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Tochie JN, Sibetcheu AT, Arrey-Ebot PE, Choukem SP. Global, Regional and National Trends in the Burden of Neonatal Respiratory Failure and essentials of its diagnosis and management from 1992 to 2022: a scoping review. Eur J Pediatr 2024; 183:9-50. [PMID: 37847265 DOI: 10.1007/s00431-023-05238-z] [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: 06/20/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
Neonatal respiratory failure (NRF) is an emergency which has not been examined extensively. We critically synthesized the contemporary in-hospital prevalence, mortality rate, predictors, aetiologies, diagnosis and management of NRF to better formulate measures to curb its burden. We searched MEDLINE and Google Scholar from 01/01/1992 to 31/12/2022 for relevant publications. We identified 237 papers from 58 high-income and low-and middle-income countries (LMICs). NRF prevalence ranged from 0.64 to 88.4% with some heterogeneity. The prevalence was highest in Africa, the Middle East and Asia. Globally as well as in Asia and the Americas, respiratory distress syndrome (RDS) was the leading aetiology of NRF. Neonatal sepsis was first aetiology in Africa, whereas in both Europe and the Middle East it was transient tachypnoea of the newborn. Independent predictors of NRF were prematurity, male gender, ethnicity, low/high birth weight, young/advanced maternal age, primiparity/multiparity, maternal smoking, pregestational/gestational diabetes mellitus, infectious anamneses, antepartum haemorrhage, gestational hypertensive disorders, multiple pregnancy, caesarean delivery, antenatal drugs, foetal distress, APGAR score, meconium-stained amniotic fluid and poor pregnancy follow-up. The NRF-related in-hospital mortality rate was 0.21-57.3%, highest in Africa, Asia and the Middle East. This death toll was primarily due to RDS globally and in all regions. Clinical evaluation using the Silverman-Anderson score was widely used and reliable. Initial resuscitation followed by specific management was the common clinical practice. CONCLUSION NRF has a high burden globally, driven by RDS, especially in LIMCs where more aggressive treatment and innovations, preferably subsidized, are warranted to curb its alarming burden. WHAT IS KNOWN • Neonatal respiratory failure is a frequent emergency associated with a significant morbidity and mortality, yet there is no comprehensive research paper summarizing its global burden. • Neonatal respiratory failure needs prompt diagnosis and treatment geared at improving neonatal survival. WHAT IS NEW • Neonatal respiratory failure has an alarmingly high global burden largely attributed to Respiratory distress syndrome. Low resource settings are disproportionately affected by the burden of neonatal respiratory failure. • Independent preditors of neonatal respiratory failure are several but can be classified into foetal, maternal and obstetrical factors. An illustrative pedagogical algorithm is provided to facilitate diagnosis and management of neonatal respiratory failure by healthcare providers.
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Affiliation(s)
- Joel Noutakdie Tochie
- Anaesthesiology and Intensive Care Unit, Douala Laquintinie Hospital, Douala, Cameroon.
| | - Aurelie T Sibetcheu
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Simeon-Pierre Choukem
- Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
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Afreen S, Kumar M, Nangia S. Lung Volume Head Ratio: A Potential Parameter for Prediction of Respiratory Distress in Newborn. Am J Perinatol 2023; 40:1461-1466. [PMID: 34544167 DOI: 10.1055/a-1649-2208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate the role of fetal lung biometry profile including fetal lung volume head ratio (LVHR) in predicting the occurrence of respiratory distress (RD) in early preterm newborn. STUDY DESIGN Prospective analytical cohort study was done to evaluate the clinical value of fetal sonographic measures, such as the total lung area (TLA), total lung volume (TLV), TLA head ratio (TLHR), LVHR, in pregnant women between 30 to 34 weeks' gestation who were expected to deliver within the next 72 hours. The cases with RD were compared with controls who had normal outcome. RESULT A total of 30 (27.4%) out of 110 patients, who underwent early preterm delivery, with RD rest 80 (72.6%) were controls. The TLA was 694.1 ± 373.1 mm2 in cases whereas 1,149.0 ± 506 0.7 mm2 in controls with significant difference between the two groups (p < 0.001). Similarly the lung volume (p < 0.001) and the LVHR were significantly less (p < 0.001) in cases compared with controls. The TLV was a better parameter (sensitivity, 73.7% and specificity, 86.4%) compared with TLA (sensitivity, 68.4% and specificity, 81.5%). Among the lung head ratios, LVHR had the best sensitivity of 95.5%, specificity: 80.3%, positive predictive value (PPV): 58.3%, and negative predictive value (NPV): 97.0% at the cut-off of 46.5. CONCLUSION RD was observed in nearly one-third of the preterm infants born between 30 and 34 weeks of gestation and could be predicted accurately in over 9 out of 10 cases using the novel parameter TLVR. KEY POINTS · Preterm newborn.. · Fetal lung volume.. · Respiratory distress..
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Affiliation(s)
- Shama Afreen
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Manisha Kumar
- Division of Fetal Medicine, Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Shushma Nangia
- Department of Neonatology, Kalavati Saran Children's Hospital, New Delhi, India
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Kaleem A, Haroon F, Fatima B, Victor G, Qadir M, Waheed KAI. Efficacy and safety of surfactant administration by MIST and INSURE techniques in Neonates with Respiratory Distress Syndrome: A randomized controlled trial. Pak J Med Sci 2023; 39:848-852. [PMID: 37250559 PMCID: PMC10214821 DOI: 10.12669/pjms.39.3.7283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 01/28/2023] [Indexed: 11/02/2023] Open
Abstract
Objective To measure the efficacy and safety of surfactant administered by MIST and INSURE to neonates with respiratory distress syndrome. Methods A randomized controlled trial was conducted from June 2021 to August 2022 at the NICU of the University of Child Health Sciences, Lahore. Neonates meeting inclusion criteria i.e with RDS who worsened on nasal Continuous positive airway pressure (nCPAP) (fiO2 30%, pressure 6cmH2O) were enrolled in the study in both interventional arms (MIST, n=36 and INSURE, n=36) using simple random sampling. Data was analysed using SPSS 25. Results The mean age of neonates in MIST was 1.27±0.40 days and 1.23±0.48 days in INSURE cohort. Neonates with MIST (n=8) required statistically significant reduced need for IMV than INSURE (n=17) technique (P-Value 0.047). This study could not achieve significant difference in duration of mechanical ventilation (1±1.67; 1.52±1.40 days, P=0.152) and duration of nCPAP (3.27±1.65;3.67±1.64 hrs, P=0.312) in MIST versus INSURE. The second dose of surfactant was administered in fewer cases in MIST (n=2) than INSURE (n=7) (P=0.075). Risk estimation, although not significant, determined less likelihood for the pulmonary haemorrhage (0.908 than 1.095), intraventricular hemorrhage (0.657 than 1.353), administration of the second dose of surfactant (0.412 than 1.690) and greater likelihood of discharge (1.082 than 0.270) at 95% confidence interval with MIST technique. Conclusion Surfactant therapy through MIST is effective and there is significantly reduced need of IMV than in INSURE. Safety profile though could not achieve statistical significance yet determines less risk of complications associated with MIST than INSURE.RCT Registration Number: TCTR20210627001.
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Affiliation(s)
- Ammara Kaleem
- Ammara Kaleem Fellow of Neonatology University of Child Health Sciences, Lahore, Pakistan
| | - Farah Haroon
- Farah Haroon Associate Professor of Neonatology University of Child Health Sciences, Lahore, Pakistan
| | - Bushra Fatima
- Bushra Fatima Assistant Professor of Neonatology University of Child Health Sciences, Lahore, Pakistan
| | - Gideon Victor
- Gideon Victor Assistant Professor of Neonatology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Mazhar Qadir
- Mazhar Qadir University of Child Health Sciences, Lahore, Pakistan
| | - Khawaja Ahmed Irfan Waheed
- Khawaja Ahmed Irfan Waheed Professor of Neonatology University of Child Health Sciences, Lahore, Pakistan
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Abo Elmagd E, El Hawary B, Hassan MM, Kassem H, El Tahan AER. Etiological profile of upper airway obstruction in infants. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2020; 36:36. [DOI: 10.1186/s43163-020-00034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/25/2020] [Indexed: 09/02/2023]
Abstract
AbstractBackgroundRespiratory distress is recognized as any sign of breathing difficulty in infants. Some congenital anomalies present immediately with airway distress, while others are asymptomatic or discovered later in infancy or childhood. Our objectives are to detect different laryngeal causes of respiratory distress in infants and to measure the relative risk of some variables like age, sex, family history, and other congenital anomalies for developing laryngeal causes of respiratory distress. This observational cross-sectional study was carried out during the period from June 2017 to December 2018 at Children’s University Hospital. The study included 80 infants who presented with respiratory distress and admitted to the hospital. All patients subjected to a detailed history from their parents and full general and ENT examinations. X-ray, MSCT neck or direct laryngoscope were carried out in selected cases.ResultsAs regard age, 58% of cases were between 1–6 months, 28% of cases between 6 months and 1 year, and 14% between 1–2 years. Laryngeal causes of respiratory distress among infants were distributed as follow: 70% laryngomalacia, 18% subglottic stenosis, 8% laryngeal web, and 4% of cases were caused by vocal fold paralysis (VFP). The laryngeal causes of respiratory distress did not reveal any statistically significant difference among different age groups or between both genders (P = 0.257, 0.286; respectively). Also, there was no statistically significant difference between infants with positive family history and those without as regard the laryngeal causes of respiratory distress (P = .378).ConclusionThe majority of respiratory distress cases (58%) were between 1–6 months. Bivariant analysis of variables age, sex, family history, and other congenital anomalies showed that they were not potent risk factors for developing laryngomalacia, subglottic stenosis, laryngeal web, and vocal fold paralysis. Laryngomalacia represented the commonest cause of respiratory distress (70%) followed by subglottic stenosis (18%), then laryngeal web (8%), and finally the vocal fold paralysis represented the least percentage (4%). Apart from laryngomalacia, the percentages of other causes seem to vary according to sample size and geographic area of study. So, being familiar with the common causes of respiratory distress in a given region is very essential in order not to miss a potentially life-threatening diagnosis.
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Hailu R, Desta T, Bekuretsion Y, Bezabih M, Alemu A, Bekele T, Abebe B, Asefa M, Tigabu Z, Girma Y, Eshetu B, Abayneh M, Mekasha A, Nigussie AK, McClure EM, Goldenberg RL, Muhe LM. Minimally Invasive Tissue Sampling in Preterm Deaths: A Validation Study. Glob Pediatr Health 2020; 7:2333794X20953263. [PMID: 32923527 PMCID: PMC7457683 DOI: 10.1177/2333794x20953263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/23/2020] [Accepted: 07/31/2020] [Indexed: 12/04/2022] Open
Abstract
Uncertainty about the causes of neonatal deaths impedes achieving global health targets to reduce mortality. Complete diagnostic autopsy (CDA) is the gold standard to determine cause of death. However, it is often difficult to perform in high-burden, low-income settings. Validations of more feasible methods to determine cause of death are needed. This prospective, multi-center study in Ethiopia assessed the validity of the minimally invasive tissue sampling (MITS) approach to contribute to causes of death in preterm neonates compared to CDA. The MITS and CDA of 105 cases were reviewed. The MITS sampling success for lungs and liver was 100% and 84%, respectively. The kidney and brain had sampling successes of 58% each. MITS showed good agreement with CDA for the diagnosis of hyaline membrane disease (kappa = 0.78), and moderate to substantial agreement for pneumonia and pulmonary hemorrhage (kappa = 0.59 and 0.68, respectively). Even though CDA is the gold standard in identifying the cause of death, we believe that the MITS method can be a useful alternative method in supporting determination of cause of death in low-resource settings.
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Affiliation(s)
| | | | | | - Messele Bezabih
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | - Mesfin Asefa
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Zemene Tigabu
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yonas Girma
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Beza Eshetu
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Lulu M Muhe
- Addis Ababa University, Addis Ababa, Ethiopia
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Shin JE, Yoon SJ, Lim J, Han J, Eun HS, Park MS, Park KI, Lee SM. Pulmonary Surfactant Replacement Therapy for Respiratory Distress Syndrome in Neonates: a Nationwide Epidemiological Study in Korea. J Korean Med Sci 2020; 35:e253. [PMID: 32808509 PMCID: PMC7431283 DOI: 10.3346/jkms.2020.35.e253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/10/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pulmonary surfactant (PS) replacement therapy, as a safe and effective treatment for respiratory distress syndrome (RDS) may have further increased with the extended insurance coverage since 2011 in Korea. Thus, this study aimed to investigate the epidemiologic data of PS replacement therapy for RDS in Korea and to analyze the complications associated with RDS. METHODS We included 19,442 infants who were treated with PS and diagnosed with RDS (International Classification of Diseases-10 codes: P22.0) between 2014 and 2018 from the Health Insurance Review and Assessment database. Birth certificate data from Statistics Korea were used to estimate the incidence of RDS. RESULTS The average incidence of RDS within the study period was 0.99% among live births. Repeated doses of PS were administered to 1,688 infants (8.7%), ranging from 2 doses in 929 infants (4.8%) to 9 doses in 1 infant (0.01%). The incidence of RDS in term infants markedly increased over 5 years from 0.2% to 0.34%. The incidence was similarly increased among the preterm infants. The RDS mortality rate was 6.3% and showed a decreasing trend according to year. The mortality rate was significantly higher in the lower gestational age group. A decreasing trend was observed in the incidence of the complications, such as patent ductus arteriosus, intraventricular hemorrhage, and bronchopulmonary dysplasia, except for pneumothorax in term infants. The complications were also higher in the lower gestational age group and the lower birth weight group. However, pneumothorax was the most frequent complication in the term infant group and in infants with birth weight ≥ 2,500 g. CONCLUSION Advancements in neonatal care and extended insurance coverage have increased the use of PS replacement therapy for RDS. This, in turn, decreased neonatal mortality and the incidence of the associated complications. The appropriate therapeutic strategy for RDS should be decided according to the gestational age and lung pathology.
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Affiliation(s)
- Jeong Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Joohee Lim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jungho Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Seon Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
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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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