - Helen Strataki
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotini Davora
- Department of Neurology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Helen Bouza
- Department of Neonatal Intensive Care Unit, Agia Sophia Children's Hospital, Athens, Greece
| | - George Damianos
- Department of Neurology, Penteli Children's Hospital, Athens, Greece
| | - Helen Skouteli
- Department of Pediatric Neurology, IASO General Hospital, Athens, Greece
| | | | - Zoi Dalivigka
- Rehabilitation Center, Children's Hospital Aglaia Kyriakou, Athens, Greece
| | - Argyris Dinopoulos
- Third Pediatric Department, University General Hospital Attikon, Athens, Greece
| | - Margarita Tzaki
- Neonatal Intensive Care Unit, Elena Venizelou General Hospital, Athens, Greece
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12
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Ying Q, You XQ, Luo F, Wang JM. Maternal-Neonatal Serum Albumin Level and Neonatal Respiratory Distress Syndrome in Late-Preterm Infants. Front Pediatr 2021; 9:666934. [PMID: 34485188 PMCID: PMC8414569 DOI: 10.3389/fped.2021.666934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To determine the correlation between maternal-neonatal serum albumin level and respiratory distress syndrome (RDS) in late-preterm infants. Methods: This case-control study included 112 late-preterm newborns admitted to the neonatal intensive care unit of our hospital between January 2018 and July 2019. Those infants were divided into the RDS group (n = 56) and the non-RDS group (n = 56). Levels of maternal-neonatal serum albumin, pregnancy complications, and baseline information of the infants were compared between the two groups. Results: 1. There was no correlation between maternal and neonatal serum albumin measures. The maternal albumin level in the RDS group was lower than that in the control group (33.38 ± 3.31 vs. 33.60 ± 3.31, P > 0.05), but the difference was not statistically significant. The neonatal albumin level in the RDS group was significantly lower than that in the control group (32.70 ± 2.48 vs. 35.66 ± 3.27, P < 0.05). To predict RDS in late-preterm infants, using the albumin cutoff level of 34 g/L provides a sensitivity of 83.9% with a specificity of 62.5%. 2. Gestational age, primipara, placenta previa, antenatal corticosteroid therapy, delivery mode, and neonatal serum albumin level were associated with RDS in the late-preterm infant. 3. After adjustment for gestational age, logistic regression analysis showed that neonatal serum albumin level, placenta previa, and delivery mode were independent risk factors for RDS in late-preterm infants. However, albumin level did not related to the severity of RDS. Conclusion: The decrease in serum albumin within the first day after birth was closely related to the occurrence of RDS in late-preterm infants.
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Affiliation(s)
- Qian Ying
- Department of Neonatal, The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Xue-Qin You
- Department of Neonatal, The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Fei Luo
- Department of Neonatal, The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Ji-Mei Wang
- Department of Neonatal, The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
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13
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Ferrante G, Carota G, Li Volti G, Giuffrè M. Biomarkers of Oxidative Stress for Neonatal Lung Disease. Front Pediatr 2021; 9:618867. [PMID: 33681099 PMCID: PMC7930002 DOI: 10.3389/fped.2021.618867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/27/2021] [Indexed: 02/01/2023] Open
Abstract
The transition from prenatal to postnatal life causes a significant increase in arterial oxygen tension and the activation of metabolic pathways enabling the newborn's adaptation to the extra-uterine environment. The balance between pro-oxidant and anti-oxidant systems is critical to preserve cellular functions. Indeed, oxidative stress (OS) occurs when the production of free radicals is not balanced by the activity of intracellular antioxidant systems, contributing to cellular and tissue damage. Perinatal OS may have serious health consequences during the postnatal period and later in life. Namely, OS has been recognized as the major cause of lung injury in newborns, especially those preterm born, due to their immature lung and antioxidant systems. The development of OS biomarkers has gained increasing research interest since they may provide useful insights about pathophysiological pathways underlying OS-mediated pulmonary diseases in newborns. Moreover, their implementation in clinical settings may help to early identify high risk-newborns and to provide targeted treatment. Ideally, a biomarker should demonstrate ease of use, biological validity and reproducibility, high sensitivity and specificity. However, none of the clinically validated biomarkers so far have been qualified for neonatal lung disease. Additionally, the complex technical procedures and the high cost of such determinations have hampered the use of OS biomarkers in clinical practice. This review aims to evaluate the current evidence on the application of biomarkers of oxidative stress for neonatal lung disease and exploring the most relevant issues affecting their implementation in practice, as well as the associated evidence gaps and research limitations.
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Affiliation(s)
- Giuliana Ferrante
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica d'Eccellenza "G. D'Alessandro", Università degli Studi di Palermo, Palermo, Italy
| | - Giuseppe Carota
- Dipartimento di Scienze Biomediche e Biotecnologiche, Università degli Studi di Catania, Catania, Italy
| | - Giovanni Li Volti
- Dipartimento di Scienze Biomediche e Biotecnologiche, Università degli Studi di Catania, Catania, Italy
| | - Mario Giuffrè
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica d'Eccellenza "G. D'Alessandro", Università degli Studi di Palermo, Palermo, Italy
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14
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Simegn A, Azale T, Addis A, Dile M, Ayalew Y, Minuye B. Youth friendly sexual and reproductive health service utilization among high and preparatory school students in Debre Tabor town, Northwest Ethiopia: A cross sectional study. PLoS One 2020; 15:e0240033. [PMID: 32997712 PMCID: PMC7526918 DOI: 10.1371/journal.pone.0240033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Youth continue to fall victim to sexual and reproductive health problems. Despite, reproductive health needs of youth had been supported by different organizations, utilization of those services is low. All efforts have not been felt across the Ethiopian learning institutions as is evidenced by persistent reproductive health problems. Therefore, this study aimed to assess the magnitude of youth friendly sexual and reproductive health service utilization and associated factors among high and preparatory school youths in Debre Tabor town, Northwest Ethiopia. METHODS An institution based cross- sectional study was conducted from March 1 to 28, 2016. The data were collected using a pre-tested and structured self-administered questionnaire. Multistage cluster sampling method was used to select the study participants. The data were entered into Epi-data version 4.2.0.0 and analyzed using SPSS version 20. Binary logistics regression was used for analysis. Odds ratio along with 95%CI was estimated to measure the strength of the association. Level of statistical significance was declared at p value ≤0.05. RESULTS Overall utilization of reproductive health service was 28.8%. Being male (AOR = 1.54, 95% CI: 1.05, 2.25), prior discussion on reproductive health issues (AOR = 6.33, 95% CI: 4.22, 9.51), and previous sexual intercourse within the past one year (AOR = 1.95, 95% CI: 1.10, 3.44) were significantly associated with youth friendly health service utilization. CONCLUSIONS Youth friendly health service utilization among high school and preparatory students in Debre Tabor town was low. Ensuring gender empowerment and advocating sexual and reproductive service discussion among themselves and with others might be important in improving reproductive health utilization and health. Future researcher should address segment of population who does not enter school.
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Affiliation(s)
- Amare Simegn
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Telake Azale
- College of Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebaw Addis
- College of Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Dile
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yitayal Ayalew
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biniam Minuye
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Abstract
OBJECTIVE To evaluate whether labor is associated with lower odds of respiratory morbidity among neonates born from 36 to 40 weeks of gestation and to assess whether this association varies by gestational age and maternal diabetic status. METHODS We conducted a secondary analysis of women in the Assessment of Perinatal Excellence obstetric cohort who delivered across 25 U.S. hospitals over a 3-year period. Women with a singleton liveborn nonanomalous neonate who delivered from 36 to 40 weeks of gestation were included in our analysis. Those who received antenatal corticosteroids, underwent amniocentesis for fetal lung maturity, or did not meet dating criteria were excluded. Our primary outcome was composite neonatal respiratory morbidity, which included respiratory distress syndrome, ventilator support, continuous positive airway pressure, or neonatal death. Maternal characteristics and neonatal outcomes between women who labored and those who did not were compared. Multivariable logistic regression models were used to evaluate the association between labor and the primary outcome. Interactions between labor and diabetes mellitus and labor and gestational age were tested. RESULTS Our analysis included 63,187 women who underwent labor and 10,629 who did not. There was no interaction between labor and diabetes mellitus (P=.90). However, there was a significant interaction between labor and gestational age (P=.01). In the adjusted model, labor was associated with lower odds of neonatal respiratory morbidity compared with no labor for neonates delivered from 36-39 weeks of gestation. A 1-week increase in gestational age was associated with a 1.2 times increase in the adjusted odds ratio for the neonatal outcome comparing labor and no labor. CONCLUSION Labor was associated with lower odds of the composite outcome among neonates delivered from 36-39 weeks of gestation. The magnitude of this association varied by gestational age. The association was similar for women with or without diabetes mellitus.
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16
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Alfarwati TW, Alamri AA, Alshahrani MA, Al-Wassia H. Incidence, Risk factors and Outcome of Respiratory Distress Syndrome in Term Infants at Academic Centre, Jeddah, Saudi Arabia. Med Arch 2020; 73:183-186. [PMID: 31402802 PMCID: PMC6643333 DOI: 10.5455/medarh.2019.73.183-186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Respiratory distress syndrome (RDS) is a respiratory disorder of neonates that manifests itself within few hours after delivery. It is one of the most common causes of admission to neonatal intensive care unit (NICU) and respiratory failure in neonates. Aim: The aim of this study was to determine the incidence, risk factors, and the short-term outcomes of RDS in term infants born in an academic tertiary care center at King Abdul-Aziz University Hospital (KAUH), Jeddah, Saudi Arabia. Methods: Data of all infants admitted to the NICU at the academic center between January 1st 2016 and December 31st 2016 were retrospectively collected. Cases were all term infants who were admitted to NICU with the diagnosis of RDS during the study period. Controls were term infants and 1:1 matched for the date of birth (one or two days from the date of birth of the case) and received routine newborn care. Results: Fifty-nine term infants (59/3601, 1.64%) were admitted to the NICU with RDS and 59 control infants were matched during the study period. Infants with RDS were significantly of lower birth weight and had lower Apgar scores at one and five minutes. Although there was a higher number of cesarean section and PROM in the RDS group, but that didn’t reach statistical significance. Three infants (5.1%) died in the RDS group. Conclusion: Respiratory distress in term infants is still a significant cause of admission to NICU and a predisposing factor for neonatal mortality and morbidity. Preventative and anticipatory measures should be further explored to decrease the burden of this disease.
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Affiliation(s)
- Tariq W Alfarwati
- Neonatal Intensive Care Unit, College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdullah A Alamri
- Neonatal Intensive Care Unit, College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mubarak A Alshahrani
- Neonatal Intensive Care Unit, College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Heidi Al-Wassia
- Department of Pediatrics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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Marseglia L, D'Angelo G, Granese R, Falsaperla R, Reiter RJ, Corsello G, Gitto E. Role of oxidative stress in neonatal respiratory distress syndrome. Free Radic Biol Med 2019; 142:132-137. [PMID: 31039400 DOI: 10.1016/j.freeradbiomed.2019.04.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/11/2019] [Accepted: 04/23/2019] [Indexed: 02/02/2023]
Abstract
Respiratory distress syndrome is the commonest respiratory disorder in preterm infants. Although it is well known that preterm birth has a key role, the mechanisms of lung injury have not been fully elucidated. The pathogenesis of this neonatal condition is based on the rapid formation of the oxygen reactive species, which surpasses the detoxification capacity of anti-oxidative defense system. The high reactivity of free radical leads to damage to a variety of molecules and may induce respiratory cell death. There is evidence that the oxidative stress involved in the physiopathology of this disease, is particularly related to oxygen supplementation, mechanical ventilation, inflammation/infection and diabetes. This narrative review summarizes what is known regarding the connection between oxidative stress and respiratory distress syndrome.
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Affiliation(s)
- Lucia Marseglia
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - Gabriella D'Angelo
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy.
| | - Roberta Granese
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Italy
| | | | - Russel J Reiter
- Department of Cell Systems and Anatomy, The University of Texas Health Science Center, San Antonio, USA
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Italy
| | - Eloisa Gitto
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
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18
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Ali RA, Obeisat SM, Tarawneh LH. Improving nursing knowledge and care for neonates with respiratory distress in Jordan. Int Nurs Rev 2019; 66:338-345. [PMID: 30937901 DOI: 10.1111/inr.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This study evaluates the effectiveness of an educational intervention in the area of nursing knowledge and practice relating to neonatal respiratory distress syndrome. BACKGROUND In Jordan, respiratory distress is the leading cause of death among neonates. Recent studies have revealed a knowledge deficit relating to respiratory distress among nurses in neonatal intensive care units, hence the need for advanced training and specialization in this area. METHODS A quasi-experimental, repeated-measures, one-group pre-test-post-test design was used to assess the effectiveness of the educational intervention. A convenience sample of 48 nurses was recruited from three hospitals in northern Jordan. A self-reporting questionnaire was used to assess the respondents' knowledge of respiratory distress and an observational checklist to assess their practice. The study intervention consisted of 12 two-hour lecture-based interactive teaching sessions lasting 4 weeks. A follow-up assessment was conducted 1 month after the post-test. RESULTS The baseline assessment revealed that more than half of the nurses scored low on knowledge and the majority scored low on practice. One-way repeated ANOVA showed that post-test and follow-up test scores on nursing knowledge and practice were significantly higher than the baseline scores. CONCLUSION The study findings show the efficacy of educational interventions in enhancing nursing knowledge and practice relating to the care of neonates with respiratory distress. IMPLICATIONS FOR NURSING AND HEALTH POLICY For neonatal nurses, periodic teaching and training interventions are essential to ensuring the quality nursing care required to reduce morbidity and mortality rates among neonates. Health policymakers should support nurses in pursuing educational opportunities aimed at enhancing their knowledge of advanced neonate care.
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Affiliation(s)
- R A Ali
- Department of Maternal and Child Health Nursing, Faculty of Nursing - Jordan University of Science and Technology, Irbid, Jordan
| | - S M Obeisat
- Department of Maternal and Child Health Nursing, Faculty of Nursing - Jordan University of Science and Technology, Irbid, Jordan
| | - L H Tarawneh
- Department of Maternal and Child Health Nursing, Faculty of Nursing - Jordan University of Science and Technology, Irbid, Jordan
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Abushanab D, Alsoukhni O, AbouNahia F, Al-Badriyeh D. Clinical and Economic Analysis of Morphine Versus Fentanyl in Managing Ventilated Neonates With Respiratory Distress Syndrome in the Intensive Care Setting. Clin Ther 2019; 41:714-727.e8. [PMID: 30846286 DOI: 10.1016/j.clinthera.2019.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/01/2019] [Accepted: 02/11/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE Morphine and fentanyl opioids are common analgesic agents for consideration in the neonatal intensive care unit (NICU) for neonates with respiratory distress syndrome (RDS) and undergoing mechanical ventilation (MV). The aim of this study was to evaluate the clinical and economic impact of morphine versus fentanyl in neonates with RDS undergoing MV. METHODS Retrospective cost-effectiveness analysis of critically ill neonates with RDS receiving standard doses of morphine versus fentanyl at Women's Wellness and Research Center, Qatar. Clinical data of neonates were extracted from medical records of patients from 2014 to 2016. A decision analytic model based on the hospital's perspective was constructed to follow possible consequences of the initial dosing of analgesia, before potential titration. Primary end points were successful pain relief rate based on the Premature Infant Pain Profile scale and overall direct medical cost of therapy. Study population of 126 neonates was used to achieve results with 80% power and 0.05 significance. Sensitivity analysis was conducted to enhance robustness of conclusions against input uncertainties and to increase generalizability of results. FINDINGS Morphine achieved a success of 68% versus 43% with fentanyl (risk ratio = 1.72; 95% CI, 1.16-2.56; P = 0.0075). Morphine was associated with a minimal incremental cost-effectiveness ratio of USD 135 per additional case of successful pain relief over fentanyl. Higher morphine cost was reported in 2% of cases. Sensitivity analysis found model insensitivity to input uncertainties except NICU stay and cost of MV. IMPLICATIONS This is the first cost-effectiveness evaluation of morphine versus fentanyl in the NICU. Morphine significantly improved the relieve of pain over fentanyl. It had 98% probability of dominance over fentanyl. Results in this study support the use of morphine over fentanyl as first-line monotherapy with MV in NICU settings.
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Affiliation(s)
- Dina Abushanab
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | - Omar Alsoukhni
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | - Fouad AbouNahia
- Neonatal Intensive Care Unit Department, Hamad Medical Corporation, Doha, Qatar
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Kullinger M, Haglund B, Kieler H, Skalkidou A. Effects of ultrasound pregnancy dating on neonatal morbidity in late preterm and early term male infants: a register-based cohort study. BMC Pregnancy Childbirth 2016; 16:335. [PMID: 27799069 PMCID: PMC5088647 DOI: 10.1186/s12884-016-1129-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 10/25/2016] [Indexed: 12/02/2022] Open
Abstract
Background Assessing gestational age by ultrasound can introduce a systematic bias due to sex differences in early growth. Methods This cohort study included data on 1,314,602 births recorded in the Swedish Medical Birth Register. We compared rates of prematurity-related adverse outcomes in male infants born early term (gestational week 37–38) or late preterm (gestational week 35–36), in relation to female infants, between a time period when pregnancy dating was based on the last menstrual period (1973–1978), and a time period when ultrasound was used for pregnancy dating (1995–2010), in order to assess the method’s influence on outcome by fetal sex. Results As expected, adverse outcomes were lower in the later time period, but the reduction in prematurity-related morbidity was less marked for male than for female infants. After changing the pregnancy dating method, male infants born early term had, in relation to female infants, higher odds for pneumothorax (Cohort ratio [CR] 2.05; 95 % confidence interval [CI] 1.33–3.16), respiratory distress syndrome of the newborn (CR 1.99; 95 % CI 1.33–2.98), low Apgar score (CR 1.26; 5 % CI 1.08–1.47), and hyperbilirubinemia (CR 1.12; 95 % CI 1.06–1.19), when outcome was compared between the two time periods. A similar trend was seen for late preterm male infants. Conclusion Misclassification of gestational age by ultrasound, due to size differences, can partially explain currently reported sex differences in early term and late preterm infants’ adverse neonatal outcomes, and should be taken into account in clinical decisions and when interpreting study results related to fetal sex. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1129-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Merit Kullinger
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden. .,Department of Obstetrics and Gynecology, Västmanland County Hospital, Västerås, Sweden.
| | - Bengt Haglund
- Department of Medicine, Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institute, Stockholm, Sweden
| | - Helle Kieler
- Department of Medicine, Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institute, Stockholm, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Thygesen SK, Olsen M, Østergaard JR, Sørensen HT. Respiratory distress syndrome in moderately late and late preterm infants and risk of cerebral palsy: a population-based cohort study. BMJ Open 2016; 6:e011643. [PMID: 27729347 PMCID: PMC5073618 DOI: 10.1136/bmjopen-2016-011643] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Infant respiratory distress syndrome (IRDS) is a known risk factor for intracerebral haemorrhage/intraventricular haemorrhage (ICH/IVH) and periventricular leucomalacia. These lesions are known to increase the risk of cerebral palsy (CP). Thus, we wanted to examine the long-term risk of CP following IRDS in moderately late and late preterm infants. DESIGN Population-based cohort study. SETTING All hospitals in Denmark. PARTICIPANTS We used nationwide medical registries to identify a cohort of all moderately and late preterm infants (defined as birth during 32-36 full gestational weeks) born in Denmark in 1997-2007 with and without hospital diagnosed IRDS. MAIN OUTCOMES MEASURES We followed study participants from birth until first diagnosis of CP, emigration, death or end of follow-up in 2014. We computed the cumulative incidence of CP before age 8 years and used Cox's regression analysis to compute HRs of IRDS, comparing children with IRDS to those without IRDS. HRs were adjusted for multiple covariates. RESULTS We identified 39 420 moderately late and late preterm infants, of whom 2255 (5.7%) had IRDS. The cumulative incidence of CP was 1.9% in infants with IRDS and 0.5% in the comparison cohort. The adjusted HR of CP was 2.0 (95% CI 1.4 to 2.9). The adjusted HR of CP was 12 (95% CI 4.5 to 34) in children with IRDS accompanied by a diagnosis of ICH/IVH. After restriction to children without diagnoses of perinatal breathing disorders other than IRDS, congenital heart disease and viral or bacterial infections occurring within 4 days of birth, the overall adjusted HR was 2.1 (95% CI 1.4 to 3.1). CONCLUSIONS The risk of CP was increased in moderately late and late preterm infants with IRDS compared with infants without IRDS born during the same gestational weeks.
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Affiliation(s)
| | - Morten Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - John R Østergaard
- Department of Paediatrics, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Departments of Health Research and Policy (Epidemiology), Stanford University, Stanford, California, USA
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Li MJ, Wu Q, Shi W, Yang Q, Tang BZ, Chen CH. [Clinical features of respiratory distress syndrome in neonates of different gestational ages]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:960-964. [PMID: 27751211 PMCID: PMC7389537 DOI: 10.7499/j.issn.1008-8830.2016.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study clinical features of respiratory distress syndrome (RDS) in neonates of different gestational ages (GA). METHODS According to GA, 133 neonates with RDS were classified into GA <34 weeks group (n=66), GA 34-36 weeks group (late preterm neonates; n=31), and GA ≥37 weeks group (full-term neonates; n=36). The mothers' medical history during pregnancy and the condition of the neonates at birth were retrospectively analyzed, and the clinical data were compared between groups. RESULTS Prenatal corticosteroids supplementation in the GA <34 weeks group was more common than that in the GA 34-36 weeks group (P<0.05). Compared with the GA ≥37 weeks group and the GA 34-36 weeks group, the GA <34 weeks group showed a significantly lower rate of primary diseases, a significantly later time of the development of dyspnea (P<0.05), and a higher rate of intraventricular hemorrhage (P<0.05). Serum albumin levels in the GA <34 weeks group were significantly lower than in the GA ≥37 weeks group (P<0.05). The GA ≥37 weeks group and the GA 34-36 weeks group showed a significantly higher reuse rate of pulmonary surfactant (P<0.05). Use of high-frequency oscillatory ventilation was more common in the GA ≥37 weeks group compared with the GA <34 weeks group (P<0.05). CONCLUSIONS The clinical features of RDS are different across neonates of different GA, suggesting that the pathogenesis of RDS may be different in neonates of different GA.
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Affiliation(s)
- Mao-Jun Li
- Department of Pediatrics, Sichuan Academy of Medical Sciences/Sichuan Provincial People's Hospital, Chengdu 610072, China.
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Condò V, Cipriani S, Colnaghi M, Bellù R, Zanini R, Bulfoni C, Parazzini F, Mosca F. Neonatal respiratory distress syndrome: are risk factors the same in preterm and term infants? J Matern Fetal Neonatal Med 2016; 30:1267-1272. [DOI: 10.1080/14767058.2016.1210597] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Congenital Brain Tumor within the First 2 Months of Life. Pediatr Neonatol 2015; 56:369-75. [PMID: 26044848 DOI: 10.1016/j.pedneo.2015.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/10/2015] [Accepted: 04/01/2015] [Indexed: 11/22/2022] Open
Abstract
Congenital brain tumors (CBTs), defined as tumors presenting within 60 days after birth, are extremely rare and account for only 0.5-1.9% of all pediatric brain tumors. Teratoma is the most common type of CBT, although there are many other poorly described forms. Prenatal diagnosis of CBT is often difficult and usually based on clinical characteristics and radiological findings with magnetic resonance imaging and ultrasonography. The prognosis of patients with CBT depends on the histopathological features of the tumor and its location. Even after several investigations have been performed, a clear direction for diagnosis and treatment of fetal intracranial tumors is still lacking. Further studies are thus needed to clarify its clinical characteristics and establish recommendations for management.
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Early amplitude-integrated electroencephalography predicts brain injury and neurological outcome in very preterm infants. Sci Rep 2015; 5:13810. [PMID: 26348553 PMCID: PMC4562298 DOI: 10.1038/srep13810] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/06/2015] [Indexed: 12/20/2022] Open
Abstract
Early amplitude-integrated electroencephalography (aEEG) has been widely used in term infants with brain injury to predict neurodevelopmental outcomes; however, the prognostic value of early aEEG in preterm infants is unclear. We evaluated how well early aEEG could predict brain damage and long-term neurodevelopmental outcomes in very preterm infants compared with brain imaging assessments. We found that severe aEEG abnormalities (p=0.000) and aEEG total score<5 (p=0.006) within 72 h after birth were positively correlated with white-matter damage, but aEEG abnormalities were not associated with intracranial hemorrhage (p=0.186). Severe abnormalities in aEEG recordings, head ultrasound, and cranial magnetic resonance imaging (MRI) were all positively correlated with poor outcome at 18 months corrected age. The predictive power of poor outcomes of the aEEG and MRI combination was the same as the aEEG, MRI, and head ultrasound combination with a sensitivity of 52.4%, specificity of 96.2%, positive predictive value of 78.6%, and negative predictive value of 88.4%. These results indicate that severely abnormal aEEG recordings within 72 h after birth can predict white-matter damage and long-term poor outcomes in very preterm infants. Thus aEEG can be used as an early marker to monitor very preterm infants.
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Caminita F, van der Merwe M, Hance B, Krishnan R, Miller S, Buddington K, Buddington RK. A preterm pig model of lung immaturity and spontaneous infant respiratory distress syndrome. Am J Physiol Lung Cell Mol Physiol 2014; 308:L118-29. [PMID: 25398985 DOI: 10.1152/ajplung.00173.2014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Respiratory distress syndrome (RDS) and bronchopulmonary dysplasia remain the leading causes of preterm infant morbidity, mortality, and lifelong disability. Research to improve outcomes requires translational large animal models for RDS. Preterm pigs delivered by caesarian section at gestation days (GD) 98, 100, 102, and 104 were provided 24 h of neonatal intensive care, monitoring (pulse oximetry, blood gases, serum biomarkers, radiography), and nutritional support, with or without intubation and mechanical ventilation (MV; pressure control ventilation with volume guarantee). Spontaneous development of RDS and mortality without MV are inversely related with GD at delivery and correspond with inadequacy of tidal volume and gas exchange. GD 98 and 100 pigs have consolidated lungs, immature alveolar architecture, and minimal surfactant protein-B expression, and MV is essential at GD 98. Although GD 102 pigs had some alveoli lined by pneumocytes and surfactant was released in response to MV, blood gases and radiography revealed limited recruitment 1-2 h after delivery, and mortality at 24 h was 66% (35/53) with supplemental oxygen provided by a mask and 69% (9/13) with bubble continuous positive airway pressure (8-9 cmH2O). The lungs at GD 104 had higher densities of thin-walled alveoli that secreted surfactant, and MV was not essential. Between GD 98 and 102, preterm pigs have ventilation inadequacies and risks of RDS that mimic those of preterm infants born during the saccular phase of lung development, are compatible with standards of neonatal intensive care, and are alternative to fetal nonhuman primates and lambs.
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Affiliation(s)
| | - Marie van der Merwe
- Department of Health and Sport Science, University of Memphis, Memphis, Tennessee
| | - Brittany Hance
- Department of Health and Sport Science, University of Memphis, Memphis, Tennessee
| | - Ramesh Krishnan
- Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sarah Miller
- Loewenburg School of Nursing, University of Memphis, Memphis, Tennessee; and
| | - Karyl Buddington
- Director of Animal Care, University of Memphis, Memphis, Tennessee
| | - Randal K Buddington
- Department of Health and Sport Science, University of Memphis, Memphis, Tennessee
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