The influence factors of neonatal respiratory distress syndrome in Southern China: a case-control study

Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome

BACKGROUND

Neonatal respiratory distress syndrome (NRDS) is one of the most common diseases in neonatal intensive care units, with an incidence rate of about 7% among infants. Additionally, it is a leading cause of neonatal death in hospitals in China. The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant.

AIM

To explore the effect of pulmonary surfactant (PS) combined with noninvasive positive pressure ventilation on keratin-14 (KRT-14) and endothelin-1 (ET-1) levels in peripheral blood and the effectiveness in treating NRDS.

METHODS

Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included. Of these, 64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation. The expression of KRT-14 and ET-1 in the two groups was compared. The deaths, complications, and PaO2, PaCO2, and PaO2/FiO2 blood gas indexes in the two groups were compared. Receiver operating characteristic curve (ROC) analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.

RESULTS

The observation group had a significantly higher effectiveness rate than the control group. There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions, such as bronchial dysplasia, cyanosis, and shortness of breath. After treatment, the levels of PaO2 and PaO2/FiO2 in both groups were significantly higher than before treatment, while the level of PaCO2 was significantly lower. After treatment, the observation group had significantly higher levels of PaO2 and PaO2/FiO2 than the control group, while PaCO2 was notably lower in the observation group. After treatment, the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels. The observation group had a reduction of KRT-14 and ET-1 levels than the control group. ROC curve analysis showed that the area under the curve (AUC) of KRT-14 was 0.791, and the AUC of ET-1 was 0.816.

CONCLUSION

Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy. KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.

Low Serum Vascular Endothelial Growth Factor Level Predicts Adverse Outcomes in Neonates with Respiratory Distress Syndrome

Objective: Preterm neonates are susceptible to neonatal respiratory distress syndrome (NRDS). Lower levels of cord blood vascular endothelial growth factor (VEGF) are implicated in NRDS. This study aims to explore whether the serum VEGF level has prognostic values on neonates with respiratory distress syndrome (RDS). Methods: A total of 80 infants diagnosed with NRDS were enrolled, with 70 preterm neonates without NRDS as controls. Cord blood samples before treatment and venous blood samples after treatment were collected and clinical information was recorded. The serum VEGF level was measured using enzyme-linked immunosorbent assay kits. Receiver operating characteristic (ROC) curve was used to evaluate whether serum VEGF is a biomarker of NRDS. Newborns were followed up for 1 month to collect survival information. The influence of VEGF levels on overall survival was analyzed using the Kaplan-Meier method. The univariate and multivariate Cox regression models were adopted to assess the prognostic factor of NRDS. Results: VEGF level was decreased in sera of neonates with RDS. The area under the ROC curve of VEGF level in distinguishing neonates with RDS from neonates without RDS was 0.949, with a cutoff value of 39.72 (87.50% sensitivity, 87.14% specificity). Serum VEGF was a biomarker of NRDS. Neonates with RDS with high VEGF levels had longer periods of survival than those with low VEGF levels. NRDS grade and VEGF level were independent prognostic factors affecting the overall survival of neonates with RDS. Conclusion: Decreased serum VEGF level in RDS neonates can predict the poor prognosis of NRDS, and VEGF level might be an independent prognostic factor for the overall survival of RDS neonates. Clinical Trial Registration No. 201901A.

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.

Inhaled Budesonide in Neonatal Respiratory Distress Syndrome of Near-Term Neonates: A Randomized, Placebo-Controlled Trial

OBJECTIVE

This study evaluates the value of inhaled budesonide (BUD) administration in neonatal respiratory distress syndrome (RDS) cases especially for near-term neonates.

METHODS

A randomized controlled trial involving 120 neonates with respiratory distress, which was diagnosed as RDS, was conducted from July 2016 to March 2018. The neonates studied were divided into 2 groups: group 1 (the inhaled BUD group), consisting of 60 neonates who received BUD (2 mL, 0.25-mg/mL suspension) inhalation, twice daily for 5 days; and group 2 (the placebo group), consisting of 60 neonates with RDS who received humidified distilled sterile water inhalation (2 mL). Downes score, RDS grades, and interleukin 8 (IL-8) levels were monitored and measured on the first and fifth days of incubation.

RESULTS

Statistically significant differences (SSDs) in RDS grades, Downes score, and IL-8 levels on the fifth day of admission were observed between groups 1 and 2 (p = 0.001) and between the first and fifth days of incubation in group 1 (p = 0.001). The SSDs in the duration of hospitalization (p = 0.001) and the number of neonates receiving mechanical ventilation (p = 0.032) were found between both groups.

CONCLUSIONS

Budesonide inhalation is associated with improvements in clinical and laboratory parameters in neonates with RDS.

Additional Adverse Perinatal Outcomes With No Effect on Neonatal Mortality and Birth Defects in Pregnancies Conceived by Assisted Reproductive Technology

BACKGROUND

Pregnancy outcomes and perinatal diseases of children conceived by assisted reproductive technology (ART) and spontaneous conception (SC) are still unclear. We sought to compare the effects of ART and SC on adverse neonatal outcomes.

METHODS

We included 5,913 neonates admitted to the neonatal intensive care unit (NICU) of the First Affiliated Hospital of the University of Science and Technology of China between January 2017 and December 2020. There were 1,112 (18.8%) ART pregnancies and 4,801 (81.2%) SC pregnancies. Data on maternal characteristics, comorbidities during pregnancy, and neonatal outcomes were collected and analyzed. Logistic regression models estimated the odds ratios (ORs) and 99% CIs of neonatal outcomes according to ART pregnancy. Neonatal outcomes primarily included neonatal respiratory distress syndrome (NRDS), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), neonatal anemia, birth defects, and mortality.

RESULTS

Among 5,913 neonates, 485 (8.2%) had NRDS, 165 (2.8%) had BPD, 113 (1.9%) had ROP, 602 (10.2%) had neonatal anemia, and 1,112 (18.8%) were ART infants. The incidence of pregnancy-related complications, such as gestational diabetes mellitus (GDM), gestational hypothyroidism, and rheumatic immune diseases, in mothers receiving ART, was higher than that in the SC group. On multivariate analysis, ART was independently associated with NRDS (OR = 1.46; 95% CI, 1.11-1.93; p = 0.008) and ROP (OR = 1.79; 95% CI, 1.06-3.05; p = 0.031). Moreover, the association persisted after adjustment for maternal age, history of cesarean section, preconception factors, and pregnancy complications. For BPD (OR = 1.44; 95% CI, 0.91-2.27; p = 0.117) and neonatal anemia (OR = 1.12; 95% CI, 0.87-1.45; p = 0.373), the associations were attenuated substantially when adjusting for pregnancy complications. ART was associated with neither birth defects (OR = 0.98; 95% CI, 0.77-1.25; p = 0.889) nor mortality (OR = 0.98; 95% CI, 0.51-1.91; p = 0.961).

CONCLUSION

ART was independently associated with adverse neonatal outcomes, including NRDS and ROP. Therefore, women who conceive by ART must improve their perinatal health and management of pregnancy-related comorbidities to enhance the quality of life of their offspring.

Effects of Pulmonary Surfactant Combined with Noninvasive Positive Pressure Ventilation on KRT-14 and ET-1 Levels in Peripheral Blood and Therapeutic Effects in Neonates with Respiratory Distress Syndrome

This study is aimed at exploring the effect of pulmonary surfactant (PS) combined with noninvasive positive pressure ventilation on the levels of Keratin-14 (KRT-14) and Endothelin-1 (ET-1) in peripheral blood and the therapeutic effect of neonatal respiratory distress syndrome (NRDS). Altogether 137 cases of neonates with respiratory distress syndrome treated in our hospital from April 2016 to July 2018 were collected. Among them, 64 cases treated with noninvasive positive pressure ventilation were considered as the control group, and 73 cases treated with PS combined with noninvasive positive pressure ventilation were considered as the observation group. The expression of KRT-14 and ET-1 in the two groups was compared. The therapeutic effect, death, complications, and blood gas indexes PaO2, PaCO2, and PaO2/FiO2 in the two groups were compared. Receiver operating characteristic curve (ROC) was applied to analyze the diagnostic value of KRT-14 and ET-1 in the therapeutic effect of NRDS. The effective rate of the observation group was higher than that of the control group. After treatment, PaO2 and PaO2/FiO2 in both groups were notably higher than that before treatment, while PaCO2 was notably lower than that before treatment. And after treatment, the levels of PaO2 and PaO2/FiO2 in the observation group were remarkably higher than that in the control group; PaCO2 was notably lower than that in the control group. After treatment, the levels of KRT-14 and ET-1 in the two groups were remarkably lower than those before treatment, and the levels of KRT-14 and ET-1 in the observation group were considerably lower than those in the control group after treatment. ROC curve showed that the area under the curve (AUC) of KRT-14 was 0.791, and the AUC of ET-1 was 0.816. PS combined with noninvasive positive pressure ventilation can notably improve the therapeutic effect of NRDS. KRT-14 and ET-1 levels may be potential therapeutic diagnostic indicators.

Risk factors for respiratory assistance in premature infants

Premature infants are prone to dyspnea after birth due to immature development, and some infants require respiratory assistance. However, the risk factors for respiratory assistance in premature infants are rarely reported. The present study enrolled 3,394 premature infants (665 infants had been provided with respiratory assistance and 2,729 had not used respiratory assistance) to retrospectively analyze the risk factors associated with respiratory aid. The multivariate logistic regression analysis demonstrated that placental abnormality [odds ratio (OR)=1.284; P=0.048], the male sex (OR=0.696; P=0.001), delivery via cesarean section (OR=1.538; P<0.001), low 1-min Apgar score (OR=0.727; P<0.001), low birth weight (OR=0.999; P=0.005) and low gestational age (OR=0.616; P<0.001) were independent risk factors for respiratory assistance in premature infants. Overall, a number of risk factors, including placental abnormality, cesarean section, low 1-min Apgar score, low birth weight and small gestational age, were identified for respiratory assistance in premature infants. By conducting a risk assessment of risk factors at birth and using this information to provide timely respiratory assistance, the survival rates of premature infants may increase.