Neonatal respiratory distress syndrome: are risk factors the same in preterm and term infants?

Betamethasone Exposure and Neonatal Respiratory Morbidity Among Late Preterm Births by Planned Mode of Delivery and Gestational Age

OBJECTIVE

To estimate the effect of late preterm antenatal steroids on the risk of respiratory morbidity among subgroups of patients on the basis of the planned mode of delivery and gestational age at presentation.

METHODS

This was a secondary analysis of the ALPS (Antenatal Late Preterm Steroid) Trial, a multicenter trial conducted within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network of individuals with singleton gestations and without preexisting diabetes who were at high risk for late preterm delivery (34-36 weeks of gestation). We fit binomial regression models to estimate the risk of respiratory morbidity, with and without steroid administration, by gestational age and planned mode of delivery at the time of presentation. We assumed a homogeneous effect of steroids on the log-odds scale, as was reported in the ALPS trial. The primary outcome was neonatal respiratory morbidity, as defined in the ALPS Trial.

RESULTS

The analysis included 2,825 patients at risk for late preterm birth. The risk of respiratory morbidity varied significantly by planned mode of delivery (adjusted risk ratio [RR] 1.90, 95% CI, 1.55-2.33 for cesarean delivery vs vaginal delivery) and week of gestation at presentation (adjusted RR 0.56, 95% CI, 0.50-0.63). For those planning cesarean delivery and presenting in the 34th week of gestation, the risk of neonatal respiratory morbidity was 39.4% (95% CI, 30.8-47.9%) without steroids and 32.0% (95% CI, 24.6-39.4%) with steroids. In contrast, for patients presenting in the 36th week and planning vaginal delivery, the risk of neonatal respiratory morbidity was 6.9% (95% CI, 5.2-8.6%) without steroids and 5.6% (95% CI, 4.2-7.0%) with steroids.

CONCLUSION

The absolute risk difference of neonatal respiratory morbidity between those exposed and those unexposed to late preterm antenatal steroids varies considerably by gestational age at presentation and planned mode of delivery. Because only communicating the relative risk reduction of antenatal steroids for respiratory morbidity may lead to an inaccurate perception of benefit, more patient-specific estimates of risk expected with and without treatment may inform shared decision making.

A Nomogram Prediction Model for Persistent Pulmonary Hypertension of the Newborn in Neonates Hospitalized for the First Time After Birth

OBJECTIVE

Persistent pulmonary hypertension of the newborn (PPHN) is one of the critical neonatal diseases associated with high morbidity and mortality. This study attempted to conduct a nomogram prediction model for performing early identification of PPHN and providing effective information for clinical practice.

METHODS

A total of 456 newborns who first admitted to the hospital after birth were included in the analysis, including 138 newborns with PPHN and 318 newborns without PPHN (as controls). The optimal predictive variables selection was performed based on LASSO (least absolute shrinkage and selection operator) regression and multivariate logistic regression. Using the selected variables, a nomogram prediction model was developed. To validate the model, the model was assessed using the receiver operating characteristic curve, calibration plot, and clinical impact curve.

RESULTS

Six predictors, namely, gestational age, neonatal respiratory distress syndrome, the levels of hemoglobin and creatine kinase-MB, gestational thyroid dysfunction, and Pa o2 , were identified by LASSO and multivariate logistic regression analysis from the original 30 variables studied. The constructed model, using these predictors, exhibited favorable predictive ability for PPHN, with an area under the receiver operating characteristic of 0.897 (sensitivity = 0.876, specificity = 0.785) in the training set and 0.871 (sensitivity = 0.902, specificity = 0.695) in the validation set, and was well calibrated, as indicated by the PHosmer-Lemeshow test values of 0.233 and 0.876 for the training and validation sets, respectively.

CONCLUSIONS

The model included gestational age, neonatal respiratory distress syndrome, the levels of hemoglobin and creatine kinase-MB, gestational thyroid dysfunction, and Pa o2 had good prediction performance for predicting PPHN among newborns first admitted to the hospital after birth.

Physical Rehabilitation Using Oromotor Stimulation, Manual Airway Clearance Technique, Positioning, and Tactile and Kinaesthetic Stimulation (PROMPT) Protocol in Low-Birth-Weight Triplets With Neonatal Respiratory Distress: A Case Series

Neonatal respiratory distress syndrome (RDS), a severe respiratory illness that is likely to affect preterm newborns especially those who were born preterm with low birth weight (LBW) or multiple births, is one of the complications that preterm babies are likely to develop. Physical Rehabilitation using Oromotor Stimulation, Manual Airway Clearance Technique, Positioning, and Tactile and Kinaesthetic Stimulations (PROMPT) is the intervention followed in this study to determine its effectiveness in the treatment of RDS in LBW triplets. The PROMPT protocol involves interventions such as manually promoting the airway, positioning, oral motor stimulation, and tactile and kinesthetic stimulation. The study examined triplets of similar weight, 1.23g, 1.36g, and 1.18g, at birth. Thus, all known triplets were suffering from the symptoms of RDS like fast breathing and grunting. They were born via premature delivery at 30+5 weeks of pregnancy. Chest X-rays were used as a diagnostic tool for assessing RDS. At the same time, the PROMPT protocol was administered and significant improvements were seen in respiratory health and there was reduced use of mechanical ventilation. The PROMPT protocol shows how effectively an organized method can be applied to treat RDS in LBW triplets.

Association of maternal serum vitamin D level with fetal pulmonary artery Doppler indices and neonatal respiratory distress syndrome

PURPOSE

Respiratory distress syndrome (RDS) is potentially fatal in infants. The present study investigated the association of maternal serum vitamin D level with fetal pulmonary artery Doppler indices and neonatal RDS.

METHODS

This cross-sectional-analytical study was conducted on 260 mothers admitted for delivery. The maternal serum 25-hydroxyvitamin D level was measured and fetal main pulmonary artery Doppler indices were evaluated. The neonate's weight, apgar score, RDS, Umbilical cord arterial pH and neonatal intensive care unit admission were recorded.

RESULTS

There was a significant relationship between RDS and the low level of vitamin D in the mother's serum. Mothers with low vitamin D had higher fetal pulmonary artery pulsatility index (PI) and peak systolic velocity (PSV) and lower acceleration time (AT) to ejection time (ET) ratio. Also, in neonates with RDS, pulmonary artery PI was higher, and PSV and the ratio of AT to ET were significantly lower than neonates without RDS. Neonates with lower one and 5-min apgar scores were born from mothers with lower vitamin D levels.

CONCLUSION

Serum levels of vitamin D in pregnant mothers as well as fetal pulmonary artery Doppler indices are correlated to RDS. There is a significant relationship between the serum level of vitamin D in pregnant mothers and fetal pulmonary artery Doppler indices.

Temporal Trend and Risk Factors for Respiratory Distress Syndrome-Associated Neonatal Mortality in Preterm Infants: A Population-Based Study in a Middle-Income Country

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..

Sudden Unexpected Postnatal Collapse: Review and Management

Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript.

The association between sex and neonatal respiratory distress syndrome

BACKGROUND

To investigate the association between sex and neonatal respiratory distress syndrome (NRDS).

METHODS

Neonates born at our hospital and transferred to the neonatal department within 1 h were retrospectively analyzed. Depending on whether they developed NRDS during their hospital stay, the neonates was divided into NRDS and non-NRDS groups. There were 142 neonates in the NRDS group (95 males and 47 females) and 310 neonates in the non-NRDS group (180 males and 140 females). The neonates' data on gestational age (GA), sex, birth weight, white blood cell count (WBC), platelet count (PLT), C-reactive protein (CRP), total immunoglobulin M (total IgM), gestational diabetes mellitus(GDM), antenatal steroids use, meconium-stained amniotic fluid, and preterm premature rupture of membranes(PPROM) were gathered.

RESULTS

452 neonates (265 males and 187 females) were involved for the purpose of collecting basic characteristic. Multivariate analysis, males had a 1.87 times higher risk of NRDS than females (P < 0.05) after controlling for the confounding effects of GA, birth weight, WBC, PLT, CRP, total IgM, GDM, antenatal steroids use, meconium-stained amniotic fluid, and PPROM.

CONCLUSIONS

Sex was associated with NRDS; males had a considerably higher risk of NRDS than females.

Prenatal Exposure to Air Pollution and Respiratory Distress in Term Newborns: Results from the MIREC Prospective Pregnancy Cohort

BACKGROUND

Respiratory distress is the leading cause of neonatal morbidity and mortality worldwide, and prenatal exposure to air pollution is associated with adverse long-term respiratory outcomes; however, the impact of prenatal air pollution exposure on neonatal respiratory distress has not been well studied.

OBJECTIVES

We examined associations between prenatal exposures to fine particular matter (PM 2.5 ) and nitrogen dioxide (NO 2 ) with respiratory distress and related neonatal outcomes.

METHODS

We used data from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a prospective pregnancy cohort (n = 2,001 ) recruited in the first trimester from 10 Canadian cities. Prenatal exposures to PM 2.5 (n = 1,321 ) and NO 2 (n = 1,064 ) were estimated using land-use regression and satellite-derived models coupled with ground-level monitoring and linked to participants based on residential location at birth. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for associations between air pollution and physician-diagnosed respiratory distress in term neonates in hierarchical logistic regression models adjusting for detailed maternal and infant covariates.

RESULTS

Approximately 7 % of newborns experienced respiratory distress. Neonates received clinical interventions including oxygen therapy (6%), assisted ventilation (2%), and systemic antibiotics (3%). Two percent received multiple interventions and 4% were admitted to the neonatal intensive care unit (NICU). Median PM 2.5 and NO 2 concentrations during pregnancy were 8.81   μ g / m 3 and 18.02  ppb , respectively. Prenatal exposures to air pollution were not associated with physician-diagnosed respiratory distress, oxygen therapy, or NICU admissions. However, PM 2.5 exposures were strongly associated with assisted ventilation (OR per 1 - μ g / m 3 increase in PM 2.5 = 1.17 ; 95% CI: 1.02, 1.35), multiple clinical interventions (OR per 1 - μ g / m 3 increase in PM 2.5 = 1.16 ; 95% CI: 1.07, 1.26), and systemic antibiotics, (OR per 1 - μ g / m 3 increase in PM 2.5 = 1.12 ; 95% CI: 1.04, 1.21). These associations were consistent across exposure periods-that is, during prepregnancy, individual trimesters, and total pregnancy-and robust to model specification. NO 2 exposure was associated with administration of systemic antibiotics (OR per 1-ppb increase in NO 2 = 1.03 ; 95% CI: 1.00, 1.06).

DISCUSSION

Prenatal exposures to PM 2.5 increased the risk of severe respiratory distress among term newborns. These findings support the development and prioritization of public health and prenatal care strategies to increase awareness and minimize prenatal exposures to air pollution. https://doi.org/10.1289/EHP12880.

Implications of maternal vitamin D administration for the neonatal respiratory distress syndrome: A randomized clinical trial

BACKGROUND

Vitamin D deficiency has been suggested to be a risk factor for neonatal respiratory distress syndrome (RDS). This study aimed to evaluate the effect of 25 (OH) D administrations in pregnant women with findings of preterm labor on the incidence of RDS in their preterm neonates.

MATERIALS AND METHODS

A randomized controlled clinical trial was conducted on pregnant mothers with gestational age (GA) of less than 34 weeks at risk of preterm delivery. 175 subjects were randomly assigned into two groups, including intervention (intramuscular injection of 50,000 units of 25(OH) D during 72 hours before delivery) and control (no injections). Serum concentrations of 25(OH) D were measured shortly after birth in both mothers and neonates. Then, clinical and laboratory results of mothers and their offspring were recorded (in a checklist). Short-term outcomes and the need for respiratory support were also assessed. Data were analyzed by independent t-test, Mann-Whitney U test, Fisher's exact test, and chi-square test.

RESULTS

Even though gestational age, birth weight, delivery method, and serum vitamin D levels are consistent among both groups, 45% of neonates in the control group and 20% in the intervention group developed respiratory distress syndrome (P = 0.05). The mean 25(OH) D level in neonates was 17.7±10.5 and 19.29±9.94 ng/mL in the intervention and control groups, respectively (P > 0.05).

CONCLUSION

A single dose of 50,000 units of intramuscular 25(OH)D in pregnant women at risk of preterm labor can lower the risk of RDS in the infant.

Comparison of the efficacy of two natural surfactants (BERAKSURF and BLES) in the treatment of respiratory distress syndrome among preterm neonates

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.

Lung Volume Head Ratio: A Potential Parameter for Prediction of Respiratory Distress in Newborn

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..

Anesthetic drug concentrations and placental transfer rate in fetus between term and preterm infants, twins, and singletons

Objective: This study aims to determine the drug concentration of etomidate, remifentanil, and rocuronium bromide for general anesthesia in fetus as well as the placental transport rate between term and preterm delivery, twins, and singleton. Study design: Sixty parturients with 72 fetuses undergoing cesarean section under general anesthesia were included. According to whether the fetus was a twin or premature, parturients were divided into Group I (term singleton), Group II (premature singleton), Group III (term twins), and Group IV (premature twins). The preoperative demographic characteristics and laboratory examination of parturients, hemodynamic indicators, the Apgar score of neonates at 1, 5, and 10 min after delivery and at specific assigned values, umbilical artery blood gas analysis results, neonatal weight, and resuscitative measures were recorded. Anesthetic drug concentrations in maternal arterial (MA), umbilical arterial (UA), and umbilical venous (UV) blood were detected by Ultra Performance Liquid Chromatography Tandem Mass Spectrometry (UPLC-MS/MS). Result: No significant differences were observed in the concentrations of etomidate, remifentanil, and rocuronium bromide in MA, UV, and UA blood, or in the UV/MA and UA/UV ratios between term and preterm infants, twins, and singletons. Moreover, there was no variation in the anesthetic drug concentration among each pair of twins. Additionally, no correlation was found between the neonatal weight and the plasma concentrations of anesthetic drugs in UV and UA blood, except for remifentanil in UA blood. Conclusion: Preterm or twin deliveries do not affect the neonatal concentration of etomidate, remifentanil, and rocuronium bromide used in general anesthesia for cesarean sections. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR2100046547.

Artificial Intelligence-Driven Respiratory Distress Syndrome Prediction for Very Low Birth Weight Infants: Korean Multicenter Prospective Cohort Study

BACKGROUND

Respiratory distress syndrome (RDS) is a disease that commonly affects premature infants whose lungs are not fully developed. RDS results from a lack of surfactant in the lungs. The more premature the infant is, the greater is the likelihood of having RDS. However, even though not all premature infants have RDS, preemptive treatment with artificial pulmonary surfactant is administered in most cases.

OBJECTIVE

We aimed to develop an artificial intelligence model to predict RDS in premature infants to avoid unnecessary treatment.

METHODS

In this study, 13,087 very low birth weight infants who were newborns weighing less than 1500 grams were assessed in 76 hospitals of the Korean Neonatal Network. To predict RDS in very low birth weight infants, we used basic infant information, maternity history, pregnancy/birth process, family history, resuscitation procedure, and test results at birth such as blood gas analysis and Apgar score. The prediction performances of 7 different machine learning models were compared, and a 5-layer deep neural network was proposed in order to enhance the prediction performance from the selected features. An ensemble approach combining multiple models from the 5-fold cross-validation was subsequently developed.

RESULTS

Our proposed ensemble 5-layer deep neural network consisting of the top 20 features provided high sensitivity (83.03%), specificity (87.50%), accuracy (84.07%), balanced accuracy (85.26%), and area under the curve (0.9187). Based on the model that we developed, a public web application that enables easy access for the prediction of RDS in premature infants was deployed.

CONCLUSIONS

Our artificial intelligence model may be useful for preparations for neonatal resuscitation, particularly in cases involving the delivery of very low birth weight infants, as it can aid in predicting the likelihood of RDS and inform decisions regarding the administration of surfactant.

Comparing the clinical and economic efficiency of four natural surfactants in treating infants with respiratory distress syndrome

Surfactant therapy has revolutionized the treatment of respiratory distress syndrome (RDS) over the past few decades. Relying on a new method, the current research seeks to compare four common surfactants in the health market of Iran to determine the best surfactant according to the selected criteria. The research was a cross-sectional, retrospective study that used the data of 13,169 infants as recorded on the information system of the Iranian Ministry of Health. To rank the surfactants used, the following indicators were measured: re-dosing rate, average direct treatment cost, average length of stay, disease burden, need for invasive mechanical ventilation, survival at discharge, and medical referrals. The CRITIC (criteria importance through intercriteria correlation) method was used to determine the weight of the indicators, and MABAC (multi-attributive border approximation area comparison) was used to prioritize the surfactants. Based on the seven selected indicators in this research (re-dosing rate, average length of stay, direct medical cost per one prescription, medical referral rate, survival at discharge, disability-adjusted life years, number of newborns in need of invasive mechanical ventilation) and using multi-criteria analysis method, Alveofact was identified as the worst surfactant in infants with either more or less than 32 weeks' gestation. So that some criteria were worse in Alveofact group infants than other groups; for example, in the comparison of the Alveofact group with the average of the total population, it was found that the survival rate at discharge was 57.14% versus 66.43%, and the rate of re-dosing was 1.63 versus 1.39. BLES (bovine lipid extract surfactant) was the best alternative for infants more than 32 weeks' gestation, whereas Survanta was identified as best option for infants with less than 32 weeks' gestation. Curosurf showed an average level of functionality in the ranking. This study advises the policy makers in the field of neonatal health to increase the market share of more effective surfactants based on this study and other similar studies. On the other hand, neonatal health care providers are also advised to prioritize the use of more effective surfactants if possible, depending on the clinical conditions and desired improvements.

Health Economic Studies of Surfactant Replacement Therapy in Neonates with Respiratory Distress Syndrome: A Systematic Literature Review

BACKGROUND

Neonatal respiratory distress syndrome (RDS) is one of the most common problems for preterm infants, and symptoms include tachypnoea, grunting, retractions and cyanosis, which occur immediately after birth. Treatment with surfactants has reduced morbidity and mortality rates associated with neonatal RDS.

OBJECTIVE

The objective of this review is to describe the treatment costs, healthcare resource utilization (HCRU) and economic evaluations of surfactant use in the treatment of neonates with RDS.

METHODS

A systematic literature review (SLR) was performed to identify available economic evaluations and costs associated with neonatal RDS. Electronic searches were conducted in Embase, MEDLINE, MEDLINE In-Process, NHS EED, DARE and HTAD to identify studies published between 2011 and 2021. Supplementary searches of reference lists, conference proceedings, websites of global health technology assessment bodies and other relevant sources were conducted. Publications were screened by two independent reviewers for inclusion and followed the population, interventions, comparators and outcomes framework eligibility criteria. Quality assessment of the identified studies was performed.

RESULTS

Eight publications included in this SLR met all eligibility criteria: three conference abstracts and five peer-reviewed original research articles. Four of these publications evaluated costs/HCRU, and five (three abstracts and two peer-reviewed articles) investigated economic evaluations (two from Russia, and one each from Italy, Spain and England). The main cost drivers and causes of increased HCRU were invasive ventilation, duration of hospitalization and RDS-associated complications. There were no significant differences in neonatal intensive care unit (NICU) length of stay or NICU total costs between infants treated with beractant (Survanta^®), calfactant (Infasurf^®) or poractant alfa (Curosurf^®). However, treatment with poractant alfa was associated with reduced total costs compared with no treatment, continuous positive airway pressure (CPAP) alone or calsurf (Kelisu^®), due to shorter duration of hospitalization and fewer complications. Early use of the surfactant after birth was more clinically effective and cost-effective than late intervention in infants with RDS. Poractant alfa was found to be cost-effective and cost-saving compared to beractant for the treatment of neonatal RDS in two Russian studies.

CONCLUSION

There were no significant differences in NICU length of stay or NICU total costs between surfactants evaluated for treating neonates with RDS. However, early use of surfactant was found to be more clinically effective and cost-effective than late treatment. Treatment with poractant alfa was found to be cost-effective versus beractant and cost-saving compared with CPAP alone or beractant or CPAP in combination with calsurf. Limitations included the small number of studies, the geographic scope of the studies and the retrospective study design of the cost-effectiveness studies.

Predicting the need for intubation within 3 h in the neonatal intensive care unit using a multimodal deep neural network

Respiratory distress is a common chief complaint in neonates admitted to the neonatal intensive care unit. Despite the increasing use of non-invasive ventilation in neonates with respiratory difficulty, some of them require advanced airway support. Delayed intubation is associated with increased morbidity, particularly in urgent unplanned cases. Early and accurate prediction of the need for intubation may provide more time for preparation and increase safety margins by avoiding the late intubation at high-risk infants. This study aimed to predict the need for intubation within 3 h in neonates initially managed with non-invasive ventilation for respiratory distress during the first 48 h of life using a multimodal deep neural network. We developed a multimodal deep neural network model to simultaneously analyze four time-series data collected at 1-h intervals and 19 variables including demographic, physiological and laboratory parameters. Evaluating the dataset of 128 neonates with respiratory distress who underwent non-invasive ventilation, our model achieved an area under the curve of 0.917, sensitivity of 85.2%, and specificity of 89.2%. These findings demonstrate promising results for the multimodal model in predicting neonatal intubation within 3 h.

Effects of Chest Physiotherapy in Preterm Infants with Respiratory Distress Syndrome: A Systematic Review

Preterm birth carries a higher risk of respiratory problems. The objectives of the study are to summarize the evidence on the effect of chest physiotherapy in the treatment of respiratory difficulties in preterm infants, and to determine the most appropriate technique and whether they are safe. Searches were made in PubMed, WOS, Scopus, Cochrane Library, SciELO, LILACS, MEDLINE, ProQuest, PsycArticle and VHL until 30 April 2022. Eligibility criteria were study type, full text, language, and treatment type. No publication date restrictions were applied. The MINCIR Therapy and PEDro scales were used to measure the methodological quality, and the Cochrane risk of bias and Newcastle Ottawa quality assessment Scale to measure the risk of bias. We analysed 10 studies with 522 participants. The most common interventions were conventional chest physiotherapy and stimulation of the chest zone according to Vojta. Lung compression and increased expiratory flow were also used. Heterogeneities were observed regarding the duration of the interventions and the number of participants. The methodological quality of some articles was not adequate. All techniques were shown to be safe. Benefits were described after conventional chest physiotherapy, Vojta's reflex rolling, and lung compression interventions. Improvements after Vojta's reflex rolling are highlighted in the comparative studies.

Risk factors for respiratory distress syndrome among high-risk early-term and full-term deliveries

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.

Surfactant proteins analysis in perinatal deceased preterm twins among the Romanian population

The molecular basis of the evaluation of children suspected of having disorders of surfactant proteins is still under discussion. In this study, we aimed to describe the morphological characteristics and to evaluate the immunohistochemical expression of surfactant proteins (surfactant protein A [SPA], surfactant protein B, and pro-surfactant protein C) in the preterm twins that deceased due to unexplained respiratory distress syndrome (n = 12). Results showed statistically significant positive correlations between surfactant protein B expressions and pulmonary hemorrhage (ρ = 0.678; P < .05), SPA levels, and Apgar score (ρ = 0.605; P < .05) and also expressions of SPA and bronchopneumonia (ρ = 0.695; P < .05). The fetuses and neonates of the same gestational age showed differences among surfactant proteins regarding the immunostaining expression. Our data evidence a marked interindividual variability in the expression of all 3 surfactant proteins among the cases analyzed (n = 12), suggesting the intervention of some individual and epigenetic factors during gestation that might influence surfactant protein production and consequently survival rate.

Mortality and morbidity of infants with trisomy 21, weighing 1500 grams or less, in Japan

Although very low birth weight (VLBW) is well studied in neonatology and the perinatal prognosis of VLBW infants has improved over time, little is known about the prognosis of VLBW infants with trisomy 21 (T21). We aimed to investigate the mortality and morbidity of VLBW infants with T21 during NICU admission in Japan, in comparison to those of infants without birth defects (BD-). Maternal and neonatal data of infants weighing 1500 grams or less admitted to the centers of the Neonatal Research Network of Japan from 2003 to 2016 were collected prospectively. Of 60,136 infants, 328 (0.55%) had T21. Although maternal age in the case of T21 infants was higher, maternal complications tended to be less frequent than in those with BD-. Multivariable analysis revealed that morbidities were higher in infants with T21 than in those with BD- but respiratory distress syndrome and retinopathy of prematurity were less frequent in those with T21 (p < 0.001, and p = 0.014, respectively), and no significant difference was observed between the two groups in the proportion of late-onset circulatory collapse of prematurity as well as cystic periventricular leukomalacia (p = 0.739 and p = 0.733, respectively). The survival rate at discharge from the NICU was 77% and 94% for T21 and BD-, respectively. This was the first nationwide survey of VLBW infants with T21 in Japan. Although there were no data regarding the timing of diagnosis, these data will aid prenatal genetic counseling and perinatal management of T21 infants.

Irrational prescription of surfactant replacement therapy in neonatal respiratory distress

Purpose

Respiratory distress is known as one of the leading causes of neonatal death. In recent decades, surfactant therapy has revolutionized respiratory failure. Since the implementation of the health system reform plan as well as the allocation of new financial resources for health system in Iran, the rate of irrational prescription has increased and prescription of surfactant for neonates, has raised unexpectedly, which is thought to be due to irrational prescriptions partly. The present study aimed to determine the rate of irrational prescription of surfactant for neonates with respiratory distress.

Methods

This research was a cross-sectional descriptive study, which was conducted retrospectively. In the current study, determining the rate of irrational prescription was done in terms of the surfactant prescription guideline. Finally, the medical data of 846 neonates who underwent surfactant therapy in Iran in 2018, were extracted from the information system of the Ministry of Health and the neonatal medical records.

Results

The results show that drug selection index, dose index, and time index were irrational for 14.30%, 27.42%, and 1.06% of neonates, respectively. Moreover, the total index of drug prescription, which is a combination of the above-mentioned three components, was found to be irrational for 31.47% of neonates.

Conclusions

The results of the present study are considered as a warning to providers and decision makers in the field of neonatal health to reduce irrational prescriptions of surfactant for neonates. This study suggests the use of educational interventions in order to reduce irrational prescriptions due to drug selection as well as the use of computer alert approaches in order to reduce irrational prescriptions due to wrong dose.

Association between Respiratory Distress Syndrome of Newborns and Fetal Growth Restriction Evaluated Using a Dichorionic Twin Pregnancy Model

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.

Comparison of minimally invasive surfactant therapy with intubation surfactant administration and extubation for treating preterm infants with respiratory distress syndrome: a randomized clinical trial

BACKGROUND

Respiratory distress syndrome (RDS) is a common cause of hospitalization and death in preterm infants who require surfactant treatment and respiratory support.

PURPOSE

This study aimed to compare the clinical outcomes of minimally invasive surfactant therapy (MIST) and the INtubation, SURfactant administration, and Extubation (INSURE) technique in preterm infants with RDS.

METHODS

In this clinical trial, 112 preterm infants born at 28-36 weeks of gestation and diagnosed with RDS randomly received 200-mg/kg surfactant by MIST or the INSURE method. In the MIST group, surfactant was administered using a thin catheter (5F feeding tube); in the INSURE group, surfactant was administered after intubation using a feeding tube and the tracheal tube was removed after positive pressure ventilation was started. Nasal continuous positive airway pressure was applied in both groups for respiratory support and the postprocedure clinical outcomes were compared.

RESULTS

The mean hospitalization time was shorter for infants in the MIST group than for those in the INSURE group (9.19± 1.72 days vs. 10.21±2.15 days, P=0.006). Patent ductus arteriosus was less frequent in the MIST group (14.3% vs. 30.4%, P=0.041). Desaturation during surfactant administration occurred less commonly in the MIST group (19.6% vs. 39.3%, P=0.023). There were no significant intergroup differences in other early or late complications.

CONCLUSION

These results suggest that surfactant administration using MIST could be a good replacement for INSURE in preterm infants with RDS since its use reduced the hospitalization time and the number of side effects.

Ultrasound Lung Image under Artificial Intelligence Algorithm in Diagnosis of Neonatal Respiratory Distress Syndrome

In order to analyze the application of ultrasonic lung imaging diagnosis model based on artificial intelligence algorithm in neonatal respiratory distress syndrome (NRDS), an ultrasonic lung imaging diagnosis model based on a deep residual network (DRN) was proposed. In this study, 90 premature infants in the hospital were selected as the research object and divided into the experimental group (45 cases) and control group (45 cases) according to whether or not they have NRDS. DRN was compared with the deep residual network (DRWSR) based on wavelet domain, deep residual network detection with normalization framework (Fisher-DRN), and distorted image edge detection preprocessor (DIEDP). Then, it was applied to the diagnosis of NRDS. The clinical data and ultrasound imaging results of infants with NRDS and ordinary premature infants were compared. The results showed that the gestational age, birth weight, and Apgar scores of the NRDS group were remarkably lower than those of ordinary children (P < 0.05). In addition, the segmentation accuracy, image feature extraction accuracy, algorithm convergence, and time loss of the DRN algorithm were better than the other three algorithms, and the differences were considerable (P < 0.05). In children with NRDS, the positive rate of abnormal pleural line, disappearance of A line, appearance of B line, and alveolar interstitial syndrome (AIS) test in the results of lung ultrasound examination in children with NRDS were all 100%. The lung consolidation became 70.8%, and the white lung-like change was 50.1%, both of which were higher than those of ordinary preterm infants, and the differences were considerable (P < 0.05). The diagnostic model of this study predicted that the AUC area of grade 1-2, grade 2-3, and grade 3-4 NRDS were 0.962, 0.881, and 0.902, respectively. To sum up, the ultrasound lung imaging diagnosis model based on the DRN algorithm had good diagnostic performance in children with NRDS and can provide useful information for clinical NRDS diagnosis and treatment.

Early-Pregnancy Intermediate Hyperglycemia and Adverse Pregnancy Outcomes Among Women Without Gestational Diabetes

CONTEXT

Universal early-pregnancy screening for overt diabetes reveals intermediate hyperglycemia (fasting plasma glucose [FPG] [5.1-6.9 mM]).

OBJECTIVE

We evaluated the association between early-pregnancy intermediate hyperglycemia and adverse pregnancy outcomes among women without gestational diabetes.

METHODS

This retrospective cohort study was conducted at the Obstetrics and Gynecology Hospital, Shanghai, China, from 2013 to 2017. All singleton pregnancies with FPG less than or equal to 6.9 mM in early pregnancy and receiving a 75-g oral glucose tolerance test (OGTT) were included. Women with prepregnancy diabetes were excluded. Individuals with normal OGTT were analyzed. Pregnancy outcomes for FPG less than 5.1 mM and intermediate hyperglycemia were evaluated. The primary outcomes were large for gestational age (LGA) and primary cesarean delivery. Multivariate logistic regressions were conducted. Statistical significance was defined as P less than .05.

RESULTS

In total, 24 479 deliveries were included, of which 23 450 (95.8%) had normal OGTTs later in pregnancy (NGT). There were 807 (3.4%) women who had an FPG of 5.1 to 6.9 mM in early pregnancy. Compared to the NGT group with an FPG of less than 5.1 mM in early pregnancy (N = 20692), the intermediate hyperglycemia NGT group (N = 693) had a higher age and body mass index (BMI), and significantly higher rates of LGA, primary cesarean delivery, preterm birth, preeclampsia, and neonatal distress. The rates of primary cesarean delivery (adjusted odds ratio [AOR] 1.24; 95% CI, 1.05-1.45), preterm birth (AOR 1.75; 95% CI, 1.29-2.36), and neonatal distress (AOR 3.29; 95% CI, 1.57-6.89) remained statistically significantly higher after adjustments for maternal age, BMI, and other potential confounding factors.

CONCLUSION

Women with intermediate hyperglycemia in early pregnancy are at an increased risk for adverse maternal-fetal outcomes, even with normal future OGTTs.

Do maternal demographics and prenatal history impact the efficacy of betamethasone therapy for threatened preterm labor?

BACKGROUND

Betamethasone (BMZ) is used to accelerate fetal lung maturation in women with threatened preterm birth, but its efficacy is variable and limited by the lack of patient individualization in its dosing and administration. To determine sources of variability and potential opportunities for individualization of therapy, the objective of this study was to evaluate maternal factors associated with development of neonatal respiratory distress syndrome (RDS) in a cohort of women who received betamethasone.

METHODS

This study prospectively enrolled women, gestational ages 23-34 weeks, who received betamethasone for threatened preterm birth. Maternal demographics, prenatal history, and neonatal outcomes were abstracted from hospital records. RDS was the primary outcome. Associations between RDS diagnosis and maternal demographics, prenatal history, and betamethasone dosing were evaluated in a case-control analysis and multivariable regression adjusted for gestational age at delivery. Secondary analyses limited the cohort to women who delivered within 1 or 2 weeks of betamethasone dosing.

RESULTS

Of 209 deliveries, 90 (43 %) resulted in neonatal RDS. Within the overall cohort and controlling for gestational age at birth, RDS was only associated with cesarean births compared to vaginal births (adjusted OR 1.17 [1.06-1.29]). Route of delivery was also the only significant factor related to RDS in the 83 neonates delivered within 7 days of BMZ dosing. However, among 101 deliveries within 14 days of betamethasone dosing and controlling for gestational age at birth, women who experienced preterm premature rupture of membranes (PPROM) had lower RDS rates than those without PPROM (57.9 % vs. 80.2 %, adjusted OR 0.81 [0.67-0.99]). Maternal age, BMI, race, and ethnicity were not associated with RDS in the regression models.

CONCLUSIONS

Of maternal characteristics analyzed, only delivery by cesarean was associated with neonatal RDS after antenatal betamethasone use.

Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case-control study

Background

Neonatal respiratory distress syndrome (NRDS) is strongly associated with premature birth, but it can also affect term neonates. Unlike the extent of research in preterm neonates, risk factors associated with incidence and severity of NRDS in term neonates are not well studied. In this study, we examined the association of maternal and neonatal risk factors with the incidence and severity of NRDS in term neonates admitted to Neonatal Intensive Care Unit (NICU) in Cyprus.

Methods

In a prospective, case-control design we recruited term neonates with NRDS and non-NRDS admitted to the NICU of Archbishop Makarios III hospital, the only neonatal tertiary centre in Cyprus, between April 2017–October 2018. Clinical data were obtained from patients’ files. We used univariate and multivariate logistic and linear regression models to analyse binary and continuous outcomes respectively.

Results

During the 18-month study period, 134 term neonates admitted to NICU were recruited, 55 (41%) with NRDS diagnosis and 79 with non-NRDS as controls. In multivariate adjusted analysis, male gender (OR: 4.35, 95% CI: 1.03–18.39, p = 0.045) and elective caesarean section (OR: 11.92, 95% CI: 1.80–78.95, p = 0.01) were identified as independent predictors of NRDS. Among neonates with NRDS, early-onset infection tended to be associated with increased administration of surfactant (β:0.75, 95% CI: − 0.02-1.52, p = 0.055). Incidence of pulmonary hypertension or systemic hypotension were associated with longer duration of parenteral nutrition (pulmonary hypertension: 11Vs 5 days, p < 0.001, systemic hypotension: 7 Vs 4 days, p = 0.01) and higher rate of blood transfusion (pulmonary hypertension: 100% Vs 67%, p = 0.045, systemic hypotension: 85% Vs 55%, p = 0.013).

Conclusions

This study highlights the role of elective caesarean section and male gender as independent risk factors for NRDS in term neonates. Certain therapeutic interventions are associated with complications during the course of disease. These findings can inform the development of evidence-based recommendations for improved perinatal care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-021-01086-5.

Factors Associated with the Occurrence of Death Outcome in Children with Neonatal Respiratory Distress Syndrome

Neonatal respiratory distress syndrome (NRDS) is a consequence of immaturity at birth and it is still associated with relatively high mortality rate. The aim of this study was to identify the factors associated with the occurrence of fatal outcome in newborns with neonatal respiratory distress syndrome.The research was designed as a case-control study nested in a retrospective cohort, and it enrolled newborns treated during 2015 at Pediatric Clinic of Clinical Center in Kragujevac. Diagnosis of NRDS and decision about the treatment were left at the discretion of attending pediatricians. The cases were patients with fatal outcome, while controls were randomly selected from the pool of survivors and matched with each case by gender in a ratio of 4:1. The study included 371 newborns, of whom 201 (54.2%) were male and 170 (45.8%) female. Lethal outcome occurred in 36 newborns (9,7%). Significant association was found between death and APGAR score (ORadjusted: 0.516, 95% CI: 0.322-0.827), weight on delivery (ORadjusted: 0.996, 95% CI: 0.993-0.999), duration of hospitalization (ORadjusted: 0.901, 95% CI: 0.835-0.972) and mechanical ventilation (ORadjusted: 165.256, 95% CI: 7.616-3585.714). Higher gestational age, higher birth weight, higher APGAR score and longer duration of hospitalization were singled out as protective factors, while use of mechanical ventilation increased the risk of death. Major limitations of the study were retrospective nature and relatively small number of identified cases. Postponing delivery and delivery in institution with neonatal intensive care unit are crucial for survival of newborns with NRDS.

Adverse Neonatal Outcome are More Common among Babies Born by Cesarean Section than Naturally Born Babies at Public Hospitals in Eastern Ethiopia: A Comparative Prospective Follow-Up Study at Eastern Ethiopia

The adverse neonatal outcome is defined as the presence of birth asphyxia, respiratory distress, birth trauma, hypothermia, meconium aspiration syndrome, neonatal intensive care admission, and neonatal death. It is a major concern in developing countries, including Ethiopia. This study tried to identify predictors of adverse neonatal outcomes at selected public hospitals in Eastern Ethiopia. A hospital-based prospective follow-up study was conducted in three public hospitals in Eastern Ethiopia from June to October 2020. A total of 2,246 laboring women and neonates born at the hospitals were enrolled in the study. Data were collected through interviews, observation checklists, and clinical chart review. Reports were presented in relative risks with 95% CIs. The overall magnitude of adverse neonatal outcome was 20.97% (95% CI: 19.33- 22.71%). It was 24.3% for babies born through cesarean section (95% CI: 21.3%, 27.5). The presence of meconium in the amniotic fluid increased the risk for neonates delivered via cesarean section (ARR, 1.52 95% CI; 1.04, 2.22). Among neonates born via vaginal delivery, the risk of adverse neonatal outcome was higher among nullipara women (ARR, 1.42 95% CI; 1.02, 1.99) and among women diagnosed with abnormal labor or pregnancy such as APH, pre-eclampsia, obstructed labor, fetal distress, and mal-presentation at admission (ARR, 1.30 95%CI; 1.01, 1.67). The risk of adverse neonatal outcome was higher among babies born through the cesarian section than those born via vaginal delivery. Abnormal labor or pregnancy and being primiparous increased the risk of adverse neonatal outcome in vaginal delivery.

The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study

BACKGROUND

Hyaline membrane disease (HMD) is a leading cause of morbidity and mortality in preterm newborn babies. Though, there are studies related to Hyaline membrane disease inclusive of all neonates, studies related to the burden among preterm neonates were limited. In addition, increasing neonatal mortality in Ethiopia could be related to increase in the burden of hyaline membrane disease among preterm neonates. Therefore, this study was aimed to assess the burden of hyaline membrane disease, mortality and its associated factors among preterm neonate admitted at neonatal intensive care unit, North Central Ethiopia.

METHODOLOGY

An institution-based retrospective follow-up study was conducted among 535 preterm neonates admitted at neonatal intensive care unit from January 1, 2014-December 30, 2017. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for statistical analysis. Binary logistic regression was used for the analysis. All variables with P-value < 0.25 during bi-variable analysis were considered for multivariable logistic regression. Level of statistical significance was declared at P value ≤0.05.

RESULTS

In the current study, proportion of hyaline membrane disease was 40% (95% CI; 35.8, 44.3) of which 49.5% died. Preterm neonate born with Gestational age of less than 34 weeks of age (Adjusted odd ratio (AOR = 2.64; 95 CI: 1.49, 4.66)), 5th minute Apgar score less than 7 (AOR = 2.2; 95% CI: 1.20, 4.07), and newborn with birth weight of less than 1500 gram (AOR = 2.4, 95% CI: 1.3, 4.3) were predictors of hyaline membrane disease.

CONCLUSIONS

The mean gestational age (±) was 33.46 (±2.55) weeks. The incidence of hyaline membrane disease among preterm admissions was high. Preterm neonate born with gestational age of less than 34 weeks of age, asphyxiated newborns and newborn with birth weight of less than 1500 gram were predictors of hyaline membrane disease. So, emphasis should be given on early screening, follow up and timely interventions for preterm neonate.

Comparison of Serum Triglyceride and Cholesterol Levels in Premature Neonates with or without Respiratory Distress Syndrome (RDS)

Background

Deficiency or reduced transmission of long-chain fatty acids and essential fatty acids may inhibit lung growth and development. We aimed to evaluate and compare serum triglyceride and cholesterol levels in premature neonates with RDS.

Methods

This study is a cross-sectional study performed on premature neonates born in Beheshti Hospital in Isfahan in 2018. Immediately after birth and after umbilical cord clumping, blood samples were taken from the umbilical artery and triglyceride and total cholesterol levels were measured. Those patients with the diagnosis of RDS were transferred to the neonatal intensive care unit (NICU). Data regarding the laboratory results of the lipid profile in patients were compared to that in the other group.

Results

A total number of 100 neonates entered the study and were divided into 2 groups. Analysis of gender and mean gestational ages among the two groups showed no significant differences between the groups (P = 0.84 and P = 0.28, respectively). Further analysis showed a significant decreased serum cholesterol in the group 1 of patients (P = 0.01), but there were no significant differences between the two groups regarding triglyceride levels (P = 0.43). There was a significant direct relationship between gestational age and serum triglyceride levels in patients with RDS (r = 0.550, P < 0.001).

Conclusion

Here, we indicated significantly lower cholesterol levels in the cord serum of premature neonates with RDS compared to non-RDS premature neonates. Our data also showed a significant direct relationship between gestational age and serum triglyceride levels in patients with RDS. These data were in line with the previous studies.

ABCA3 gene mutations shape the clinical profiles of severe unexplained respiratory distress syndrome in late preterm and term infants

BACKGROUND

The majority of unexplained respiratory distress syndrome (URDS) cases in late preterm and term infants are caused by genetic abnormalities, with the most common of these being ABCA3 gene mutation. At present, it is unclear to neonatologists whether URDS patients with ABCA3 mutation have similar or more challenging clinical profiles to those without any defined genetic abnormalities. Our study aimed to answer this question by comparing the clinical characteristics of severe URDS patients with homozygous or compound heterozygous ABCA3 mutations, a single ABCA3 mutation, or no defined genetic abnormalities.

METHODS

This retrospective cohort study involved 39 late preterm and term infants with URDS underwent a clinical exome sequencing at a tertiary neonatal intensive care unit between January 2013 and December 2019. Based on the sequencing result, the study subjects were classified into the homozygous or compound heterozygous mutations, single ABCA3 mutation, or no defined genetic abnormalities groups. The major outcomes, including mortality, the age of symptom onset and development of severe RDS, and the radiological score, were compared between the groups.

RESULTS

A novel splicing site (c.3862+1G>C) was identified in one twin with homozygous expression. Patients with homozygous or compound heterozygous ABCA3 mutations exhibited symptom onset and development of severe respiratory distress syndrome (RDS) earlier than those with a single mutation or no genetic abnormalities (P<0.05). These patients also had higher mortality rates than those without genetic abnormalities (P=0.029). The total radiological scores were 51.14±4.91, 44.20±6.54, 35.91±4.42 for patients with homozygous or compound heterozygous mutations, a single mutation, and a wild-type gene, respectively, with significant differences between the groups observed by pairwise comparison (all P<0.05).

CONCLUSIONS

Late preterm or term infants with URDS due to homozygous or compound heterozygous ABCA3 mutations exhibited more challenging clinical profiles than those without genetic abnormalities. However, whether this relationship exists between patients with a single ABCA3 mutation and those without genetic abnormalities warrants further study.

Gender variations in neonatal and early infant mortality in India and Pakistan: a secondary analysis from the Global Network Maternal Newborn Health Registry

Background

To determine the gender differences in neonatal mortality, stillbirths, and perinatal mortality in south Asia using the Global Network data from the Maternal Newborn Health Registry.

Methods

This study is a secondary analysis of prospectively collected data from the three south Asian sites of the Global Network. The maternal and neonatal demographic, clinical characteristics, rates of stillbirths, early neonatal mortality (1–7 days), late neonatal mortality (8–28 days), mortality between 29–42 days and the number of infants hospitalized after birth were compared between the male and female infants.

Results

Between 2010 and 2018, 297,509 births [154,790 males (52.03%) and 142,719 females (47.97%)] from two Indian sites and one Pakistani site were included in the analysis [288,859 live births (97.1%) and 8,648 stillbirths (2.9%)]. The neonatal mortality rate was significantly higher in male infants (33.2/1,000 live births) compared to their female counterparts (27.4/1,000, p < 0.001). The rates of stillbirths (31.0 vs. 26.9/1000 births) and early neonatal mortality (27.1 vs 21.6/1000 live births) were also higher in males. However, there were no significant differences in late neonatal mortality (6.3 vs. 5.9/1000 live births) and mortality between 29–42 days (2.1 vs. 1.9/1000 live births) between the two groups. More male infants were hospitalized within 42 days after birth (1.8/1000 vs. 1.3/1000 live births, p < 0.001) than females.

Conclusion

The risks of stillbirths, and early neonatal mortality were higher among male infants than their female counterparts. However, there was no gender difference in mortality after 7 days of age. Our results highlight the importance of stratifying neonatal mortality into early and late neonatal period to better understand the impact of gender on neonatal mortality. The information from this study will help in developing strategies and identifying measures that can reduce differences in sex-specific mortality.

Predicting neonatal respiratory distress syndrome and hypoglycaemia prior to discharge: Leveraging health administrative data and machine learning

OBJECTIVES

A major challenge for hospitals and clinicians is the early identification of neonates at risk of developing adverse conditions. We develop a model based on routinely collected administrative data, which accurately predicts two common disorders among early term and preterm (<39 weeks) neonates prior to discharge.

STUDY DESIGN

The data included all inpatient live births born prior to 39 weeks (n = 154,755) occurring in the Australian state of Queensland between January 2009 and December 2015. Predictor variables included all maternal data captured in administrative records from the beginning of gestation up to, and including, the delivery, as well as neonatal data recorded at the delivery. Gradient boosted trees were used to predict neonatal respiratory distress syndrome and hypoglycaemia prior to discharge, with model performance benchmarked against a logistic regression models.

RESULTS

The gradient boosted trees model achieved very high discrimination for respiratory distress syndrome [AUC = 0.923, 95% CI (0.917, 0.928)] and good discrimination for hypoglycaemia [AUC = 0.832, 95% CI (0.827, 0.837)] in the validation data, as well as outperforming the logistic regression models.

CONCLUSION

Our study suggests that routinely collected health data have the potential to play an important role in assisting clinicians to identify neonates at risk of developing selected disorders shortly after birth. Despite achieving high levels of discrimination, many issues remain before such models can be implemented in practice, which we discuss in relation to our findings.

Pregnancy in Charcot-Marie-Tooth disease: Data from the Italian CMT national registry

OBJECTIVE

To collect information on frequency of pregnancy and delivery complications in Charcot-Marie-Tooth (CMT) disease and on CMT course during pregnancy.

METHODS

Through an ad hoc online questionnaire, we investigated pregnancy and neuropathy course in women with CMT adhering to the Italian CMT Registry. Data were compared to those of controls (recruited among friends and unaffected relatives) and the Italian (or other reference) population.

RESULTS

We collected data on 193 pregnancies from 86 women with CMT (age 20-73 years) with 157 deliveries (81.4%) after a mean of 38.6 gestational weeks. In women with CMT, there were no differences compared to controls (59 pregnancies and 46 deliveries from 24 controls) and the reference population for miscarriages (11.4%) and planned (21.0%) and emergency (14.0%) cesarean sections. We found a significantly higher frequency of placenta previa (1.6% vs 0.4%), abnormal fetal presentations (8.4% vs 4.5%), and preterm deliveries (20.3% vs 6.9%; most in week 34-36 of gestation) compared to reference populations. Excluding twins, newborn weight did not differ from the reference population. Postpartum bleeding rate in patients with CMT (2.1%) was similar to that of the general population (2.4%). CMT status worsened during 18 of 193 pregnancies (9.3%) with no recovery in 16 of them and with similar figures in the CMT1A and non-CMT1A subtypes.

CONCLUSIONS

We observed higher rates of placenta previa, abnormal presentations, and preterm deliveries in CMT, but pregnancy outcome and newborn weight and health were similar to those of the reference populations. Worsening of CMT is not infrequent and occurs not only in CMT1A. Pregnant women with CMT should be monitored with particular care.

Pulmonary Surfactant Replacement Therapy for Respiratory Distress Syndrome in Neonates: a Nationwide Epidemiological Study in Korea

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.

The effectiveness of the neonatal diagnosis-related group scheme

The goal of this study is to investigate the effectiveness of the neonatal diagnosis-related group scheme in patients affected by respiratory distress syndrome. The variable costs of individual patients in the same group are examined. This study uses the data of infants (N = 243) hospitalized in the Neonatal Intensive Care Unit of the Gaslini Children's Hospital in Italy in 2016. The care unit's operating and management costs are employed to estimate the average cost per patient. Operating costs include those related to personnel, drugs, medical supplies, treatment tools, examinations, radiology, and laboratory services. Management costs relate to administration, maintenance, and depreciation cost of medical equipment. Cluster analysis and Tobit regression are employed, allowing for the assessment of the total cost per patient per day taking into account the main cost determinants: birth weight, gestational age, and discharge status. The findings highlight great variability in the costs for patients in the same diagnosis-related group, ranging from a minimum of €267 to a maximum of €265,669. This suggests the inefficiency of the diagnosis-related group system. Patients with very low birth weight incurred costs approximately twice the reimbursement set by the policy; a loss of €36,420 is estimated for every surviving baby with a birth weight lower than 1,170 grams. On the contrary, at term, newborns cost about €20,000 less than the diagnosis-related group reimbursement. The actual system benefits hospitals that mainly treat term infants with respiratory distress syndrome and penalizes hospitals taking care of very low birth weight patients. As a result, strategic behavior and "up-coding" might occur. We conduct a cluster analysis that suggests a birth weight adjustment to determine new fees that would be fairer than the current costs.

Respiratory Distress Syndrome in Infants Delivered via Cesarean from Mothers with Preterm Premature Rupture of Membranes: A Propensity Score Analysis

Objective

This study aimed to clarify the effects of cesarean delivery on neonatal respiratory morbidity when women had preterm premature rupture of membranes.

Methods

This retrospective study included women with preterm premature rupture of membranes who delivered from 23 weeks to 33 weeks of gestation between January 2009 and December 2014. Neonatal outcomes were compared between infants delivered by cesarean section and those delivered vaginally. The primary outcome was respiratory distress syndrome (RDS). Neonatal intubation and mechanical ventilation periods were secondary outcomes. Propensity score matching was used to compare outcomes between cesarean and vaginal delivery cases.

Results

There were 101 cesarean deliveries and 89 vaginal deliveries. A comparison of the presence or absence of neonatal complications based on the delivery type indicated a higher occurrence of RDS with cesarean deliveries (P = 0.025). The intubation and mechanical ventilation periods were not significantly longer in neonates delivered via cesarean section.

Conclusions

Cesarean delivery is a risk factor for neonatal RDS in women with preterm premature rupture of membranes. Trials identifying long-term neonatal prognoses are needed to further develop optimal management strategies in such cases.

Incidence of respiratory distress and its predictors among neonates admitted to the neonatal intensive care unit, Black Lion Specialized Hospital, Addis Ababa, Ethiopia

BACKGROUND

Although respiratory distress is one of the major causes of neonatal morbidity and mortality throughout the globe, it is a particularly serious concern for nations like Ethiopia that have significant resource limitations. Additionally, few studies have looked at neonatal respiratory distress and its predictors in developing countries, and thus we sought to investigate this issue in neonates who were admitted to the Neonatal Intensive Care Unit at Black Lion Specialized Hospital, Ethiopia.

METHODS

An institution-based retrospective follow-up study was conducted with 571 neonates from January 2013 to March 2018. Data were collected by reviewing patients' charts using a systematic sampling technique with a pretested checklist. The data was then entered using Epi-data 4.2 and analyzed with STATA 14. Median time, Kaplan-Meier survival estimation curves, and log-rank tests were then computed. Bivariable and multivariable Gompertz parametric hazard models were fitted to detect the determinants of respiratory distress. The hazard ratio with a 95% confidence interval was subsequently calculated. Variables with reported p-values < 0.05 were considered statistically significant.

RESULTS

The proportion of neonates with respiratory distress among those admitted to the Black Lion Specialized Hospital neonatal intensive care unit was 42.9% (95%CI: 39.3-46.1%) The incidence rate was 8.1/100 (95%CI: 7.3, 8.9). Significant predictors of respiratory distress in neonates included being male [Adjusted hazard ratio (HR): 2.4 (95%CI: 1.1, 3.1)], born via caesarean section [AHR: 1.9 (95%CI: 1.6, 2.3)], home delivery [AHR: 2.9 (95%CI: 1.5, 5,2)], maternal diabetes mellitus (AHR: 2.3 (95%CI: 1.4, 3.6)), preterm birth [AHR: 2.9 (95%CI: 1.6, 5.1)], and having an Apgar score of less than 7 [AHR: 3.1 (95%CI: 1.8, 5.0)].

CONCLUSIONS

In this study, the proportion of respiratory distress (RD) was high. Preterm birth, delivery by caesarean section, Apgar score < 7, sepsis, maternal diabetes mellitus, and home delivery were all significant predictors of this condition. Based on our findings this would likely include encouraging more hospital births, better control of diabetes in pregnancy, improved neonatal resuscitation and addressing ways to decrease the need for frequent caesarean sections.

Antenatal corticosteroids and fetal lung immaturity in preterm birth

BACKGROUND

Respiratory distress syndrome (RDS), a consequence of lung immaturity, is a serious complication of preterm birth and the primary cause of early neonatal mortality. Administration of antenatal steroids is a standard care method for mothers with anticipated preterm labor. However, the gestational age range at which antenatal corticosteroids (ACS) provide benefit has been subjected to debate. This study aimed to find the prevalence of ACS use in patients that developed/did not develop RDS.

METHODS

This cross-sectional study was conducted at Rafidia governmental surgical hospital. It is based on the data obtained from the files of mothers who gave birth to premature babies and from a face-to-face interview. One hundred and twenty-eight data collection forms were completed over a period of seven months.

RESULTS

Approximately 64% of mothers, mothers who gave birth to premature babies, were given ACS, and about 33% of premature neonates developed RDS. Mothers who gave birth to newborns with RDS have lower odds of being administered ACS by 44% (OR = 0.44, CI = 0.202-0.94, p value = 0.034). However, the association became statistically not significant after adjusting gestational age, birth weight, gender, mother's age, intrauterine growth restriction (IUGR), mode of delivery and gestational hypertension (OR = 0.462, CI = 0.137-1.56, p value = 0.212). Higher risk of RDS was significantly associated with lower gestational age (p-value < 0.001) and IUGR after adjustment (p value = 0.035). However, no significant association could be found between RDS and mode of delivery (p value = 0.730), maternal age (p value = 0.63) and gender of the baby (p value = 0.22).

CONCLUSIONS

the overall prevalence of RDS in preterm infants was 33.3% and the identified risk factors were lower gestational age and IUGR. We showed that the administration of ACS wasn't significantly associated with the development of RDS after adjusting gestational age, birth weight, gender, mother's age, IUGR, mode of delivery and gestational hypertension, as the administration of ACS didn't fully meet the international guidelines.

MicroRNA‑431 inhibits the expression of surfactant proteins through the BMP4/activin/TGF‑β signaling pathway by targeting SMAD4

The synthesis and secretion of surfactant proteins (SPs) is an important sign of lung maturation. Furthermore, the morbidity of lung developmental diseases, including respiratory distress syndrome and bronchopulmonary dysplasia which are mainly caused by immature lung development and lack of SPs, is increasing. As is well known, multiple microRNAs (miRs/miRNAs) are able to influence lung development via numerous different signaling pathways. However, few studies examine the association between the miRNAs and lung developmental diseases. A previous study has demonstrated that miR‑431 was significantly (F=33.49; P<0.001) downregulated in the lung tissues of Sprague‑Dawley rats at 3 time points, embryonic day 19, embryonic day 21 and postnatal day 3. The present study reported that the regulation of miR‑431 may influence the expression of SPs. Thus, the further potential mechanisms of miR‑431 in negatively regulating lung development were examined in the present study. Stable A549 cell lines overexpressing or knocking down SMAD family member 4 (SMAD4) transfected with miR‑431 overexpressed or knocked down, and their control groups were established. Subsequently, the expression of bone morphogenetic protein 4 (BMP4), SMAD4 and SPs (SP‑A, SP‑B and SP‑C) at the RNA and protein levels were validated respectively by reverse transcription quantitative PCR and western blotting. miR‑431 exhibited a decreased expression, while BMP4 and SPs exhibited increased expression at the mRNA and protein levels in the SMAD4 knockdown group. Meanwhile, the expression of SPs were reduced in the SMAD4‑knockdown group via overexpressing miR‑431 and increased in the SMAD4‑overexpression group via inhibiting miR‑431. The present results indicate that SMAD4 negatively regulates the expression of SPs, and that miR‑431 negatively regulates the expression of SPs through inhibiting the BMP4/activin/transforming growth factor‑β signaling pathway by targeting SMAD4.

Incidence, Risk factors and Outcome of Respiratory Distress Syndrome in Term Infants at Academic Centre, Jeddah, Saudi Arabia

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 1^st 2016 and December 31^st 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.

Maternal hypertension, preeclampsia, and risk of neonatal respiratory disorders in a large-prospective cohort study

BACKGROUND

Possible impact of maternal hypertension and preeclampsia on neonatal respiratory disorders was unknown. We investigated the association of maternal hypertension and preeclampsia with neonatal respiratory disorders in preterm and full-term newborns.

METHOD

In this study, we used a large Chinese population-based study which includes 185,687 singleton livebirths with gestational weeks between 28 and 42 weeks. The "exposure" was maternal hypertension and preeclampsia. The outcome was neonatal respiratory disorders including neonatal respiratory distress syndrome (NRDS), pneumonia and low Apgar scores. Logistic regression was used to examine the association between the maternal hypertensive disorders and the risk for neonatal respiratory disorders. We further evaluated the association in preterm and full-term infants.

RESULTS

As a result, the incidence of neonatal RDS, pneumonia, and low Apgar score in hypertensive group was higher than that in normotensive group. Preeclampsia was associated with RDS [(adjusted relative risk (aRR): 1.85, 95% confidence interval (CI): 1.22-3.05)]. Both maternal hypertension and preeclampsia increased risks for neonatal pneumonia (aRR: 1.79, 95%CI: 1.48-2.17; aRR: 1.81, 95%CI: 1.36-2.40, respectively), for low Apgar score at 1 min (aRR: 1.20, 95%CI: 1.13-1.27; aRR: 1.53, 95%CI: 1.41-1.67, respectively), and for low Apgar score at 5 min (aRR: 1.30, 95%CI: 1.17-1.45; aRR: 1.70, 95%CI: 1.46-1.99, respectively). The risk for neonatal respiratory disorders increased with severity of maternal hypertension. The observed associations were present in both full-term and preterm birth.

CONCLUSION

Maternal hypertension and preeclampsia are risk factors for neonatal respiratory disorders in full-term and preterm newborns.

Respiratory distress in newborn infants in Western Switzerland

AIM

To assess epidemiological data about respiratory distress (RD) in newborn infants hospitalized in Western Switzerland.

METHODS

During 1 year, two questionnaires were sent out to the seven neonatal and pediatric units of a well-defined geographic region in Switzerland. Data about their obstetrical activity and details about all newborn infants hospitalized with RD were collected, asking for pre-, peri-, and postnatal clinical data in association with RD.

RESULTS

Almost 6% of all newborn infants born in the Canton of Vaud had to be hospitalized for RD. All newborn infants below 32 weeks of gestational age (GA) had developed RD, accounting for 14.6% of all neonates, hospitalized with RD, whereas the moderate to late preterm infants contributed with 36.8% much more to the RD hospitalizations. Associated factors to hospitalizations with RD were prematurity, cesarean delivery, and multiple births.

CONCLUSIONS

Efforts should be made to reduce avoidable RD by reconsidering the management of pregnancies with premature rupture of the membranes around 34 weeks of GA and by delaying elective cesarean sections after 39 completed weeks of gestation.

Heated Humidified High Flow Nasal Cannula (HHHFNC) is not an effective method for initial treatment of Respiratory Distress Syndrome (RDS) versus nasal intermittent mandatory ventilation (NIMV) and nasal continuous positive airway pressure (NCPAP)

BACKGROUND

Noninvasive respiratory support techniques are widely used to treat respiratory distress syndrome (RDS) in preterm infants, and the effectiveness of these methods should be compared. In the current study, nasal continuous positive airway pressure (NCPAP), nasal intermittent mandatory ventilation (NIMV), and heated humidified high-flow nasal cannula (HHHFNC) were compared.

MATERIALS AND METHODS

In the current bicenter clinical trial, 109 preterm infants with RDS not treated with surfactant were randomly assigned to three groups: NCPAP, NIMV, and HHHFNC. The initial outcomes including the failure of treatment within the first initial 72 h, and the duration of RDS treatment, and the secondary outcomes including the need for intubation, the need for surfactants, the duration of oxygen dependency, the incidence of pneumothorax, the patent ductus arteriosus, intraventricular hemorrhage, length of stay, and mortality were compared among the groups.

RESULTS

The frequency of HHHFNC treatment failure (54.3%) was significantly higher compared with those of NIMV (21.6%) (P < 0.001, hazard ratio [HR] = 9.12, 95% confidence interval [CI] = 2.59 - 32.07) and NCPAP (35.1%) (P = 0.004, HR = 21.25, 95% CI = 2.51-180.08). The median duration of RDS treatment was longer (40 h) in the HHHFNC group, although it was not significantly different from those of NIMV (31.16 h) and NCPAP (38.91 h).

CONCLUSION

Based on the high prevalence of failure of HHHFNC treatment than the other two methods (NCPAP and NIMV), HHHFNC is not recommended as the initial treatment of RDS.

Differential expression of circRNAs during rat lung development

At present, thousands of circular RNAs (circRNAs) have been found in cancer and various tissues from different species. However, the expression of circRNAs during rat lung development remains largely unknown. In the present study, circRNA expression profiles were screened in three mixed rat lung tissues at 3 time-points [embryonic day (E) 19, E21 and post-natal (P) day 3] during fetal rat development with circRNA high-throughput sequencing. Preliminary results were verified by reverse transcription-PCR (RT-PCR) at 4 time-points (E16, E19, E21 and P3). A total of 375 circRNAs were differently expressed in E19 vs. E21 (fold change ≥1.5; P<0.05). At the same time, a total of 358 circRNAs were differently expressed in E21 vs. P3 (fold change ≥1.5; P<0.05). A total of 3 circRNAs (rno_circ:chr7:24777879-24784993, r n o _c i r c:c h r14:14 62 0 910 −14 62 49 33 a n d r n o _circ:chr3:1988750- 1998592) were characterized by having consistent fold changes (≥1.5) between 3 time-points (E19, E21 and P3) and were selected for RT-PCR at 4 time-points (E16, E19, E21 and P3). Subsequently, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis of parent genes of the differentially expressed circRNAs revealed that these circRNAs may serve important roles in lung development. The present results support that these new found circRNAs participate in lung development. Furthermore, these findings may help to clarify the physiopathological mechanism of normal rat lung development, and may further provide a physiopatho-logical basis of lung developmental diseases.

Differences in Clinical Characteristics and Therapy of Neonatal Acute Respiratory Distress Syndrome (ARDS) and Respiratory Distress Syndrome (RDS): A Retrospective Analysis of 925 Cases

BACKGROUND This study assessed the clinical characteristics of neonatal acute respiratory distress syndrome (ARDS) and differences in therapy in comparison to RDS. MATERIAL AND METHODS The clinical data of 925 preterm infants with respiratory distress were collected and divided into 4 groups. Group A and B both met the diagnosis of neonatal RDS, whereas infants in group B also showed inflammatory response. Group C met the Montreux definition of neonatal ARDS and group D was the control. RESULTS We found that 73.50% of the 925 preterm infants were diagnosed with RDS, of which RDS with inflammatory response accounted for 42.05%. ARDS accounted for 5.29% and control group accounted for 21.19%. Group C infants were the heaviest (2168.16±654.43 g) and had the oldest gestational age. The pregnancy-induced hypertension was highest (30.07%) in group B and lowest in group D (13.26%). Group C had higher iNO and longer invasive ventilator times, but had less frequent surfactant treatment, as well as shorter oxygen time and hospital stay. Group B had significantly longer invasive ventilator use than in Group A. In group A, PDA, ROP, and PPHN were the most common complications, with morbidity rates at 78.35%, 8.4%, and 25.77%, respectively, while group C had higher incidence of PDA (71.42%) and coagulation disorders (38.77%). CONCLUSIONS ARDS mainly occurs in late preterm infants. Its treatment is dependent on iNO and invasive ventilator-assisted therapy, and the surfactant treatment rate was relatively lower in comparison to RDS. RDS accompanied with inflammatory response is also dependent on prolonged use of an invasive ventilator.

Improving nursing knowledge and care for neonates with respiratory distress in Jordan

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.

Clinical and Economic Analysis of Morphine Versus Fentanyl in Managing Ventilated Neonates With Respiratory Distress Syndrome in the Intensive Care Setting

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.