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Yan C, Gong X, Luo H, Liu Y, Lin Y, Weng B, Cai C. Impact of implementation of 2019 European respiratory distress syndrome guidelines on bronchopulmonary dysplasia in very preterm infants. Ital J Pediatr 2024; 50:178. [PMID: 39285390 PMCID: PMC11407007 DOI: 10.1186/s13052-024-01752-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 08/31/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND To evaluate the impact of implementation of 2019 European respiratory distress syndrome (RDS) guidelines on the incidence of bronchopulmonary dysplasia (BPD). METHOD We retrospectively collected the clinical data of very preterm infants (VPIs) born before 32 gestational weeks from January 1st 2018 to December 31st 2021. VPIs were divided into group A and group B according to their birth date which was before or at/after January 1st 2020, when the 2019 European RDS guidelines were introduced. BPD is considered as primary outcome. We statistically analyzed all the data, and we compared the general characteristics, ventilation support, medication, nutrition and the outcomes between the two groups. RESULTS A total of 593 VPIs were enrolled, including 380 cases in group A and 213 cases in group B. There were no statistic differences regarding to gender ratio, gestational age, birth weight and delivery mode between the two groups. Compared with group A, group B showed higher rate of antenatal corticosteroid therapy (75.1% vs. 65.5%). The improvement of ventilation management in these latter patients included lower rate of invasive ventilation (40.4% vs. 50.0%), higher rate of volume guarantee (69.8% vs. 15.3%), higher positive end expiratory pressure (PEEP) [6 (5, 6) vs. 5 (5, 5) cmH2O] and higher rate of synchronized nasal intermittent positive pressure ventilation (sNIPPV) (36.2% vs. 5.6%). Compared with group A, group B received higher initial dose of pulmonary surfactant [200 (160, 200) vs. 170 (130, 200) mg/Kg], shorter antibiotic exposure time [13 (7, 23) vs. 17 (9, 33) days], more breast milk (86.4% vs. 70.3%) and earlier medication for hemodynamically significant patent ductus arteriosus (hsPDA) treatment [3 (3, 4) vs. 8 (4, 11) days] (p < 0.05). As the primary outcome, the incidence of BPD was significantly decreased (16.9% vs. 24.2%) (p < 0.05), along with lower extrauterine growth retardation (EUGR) rate (39.0% vs. 59.7%), while there were no statistic differences regarding to other secondary outcomes, including mortality, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), retinopathy of preterm (ROP) and necrotizing enterocolitis (NEC). However, in the subgroups of infants less than 28 gestational weeks or infants less than 1,000 g, the incidence of BPD was not significantly decreased (p > 0.05). CONCLUSIONS After implementation of 2019 European RDS guidelines, the overall incidence of BPD was significantly decreased in VPIs. Continuous quality improvement is still needed in order to decrease the incidence of BPD in smaller infants who are less than 28 gestational weeks or less than 1,000 g.
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Affiliation(s)
- Chongbing Yan
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Luo
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yibo Liu
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yating Lin
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bowen Weng
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Cai
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Marinonio ASS, Costa-Nobre DT, Sanudo A, Miyoshi MH, Areco KCN, Kawakami MD, Xavier RDC, Konstantyner T, Bandiera-Paiva P, Freitas RMVD, Morais LCC, Teixeira MLP, Waldvogel BC, Kiffer CRV, Almeida MFBD, Guinsburg R. Temporal Trend and Risk Factors for Respiratory Distress Syndrome-Associated Neonatal Mortality in Preterm Infants: A Population-Based Study in a Middle-Income Country. Am J Perinatol 2024; 41:e298-e304. [PMID: 35973740 PMCID: PMC11093649 DOI: 10.1055/s-0042-1754410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/01/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This article aimed to report a temporal series of respiratory distress syndrome (RDS)-associated neonatal mortality rates in preterm live births in São Paulo state, Brazil, and to identify social, maternal, and neonatal characteristics associated with these deaths. STUDY DESIGN This is a population-based study of all live births with gestational age (GA) between 22 and 36 weeks, birth weight ≥400 g, without congenital anomalies from mothers living in São Paulo state during 2004 to 2015. RDS-associated neonatal mortality was defined as death up to 27 days after birth with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality rate (annual percent change [APC] with 95% confidence intervals [95% CIs]) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that the RDS-associated neonatal death occurred. Poisson's regression model compared social maternal and neonatal characteristics between preterm live births that survived the neonatal period and those with RDS-associated neonatal deaths, with results expressed in incidence rate ratio and 95% CI. RESULTS A total of 645,276 preterm live births were included in the study, of which 612,110 survived and 11,078 had RDS-associated neonatal deaths. RDS-associated neonatal mortality rate was 17.17 per thousand preterm live births, with a decreasing annual trend (APC: -6.50%; 95% CI: -9.11 to -3.82%). The median time of these deaths was 48 hours after birth. The following risk factors for RDS-associated neonatal death were identified: maternal schooling ≤7 years (1.18; 1.09-1.29), zero to three prenatal care visits (1.25; 1.18-1.32), multiple pregnancy (1.24; 1.16-1.33), vaginal delivery (1.29; 1.22-1.36), GA 22 to 27 weeks (106.35; 98.36-114.98), GA 28 to 31 weeks (20.12; 18.62-21.73), male sex (1.16; 1.10-1.22), and 5-minute Apgar scores of 0 to 3 (6.74; 6.08-7.47) and 4 to 6 (3.97; 3.72-4.23). CONCLUSION During the study period, RDS-associated neonatal mortality rates showed significant reduction. The relationship between RDS-associated neonatal deaths and social, maternal, and neonatal factors suggests the need for perinatal strategies to reduce prematurity and to improve the initial management of preterm infants. KEY POINTS · RDS is associated with preterm live births.. · Impact of RDS-associated neonatal mortality in middle-income countries is scarce.. · Qualified perinatal care can reduce RDS-associated neonatal mortality..
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Affiliation(s)
| | - Daniela Testoni Costa-Nobre
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Milton Harumi Miyoshi
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Kelsy Catherina Nema Areco
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Mandira Daripa Kawakami
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Rita de Cassia Xavier
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | | | | | | | | | - Carlos Roberto Veiga Kiffer
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
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Cucerea M, Simon M, Anciuc-Crauciuc M, Marian R, Rusneac M, Ognean ML. Updated Clinical Practice Guidelines in Resuscitation and the Management of Respiratory Distress Syndrome in Extremely Preterm Infants during Two Epochs in Romania: Impact on Outcomes. J Clin Med 2024; 13:1103. [PMID: 38398420 PMCID: PMC10889373 DOI: 10.3390/jcm13041103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Adequate perinatal management is essential in caring for extremely preterm (EP) infants. We aimed to evaluate and compare the impact of different protocols on short-term outcomes. METHODS A retrospective study was conducted on EP infants in a Romanian perinatal tertiary center during 2008-2012 and 2018-2022. RESULTS Data on 270 EP infants (121 in period I, 149 in period II) were analyzed collectively and stratified into two subgroups by gestational age. Initial FiO2 administration (100% vs. 40%% p < 0.001), lung recruitment at birth (19.0% vs. 55.7% p < 0.001), early rescue surfactant administration (34.7% vs. 65.8%; p < 0.001), and the mechanical ventilation rate (98.3% vs. 58.4%; p < 0.001) were significantly improved during period II. Survival rates of EP infants significantly improved from 41.3% to 72.5%, particularly in the 26-28 weeks subgroup (63.8% to 83%). Compared to period I, the overall frequency of severe IVH decreased in period II from 30.6% to 14.1%; also, BPD rates were lower (36.6% vs. 23.4%; p = 0.045) in the 26-28 weeks subgroup. Despite improvements, there were no significant differences in the frequencies of NEC, sepsis, PVL, ROP, or PDA. CONCLUSIONS Implementing evidence-based clinical guidelines can improve short-term outcomes.
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Affiliation(s)
- Manuela Cucerea
- Department of Neonatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania; (M.C.); (M.A.-C.)
| | - Marta Simon
- Department of Neonatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania; (M.C.); (M.A.-C.)
| | - Mădălina Anciuc-Crauciuc
- Department of Neonatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania; (M.C.); (M.A.-C.)
| | - Raluca Marian
- Department M1, Cellular and Molecular Biology, 540142 Targu Mures, Romania;
| | - Monika Rusneac
- Clinical Department, Targu Mures Clinical and Emergency County Hospital, 540142 Targu Mures, Romania;
| | - Maria Livia Ognean
- Clinical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania;
- Neonatology Department, Sibiu Clinical and Emergency County Hospital, Lucian Blaga University Sibiu, 550245 Sibiu, Romania
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林 梅, 张 雪, 王 亚, 朱 晓, 薛 江. [Interpretation of the key updates in the 2022 European guideline on the management of neonatal respiratory distress syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:779-784. [PMID: 37668023 PMCID: PMC10484088 DOI: 10.7499/j.issn.1008-8830.2303046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 09/06/2023]
Abstract
With the deepening of clinical research, the management of neonatal respiratory distress syndrome (RDS) needs to be optimized and improved. This article aims to introduce the 2022 European guideline on the management of neonatal RDS, focusing on its key updates. The guide has optimized the management of risk prediction for preterm birth, maternal referral, application of prenatal corticosteroids, application of lung protective ventilation strategies, and general care for infants with RDS. The guideline is mainly applicable to the management of RDS in neonates with gestational age greater than 24 weeks.
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Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E, te Pas A, Plavka R, Roehr CC, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GH, Halliday HL. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology 2023; 120:3-23. [PMID: 36863329 PMCID: PMC10064400 DOI: 10.1159/000528914] [Citation(s) in RCA: 133] [Impact Index Per Article: 133.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2023]
Abstract
Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS" by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12, 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).
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Affiliation(s)
- David G. Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Belfast, UK
| | - Virgilio P. Carnielli
- Department of Neonatology, University Polytechnic Della Marche, University Hospital Ancona, Ancona, Italy
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Mikko Hallman
- Department of Children and Adolescents, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Vienna, Vienna, Austria
| | - Eren Ozek
- Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
| | - Arjan te Pas
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Charles C. Roehr
- Faculty of Health Sciences, University of Bristol, UK and National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ola D. Saugstad
- Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Christian P. Speer
- Department of Pediatrics, University Children's Hospital, Wuerzburg, Germany
| | - Maximo Vento
- Department of Pediatrics and Neonatal Research Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Gerry H.A. Visser
- Department of Obstetrics and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - Henry L. Halliday
- Department of Child Health, Queen's University Belfast and Royal Maternity Hospital, Belfast, UK
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Zheng L, Jing H, Liu L, Wang L. Feasibility of ultrasound in the diagnosis of neonatal respiratory distress syndrome in preterm infants. J Trop Pediatr 2023; 69:7028467. [PMID: 36744917 PMCID: PMC9901274 DOI: 10.1093/tropej/fmad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the feasibility of lung ultrasound in the diagnosis of neonatal respiratory distress syndrome (NRDS) in preterm infants. METHODS One hundred and nine preterm infants were prospectively recruited. Three ultrasound diagnostic criteria were developed to diagnose preterm infants with NRDS: (A) thickened or not smooth pleural line, part of the lung field shows diffuse 'B-line' sign or alveolar-interstitial syndrome (AIS); (B) thickened or not smooth pleural line, all lung fields show AIS, signifying the 'white lung' sign; (C) thickened or rough pleural line, 'white lung' sign and 'lung consolidation' sign can be observed in any lung field. RESULTS The sensitivity and negative predictive value of NRDS in preterm infants with diagnostic criteria A were 100%, but the specificity and positive predictive value were 67.95 and 55.36%, respectively. The specificity and positive predictive value of diagnostic criteria B and C were 100%, while the 95% CI of diagnostic criteria B was narrower than diagnostic criteria C. The sensitivity and negative predictive value of diagnostic criteria B were higher than that of diagnostic criteria C. Of the 31 NRDS cases, 15 cases had severe NRDS and the other 16 did not have severe NRDS. CONCLUSION Thickened or rough pleural line with white lung sign is an important characteristic for the diagnosis of NRDS by lung ultrasound. White lung sign combined with the lung consolidation sign had high diagnostic efficacy when distinguishing severe NRDS from not severe NRDS.
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Affiliation(s)
- Lei Zheng
- Department of Ultrasonography, First Hospital of Tsinghua University, Beijing 100016, PR China
| | - Hongyan Jing
- Operating Room, First Hospital of Tsinghua University, Beijing 100016, PR China
| | - Lihong Liu
- Department of Ultrasonography, First Hospital of Tsinghua University, Beijing 100016, PR China
| | - Lianyi Wang
- Department of Ultrasonography, First Hospital of Tsinghua University, Beijing 100016, PR China
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Kim KT, Knopp J, Dixon B, Chase JG. Quantifying neonatal patient effort using non-invasive model-based methods. Med Biol Eng Comput 2022; 60:739-751. [PMID: 35043368 DOI: 10.1007/s11517-021-02491-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
Patient-specific spontaneous breathing effort (SB) is common in invasively mechanically ventilated (MV) adult patients, and especially common in preterm neonates who are not typically sedated. However, there is no proven, ethically feasible and non-invasive method to quantify SB effort in neonates, creating the potential for model-based measures. Lung mechanics and SB effort are segregated using a basis function model to identify passive lung mechanics, and an additional time-varying elastance model to identify patient-specific SB effort and asynchrony as negative and positive added elastances, respectively. Data from ten preterm neonates on standard MV care in the neonatal intensive care unit (NICU) are used to assess this model-based approach, using area under the curve (AUC) for positive (asynchrony) and negative (SB effort) time-varying elastance. Median [interquartile-range (IQR)] of passive pulmonary lung elastance was 3.82 [2.09-5.80] cmH2O/ml. Median [IQR] AUC quantified SB effort was -0.32 [-0.43--0.12]cmH2O/ml. AUC quantified asynchrony was 0.00 [0.00-0.01]cmH2O/ml, and affected 28% of the 25,287 total breaths. This proof of concept model-based approach provides a non-invasive, computationally straightforward, and thus clinically feasible means to quantify patient-specific spontaneous breathing effort and asynchrony.
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Affiliation(s)
- Kyeong Tae Kim
- Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand.
| | - Jennifer Knopp
- Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
| | - Bronwyn Dixon
- Neonatal Intensive Care Unit, Christchurch Women's Hospital, Christchurch, New Zealand
| | - J Geoffrey Chase
- Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
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Bührer C, Heller G, Thome UH. Population-Based Outcome Data of Extremely Preterm Infants in Germany during 2010-2017. Neonatology 2022; 119:370-376. [PMID: 35490674 DOI: 10.1159/000524455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/03/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Results of five randomized controlled trials (RCT) sequentially published in 2010-2013 suggested that aiming for higher, as opposed to lower oxygen saturation targets, reduces rates of mortality in infants <28 weeks of gestation, while increasing rates of severe retinopathy of prematurity (ROP). Two further RCTs published in 2011 and 2015 demonstrated that avoiding endotracheal intubation by minimally invasive surfactant administration reduces respiratory morbidity. Assuming that such data are likely to affect clinical practice and ultimate outcome, we analyzed population-level results in extremely preterm infants born across Germany during 2010-2017. METHODS We used mandatory German quality surveillance data to compare mortality and morbidities in preterm infants born between 24 weeks 0 days and 27 weeks 6 days of gestation in 2010-2013 versus 2014-2017. RESULTS Mortality decreased from 15.1% (1,366/9,058) in 2010-2013 to 12.7% (1,385/10,924) in 2014-2017, risk ratio (RR) 0.845 (95% confidence interval [CI], 0.784-0.901). Rates of severe ROP (≥grade 3) per survivor increased from 12.1% (930/7,692) to 13.3% (1.269/9,539), RR 1.100 (95% CI: 1.017-1.191). The lowest mortality and highest ROP rates were found in infants born in 2014. There was no change in rates of necrotizing enterocolitis, while those of bronchopulmonary dysplasia (BPD) decreased steadily between 2010 and 2017, alongside the increased proportion of infants who were never intubated. CONCLUSIONS There was a moderate decline in mortality, an insignificant increase in severe ROP, and a steady decline of BPD in Germany during 2010-2017. Avoiding endotracheal intubation may have contributed to lowered BPD rates.
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Affiliation(s)
- Christoph Bührer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Günther Heller
- Institut für Qualität und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Ulrich H Thome
- Division of Neonatology, Center for Pediatric Research, University of Leipzig, Leipzig, Germany
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Rothberg AD, Smith J, Lubbe W. Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report. J Med Case Rep 2021; 15:592. [PMID: 34903289 PMCID: PMC8670276 DOI: 10.1186/s13256-021-03161-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Cushing reflex does not appear to have been described in preterm neonates. This case report shows the presence of an active Cushing reflex in a 32-week preterm neonate with hyaline membrane disease. Case presentation The 1.94 kg Caucasian infant was delivered by caesarean section following concerns about possible maternal infection and fetal compromise. Chest X-ray showed mild-to-moderate hyaline membrane disease and treatment was initiated with supplemental oxygen and nasal continuous positive airway pressure. It is probable that a pneumothorax occurred at 5–6 hours of age, with progression during the day. Interstitial air, pneumomediastinum, and tension pneumothorax were diagnosed on subsequent X-ray, and ultrasound of the brain showed a grade IV intraventricular hemorrhage. A review of the nurses’ recordings of heart rate, blood pressure, and respiratory rate showed a progressive increase in blood pressure accompanied by slowing of the heart rate and irregular respiration. These are features of the Cushing reflex that is elicited in response to raised intracranial pressure. Conclusion While well-described in older children and adults, in neonates the Cushing reflex has mainly been described in animal experiments and infants who have developed hydrocephalus. It is likely that in this case, the reflex was elicited as a result of a progressive increase in intracranial pressure due to the combination of elevated intrathoracic pressure, obstructed venous return from the brain, and concurrent intraventricular hemorrhage.
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Affiliation(s)
- Alan D Rothberg
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, 2193, South Africa.
| | - Johan Smith
- Division of Neonatology, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Welma Lubbe
- School of Nursing Science, North-West University, Potchefstroom, South Africa
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Subramaniam P, Ho JJ, Davis PG. Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants. Cochrane Database Syst Rev 2021; 10:CD001243. [PMID: 34661278 PMCID: PMC8521644 DOI: 10.1002/14651858.cd001243.pub4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cohort studies have suggested that nasal continuous positive airway pressure (CPAP) starting in the immediate postnatal period before the onset of respiratory disease (prophylactic CPAP) may be beneficial in reducing the need for intubation and intermittent positive pressure ventilation (IPPV), and in preventing bronchopulmonary dysplasia (BPD), in preterm or low birth weight infants. OBJECTIVES To determine if prophylactic nasal CPAP (started within the first 15 minutes) or very early nasal CPAP regardless of respiratory status (started within the first hour of life), reduces the use of mechanical ventilation and the incidence of bronchopulmonary dysplasia without any adverse effects in preterm infants. SEARCH METHODS A comprehensive search was run on 6 November 2020 in the Cochrane Central Register of Controlled Trials (CENTRAL via CRS Web) and MEDLINE via Ovid. We also searched the reference lists of retrieved studies. SELECTION CRITERIA We included all randomised controlled trials (RCTs) and quasi-RCTs in preterm infants (under 37 weeks of gestation). We included trials if they compared prophylactic nasal CPAP (started within the first 15 minutes) or very early nasal CPAP (started within the first hour of life) in infants with minimal signs of respiratory distress with 'supportive care', such as supplemental oxygen therapy, standard nasal cannula, or mechanical ventilation. We excluded studies where prophylactic CPAP was compared with CPAP along with co-interventions. DATA COLLECTION AND ANALYSIS We used the standard methods of Cochrane Neonatal, including independent study selection, assessment of trial quality, and extraction of data by two review authors. MAIN RESULTS We included eight trials (seven from the previous version of the review and one new study), recruiting 3201 babies, in the meta-analysis. Four trials, involving 765 babies, compared CPAP with supportive care, and three trials (2364 babies) compared CPAP with mechanical ventilation. One trial (72 babies) compared prophylactic CPAP with very early CPAP. Apart from a lack of blinding of the intervention, we judged seven studies to have a low risk of bias. However, one study had a high risk of selection bias. Prophylactic or very early CPAP compared to supportive care There may be a reduction in failed treatment (risk ratio (RR) 0.6, 95% confidence interval (CI) 0.49 to 0.74; risk difference (RD) -0.16, 95% CI -0.34 to 0.02; 4 studies, 765 infants; very low certainty evidence). CPAP possibly reduces BPD at 36 weeks (RR 0.76, 95% CI 0.51 to 1.14; 3 studies, 683 infants, moderate certainty evidence); there may be little or no difference in death (RR 1.04, 95% CI 0.56 to 1.93; 4 studies, 765 infants; moderate certainty evidence). Prophylactic CPAP may reduce the composite outcome of death or BPD (RR 0.69, 95% CI 0.40 to 1.19; 1 study, 256 infants; low certainty evidence). There may be no difference in pulmonary air leak (pneumothorax) (RR 0.75, 95% CI 0.35 to 1.16; 3 studies, 568 infants; low certainty evidence), or intraventricular haemorrhage (IVH) Grade 3 or 4 (RR 0.96, 95% CI 0.39 to 2.37; 2 studies, 486 infants; moderate certainty evidence). Neurodevelopmental impairment was not reported in any of the studies. Prophylactic or very early CPAP compared to mechanical ventilation There was probably a reduction in the incidence of BPD at 36 weeks (RR 0.89, 95% CI 0.8 to 0.99; RD -0.04, 95% CI -0.08 to 0.00; 3 studies, 2150 infants; moderate certainty evidence); and death or BPD (RR 0.89, 95% CI 0.81 to 0.97; RD -0.05, 95% CI -0.09 to 0.01; 3 studies, 2358 infants; moderate certainty evidence). There was also probably a reduction in the need for mechanical ventilation (failed treatment) (RR 0.49, 95% CI 0.45 to 0.54; RD -0.50, 95% CI -0.54 to -0.45; 2 studies, 1042 infants; moderate certainty evidence). There was probably a reduction in the incidence of death (RR 0.82, 95% CI 0.66 to 1.03; 3 studies, 2358 infants; moderate certainty evidence); pulmonary air leak (pneumothorax) (RR 1.24, 95% CI 0.91 to 1.69; 3 studies, 2357 infants; low certainty evidence); and IVH Grade 3 or 4 (RR 1.09, 95% CI 0.86 to 1.39; 3 studies, 2301 infants; moderate certainty evidence). One study in this comparison reported that there was probably little or no difference between the groups in the incidence of neurodevelopmental impairment at 18 to 22 months (RR 0.91, 95% CI 0.62 to 1.32; 976 infants; moderate certainty evidence). Prophylactic CPAP compared with very early CPAP There was one study in this comparison. We are very uncertain whether there is any difference in the incidence of BPD (RR 0.5, 95% CI 0.05 to 5.27; very low certainty evidence). The combined outcome of death and BPD was not reported, and failed treatment was reported but without data. There may have been little to no effect on death (RR 0.75, 95% CI 0.29 to1.94; 1 study, 72 infants; very low certainty evidence). Intraventricular haemorrhage Grade 3 or 4 and neurodevelopmental outcomes were not reported in this study. Pulmonary air leak (pneumothorax) was reported in this study, but there were no events in either group. AUTHORS' CONCLUSIONS For preterm and very preterm infants, there is insufficient evidence to evaluate prophylactic CPAP compared to oxygen therapy and other supportive care. When compared to mechanical ventilation, prophylactic nasal CPAP in very preterm infants reduces the incidence of BPD, the combined outcome of death and BPD, and mechanical ventilation. There is probably no difference in neurodevelopmental impairment at 18 to 22 months of age. When prophylactic CPAP is compared to early CPAP, we are very uncertain about whether there is any difference between prophylactic and very early CPAP. There is no information about the effect of prophylactic or very early CPAP in late preterm infants. There is one study awaiting classification.
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Affiliation(s)
- Prema Subramaniam
- Paediatric Department, Mount Isa Base Hospital, Mount Isa, Australia
| | - Jacqueline J Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Peter G Davis
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia
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11
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Guthrie SO, Fort P, Roberts KD. Surfactant Administration Through Laryngeal or Supraglottic Airways. Neoreviews 2021; 22:e673-e688. [PMID: 34599065 DOI: 10.1542/neo.22-10-e673] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Noninvasive ventilation is frequently used in the treatment of infants with respiratory distress syndrome. This practice is often effective in higher gestational age neonates, but can be difficult in those with lower gestational ages as surfactant deficiency can be severe. While noninvasive ventilation avoids the negative effects of intubation and ventilator-induced lung injury, failure of this mode of support does occur with relative frequency and is primarily caused by the poorly compliant, surfactant-deficient lung. Because of the potential problems associated with laryngoscopy and intubation, neonatologists have developed various methods to deliver surfactant in minimally invasive ways with the aim of improving the success of noninvasive ventilation. Methods of minimally invasive surfactant administration include various thin catheter techniques, aerosolization/nebulization, and the use of a laryngeal mask airway/supraglottic airway device. The clinician should recognize that currently the only US Food and Drug Administration-approved device to deliver surfactant is an endotracheal tube and all methods reviewed here are considered off-label use. This review will focus primarily on surfactant administration through laryngeal or supraglottic airways, providing a review of the history of this technique, animal and human trials, and comparison with other minimally invasive techniques. In addition, this review provides a step-by-step instruction guide on how to perform this procedure, including a multimedia tutorial to facilitate learning.
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Affiliation(s)
- Scott O Guthrie
- Department of Pediatrics, Division of Neonatology, Vanderbilt University School of Medicine, Nashville, TN.,Co-first authors
| | - Prem Fort
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, MD.,Johns Hopkins All Children's Maternal Fetal and Neonatal Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL.,Co-first authors
| | - Kari D Roberts
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN
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12
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Khabbache K, Hennequin Y, Vermeylen D, Van Overmeire B. Current respiratory support practices in premature infants: an observational study. Pan Afr Med J 2021; 39:66. [PMID: 34422189 PMCID: PMC8363955 DOI: 10.11604/pamj.2021.39.66.14482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/28/2018] [Indexed: 11/11/2022] Open
Abstract
This study aims to describe longitudinally the current invasive and non-invasive ventilation practices in premature infants in a single neonatal intensive care unit (NICU). It´s a retrospective chart review including 682 babies born at gestational age ≤35 weeks, admitted to the NICU at Erasme Hospital, between 1st of January 2001 and 31st of December 2011, the different ventilatory support used were analyzed. This population was stratified depending on gestational age and the recruitment period on 3 groups. All infants born <28 weeks of GA (group 1) needed some kind of respiratory support of which 22% non-invasive. Among babies born after 28 to 31 weeks (group 2), 10.2% didn´t need any ventilatory support and 42% needed a non-invasive respiratory support. In neonates from 32 to 35 weeks of GA (group 3) respiratory support was needed in 34.9%, 65% of which was non-invasive. The median duration of endotracheal ventilation was: 6, 1 and 2 days, and of non-invasive support: 41, 17 and 2 days in group 1, 2 and 3 respectively. One single premature baby could pass along the first weeks through all modes. In premature infants whose respiratory support was needed, the median age at the end of support was remarkably constant at 33 - 34 weeks of corrected age. We conclude that is an important diversity and a significant complementarity between modes of respiratory support for premature infants. Invasive ventilation decreased significantly for group 2, but is still remarkably long for group 1.
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Affiliation(s)
- Kaoutar Khabbache
- Neonatal Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Yves Hennequin
- Neonatal Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Daniel Vermeylen
- Neonatal Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Bart Van Overmeire
- Neonatal Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgique
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13
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Challis P, Nydert P, Håkansson S, Norman M. Association of Adherence to Surfactant Best Practice Uses With Clinical Outcomes Among Neonates in Sweden. JAMA Netw Open 2021; 4:e217269. [PMID: 33950208 PMCID: PMC8100866 DOI: 10.1001/jamanetworkopen.2021.7269] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE While surfactant therapy for respiratory distress syndrome (RDS) in preterm infants has been evaluated in clinical trials, less is known about how surfactant is used outside such a framework. OBJECTIVE To evaluate registered use, off-label use, and omissions of surfactant treatment by gestational age (GA) and associations with outcomes, mainly among very preterm infants (GA <32 weeks). DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used registry data for 97 377 infants born in Sweden between 2009 and 2018. Infants did not have malformations and were admitted for neonatal care. Data analysis was conducted from June 2019 to June 2020. EXPOSURES Timing and number of surfactant administrations, off-label use, and omission of use. Registered use was defined by drug label (1-3 administrations for RDS). Omissions were defined as surfactant not administered despite mechanical ventilation for RDS. MAIN OUTCOME AND MEASURES In-hospital survival, pneumothorax, intraventricular hemorrhage grade 3 to 4, duration of mechanical ventilation, use of postnatal systemic corticosteroids for lung disease, treatment with supplemental oxygen at 28 days' postnatal age and at 36 weeks' postmenstrual age. Odds ratios (ORs) were calculated and adjusted for any prenatal corticosteroid treatment, cesarean delivery, GA, infant sex, Apgar score at 10 minutes, and birth weight z score of less than -2. RESULTS In total, 7980 surfactant administrations were given to 5209 infants (2233 [42.9%] girls; 2976 [57.1%] boys): 629 (12.1%) born at full term, 691 (13.3%) at 32 to 36 weeks' GA, 1544 (29.6%) at 28 to 31 weeks' GA, and 2345 (45.0%) at less than 28 weeks' GA. Overall, 977 infants (18.8%) received off-label use. In 1364 of 3508 infants (38.9%) with GA of 22 to 31 weeks, the first administration of surfactant was given more than 2 hours after birth, and this was associated with higher odds of pneumothorax (adjusted OR [aOR], 2.59; 95% CI, 1.76-3.83), intraventricular hemorrhage grades 3 to 4 (aOR, 1.71; 95% CI, 1.23-2.39), receipt of postnatal corticosteroids (aOR, 1.57; 95% CI, 1.22-2.03), and longer duration of assisted ventilation (aOR, 1.34; 95% CI, 1.04-1.72) but also higher survival (aOR, 1.45; 95% CI, 1.10-1.91) than among infants treated within 2 hours of birth. In 146 infants (2.8%), the recommended maximum of 3 surfactant administrations was exceeded but without associated improvements in outcome. Omission of surfactant treatment occurred in 203 of 3551 infants (5.7%) who were receiving mechanical ventilation and was associated with lower survival (aOR, 0.49; 95% CI, 0.30-0.82). In full-term infants, 336 (53.4%) of those receiving surfactant had a diagnosis of meconium aspiration syndrome. Surfactant for meconium aspiration was not associated with improved neonatal outcomes. CONCLUSIONS AND RELEVANCE In this study, adherence to best practices and labels for surfactant use in newborn infants varied, with important clinical implications for neonatal outcomes.
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Affiliation(s)
- Pontus Challis
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Per Nydert
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Stellan Håkansson
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
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14
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Miyake F, Ito M, Minami H, Tamura M, Namba F. Management of bronchopulmonary dysplasia in Japan: A 10-year nationwide survey. Pediatr Neonatol 2020; 61:272-278. [PMID: 31843363 DOI: 10.1016/j.pedneo.2019.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/19/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a common complication in very preterm infants. Despite advances in perinatal medicine, the number of BPD patients is increasing in Japan. The aim of this study was to conduct a nationwide survey of the strategies used for the prevention or treatment of BPD. METHODS Questionnaires assessing the current strategies used to prevent or treat BPD, including neonatal resuscitation, drug therapy, and respiratory supportive care, were sent to secondary or tertiary perinatal units in 2015; responses were compared with those obtained from similar surveys in 2005 and 2010. The annual trend in incidence of BPD among the very low birth weight infants (VLBWIs) was determined using the Neonatal Research Network of Japan database. RESULTS The response rates in 2005, 2010, and 2015 were 86.8% (230/265), 64.5% (185/287), and 82.8% (236/285) of units, respectively. The use of patient-triggered ventilation for initial management significantly increased from 50% of units in 2005 to 91% in 2015. By contrast, decreased use of high-frequency oscillatory ventilation (HFOV) from 72% to 65% and that of nasal continuous positive airway pressure from 79% to 68% were reported. The proportion of units where the upper limit of targeted blood oxygen saturation before a diagnosis of BPD was set to ≥95% decreased substantially from 92% to 56% over the 10-year period. Despite these changes in management of BPD, the incidence of BPD among VLBWIs in Japan was increasing over a decade. CONCLUSION This survey demonstrated that there were various changes in practice regarding the prevention or treatment of BPD in Japan. Continuous surveys are required to understand the current clinical situation, and research is needed to develop and evaluate a novel treatment for BPD in premature infants.
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Affiliation(s)
- Fuyu Miyake
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masato Ito
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Hirotaka Minami
- Department of Pediatrics and Neonatology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Masanori Tamura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
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15
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Stensvold HJ, Saugstad OD. The oxygen dilemma: oxygen saturation targets in preterm infants. Acta Paediatr 2019; 108:1556-1558. [PMID: 31347194 DOI: 10.1111/apa.14852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/14/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Hans Jorgen Stensvold
- Neonatal Department, Division of Paediatric and Adolescent Medicine Oslo University Hospital Rikshospitalet Oslo Norway
- Norwegian Neonatal Network Oslo University Hospital Rikshospitalet Oslo Norway
| | - Ola Didrik Saugstad
- Neonatal Department, Division of Paediatric and Adolescent Medicine Oslo University Hospital Rikshospitalet Oslo Norway
- Department of Pediatric Research, Division of Paediatric and Adolescent Medicine, Oslo University Hospital University of Oslo Oslo Norway
- Ann and Robert H. Lurie Children’s Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago IL USA
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16
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Abstract
So far, great efforts have been made to understand the demands of extremely premature neonates (EPNs´; born before the 28(th) week of gestation) on postnatal care, including optimal oxygen saturation, that will allow them to survive without disability. A major yet unresolved problem is to find an "optimal range" of their oxygen saturation and to maintain it without drops or increases, i.e., without hypoxia or hyperoxia. The individual sections of this paper deal with the changes of SpO(2) (an estimate of SaO(2) measured by pulse oximetry) that occur before, during, and after premature labor, postnatal factors affecting SpO(2), and especially how to find an acceptable compromise in choosing the most effective and minimally harmful range of SpO(2) for EPNs' with the careful FiO(2) adjustment and continually monitored SpO(2). At present, the two SpO(2) ranges, narrow (90-94%) vs. wider (88-94%), are most discussed. However, the question of how much oxygen is too much or little remains unanswered. There is even a view that there is no uniform optimal SpO(2) range for EPNs, and that each newborn has its own, individually specific range that changes due to its intrinsic and/or extrinsic factors.
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Affiliation(s)
- P Zoban
- Ward of Neonatology, Department of Obstetrics and Gynecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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17
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Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, Plavka R, Roehr CC, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GHA, Halliday HL. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology 2019; 115:432-450. [PMID: 30974433 PMCID: PMC6604659 DOI: 10.1159/000499361] [Citation(s) in RCA: 654] [Impact Index Per Article: 130.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of "European Guidelines for the Management of RDS" by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.
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Affiliation(s)
- David G Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Belfast, United Kingdom,
| | - Virgilio Carnielli
- Department of Neonatology, Polytechnic University of Marche, and Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Ancona, Italy
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Mikko Hallman
- Department of Pediatrics and Adolescence, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
| | - Eren Ozek
- Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
| | - Arjan Te Pas
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Charles C Roehr
- Department of Paediatrics, University of Oxford, Medical Sciences Division, Newborn Services, John Radcliffe Hospitals, Oxford, United Kingdom
| | - Ola D Saugstad
- Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - Umberto Simeoni
- Division of Pediatrics, CHUV & University of Lausanne, Lausanne, Switzerland
| | - Christian P Speer
- Department of Pediatrics, University Children's Hospital, Würzburg, Germany
| | - Maximo Vento
- Department of Pediatrics and Neonatal Research Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Gerhard H A Visser
- Department of Obstetrics and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - Henry L Halliday
- Department of Child Health, Queen's University Belfast and Royal Maternity Hospital, Belfast, United Kingdom
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18
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Kum CD, Lee MJ, Park MS, Sohn YB, Noh OK, Lee JH. Analysis of the Influencing Factors of 17-Hydroxyprogesterone Level and the Correlation between 17-Hydroxyprogesterone Level and the Clinical Parameters Related to Adrenal Cortical Function in Very-Low-Birth-Weight Infants. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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19
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Zhang ZQ, Zhong Y, Huang XM, Du LZ. Airway administration of corticosteroids for prevention of bronchopulmonary dysplasia in premature infants: a meta-analysis with trial sequential analysis. BMC Pulm Med 2017; 17:207. [PMID: 29246209 PMCID: PMC5732371 DOI: 10.1186/s12890-017-0550-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/30/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Uncertainly prevails with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. The meta-analysis with sequential analysis was designed to evaluate the efficacy and safety of airway administration (inhalation or instillation) of corticosteroids for preventing bronchopulmonary dysplasia (BPD) in premature infants. METHODS We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL from their inceptions to February 2017. All published randomized controlled trials (RCTs) evaluating the effect of airway administration of corticosteroids (AACs) vs placebo or systemic corticosteroid in prematurity were included. All meta-analyses were performed using Review Manager 5.3. RESULTS Twenty five RCTs retrieved (n = 3249) were eligible for further analysis. Meta-analysis and trial sequential analysis corrected the 95% confidence intervals estimated a lower risk of the primary outcome of BPD (relative risk 0.71, adjusted 95% confidence interval 0.57-0.87) and death or BPD (relative risk 0.81, adjusted 95% confidence interval 0.71-0.97) in AACs group than placebo and it is equivalent for preventing BPD than systemic corticosteroids. Moreover, AACs fail to increasing risk of death compared with placebo (relative risk 0.90, adjusted 95% confidence interval 0.40-2.03) or systemic corticosteroids (relative risk 0.81, 95% confidence interval 0.62-1.06). CONCLUSIONS Our findings suggests that AACs (especially instillation of budesonide using surfactant as a vehicle) are an effective and safe option for preventing BPD in preterm infants. Furthermore, the appropriate dose and duration, inhalation or instillation with surfactant as a vehicle and the long-term safety of airway administration of corticosteroids needs to be assessed in large trials.
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Affiliation(s)
- Zhi-Qun Zhang
- Department of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, No. 3333 Bingsheng Road, Hangzhou City, Zhejiang 310002 China
- Department of Pediatrics, Hangzhou First People’s Hospital, Nanjing Medical University, No. 261 Huansha Road, Hangzhou City, Zhejiang 310002 China
| | - Ying Zhong
- Department of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, No. 3333 Bingsheng Road, Hangzhou City, Zhejiang 310002 China
| | - Xian-Mei Huang
- Department of Pediatrics, Hangzhou First People’s Hospital, Nanjing Medical University, No. 261 Huansha Road, Hangzhou City, Zhejiang 310002 China
| | - Li-Zhong Du
- Department of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, No. 3333 Bingsheng Road, Hangzhou City, Zhejiang 310002 China
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20
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Sherman TI, Moya F, Simmons PD, Kurtz D, Shaffer TH. Parental preferences regarding administration of an animal-derived versus a synthetic medication to newborn infants. J Neonatal Perinatal Med 2017; 9:7-14. [PMID: 27002267 DOI: 10.3233/npm-16915062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM We examined the perceptions of parents with regard to animal-derived versus synthetic medications of comparable efficacy. We hypothesized that this issue is a concern in neonatal care and that the perceptions of parents from one geographical location would be similar to those of another. METHODS A survey was distributed to parents of neonates admitted to a neonatal intensive care unit of a southeastern hospital. RESULTS Of 153 parents surveyed, 150 (98%) responded. More mothers than fathers completed the surveys (113 vs. 34). Fifty-six percent of participants indicated a college or higher education; 40% had an income of $51,000/yr or higher. Thirty-four percent of parents had concerns about animal-derived medications, 41% preferred a synthetic medication of equivalent efficacy, and 69% would like to be informed if a medication was animal-derived. CONCLUSION Parents have concerns about exposing neonates to animal-derived medication and wish to be informed if an animal-derived medication is being considered.
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Affiliation(s)
| | - Fernando Moya
- Betty Cameron Women & Children's Hospital, Wilmington, NC, USA
| | - Phillip D Simmons
- Biostatistics and Data Management, Discovery Laboratories, Inc., Warrington, PA, USA
| | | | - Thomas H Shaffer
- Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
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21
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Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GHA, Halliday HL. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update. Neonatology 2017; 111:107-125. [PMID: 27649091 DOI: 10.1159/000448985] [Citation(s) in RCA: 321] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/08/2016] [Indexed: 02/04/2023]
Abstract
Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.
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Affiliation(s)
- David G Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Belfast, UK
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22
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Hawcutt DB, Russell NJ, Maqsood H, Kouranloo K, Gomberg S, Waitt C, Sharp A, Riordan A, Turner MA. Spontaneous adverse drug reaction reports for neonates and infants in the UK 2001-2010: content and utility analysis. Br J Clin Pharmacol 2016; 82:1601-1612. [PMID: 27597136 DOI: 10.1111/bcp.13067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS The UK Medicines and Healthcare products Regulatory Agency (MHRA) runs a national spontaneous reporting system (Yellow Card [YC] Scheme) to collect 'suspected' adverse drug reaction (ADR) data. We aim to describe the content and utility of YC reports received for patients aged <2 years. METHODS Data on all ADRs reported using YC in infants aged <2 years from the years 2001-10 were supplied by the MHRA. RESULTS For infants age <2 years, 3496 suspected ADRs were reported using YC (paternal medication pre-conception n = 3, transplacental n = 246, transmammary n = 30, neonates n = 97, infant n = 477, and vaccinations n = 2673), averaging 0.96 YC per day. There was a male preponderance (male 49.1%, female 44.4%, unknown 6.5%), and only 34 (1.0%) of YC reports stated a gestational age. The medications most frequently reported were: transplacental and transmammary (fluoxetine, n = 21 and n = 4 respectively), neonate (swine flu vaccine, n = 8) infant (oseltamivir, n = 37) and vaccines (meningococcal vaccine, n = 693). Paternal, transmammary, neonatal and infant YC did not reflect clinical concerns raised by the UK regulator. Transplacental and vaccination reports did correlate with some of the changes in practice and clinical alerts received. CONCLUSIONS The frequency of YC reports for those <2 years is low, neonates are poorly represented, and recording of gestational age is poor. With the exception of vaccinations, spontaneous reports alone are not currently generating the data required, and important safety messages from the regulator do not match reporting patterns. Additional reporting strategies are required to improve the quantity and quality of suspected ADR data in young children.
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Affiliation(s)
- Daniel B Hawcutt
- Department of Women's and Children's Health, University of Liverpool.,NIHR Alder Hey Clinical Research Facility.,Alder Hey Children's Hospital, Liverpool
| | | | | | | | | | - Catriona Waitt
- Department of Molecular and Clinical Pharmacology, University of Liverpool
| | - Andrew Sharp
- Department of Women's and Children's Health, University of Liverpool.,Liverpool Women's NHS Foundation Trust, Liverpool
| | | | - Mark A Turner
- Department of Women's and Children's Health, University of Liverpool.,Liverpool Women's NHS Foundation Trust, Liverpool
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Subramaniam P, Ho JJ, Davis PG. Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants. Cochrane Database Syst Rev 2016:CD001243. [PMID: 27315509 DOI: 10.1002/14651858.cd001243.pub3] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cohort studies have suggested that nasal continuous positive airways pressure (CPAP) starting in the immediate postnatal period before the onset of respiratory disease (prophylactic CPAP) may be beneficial in reducing the need for intubation and intermittent positive pressure ventilation (IPPV) and in preventing bronchopulmonary dysplasia (BPD) in preterm or low birth weight infants. OBJECTIVES To determine if prophylactic nasal CPAP started soon after birth regardless of respiratory status in the very preterm or very low birth weight infant reduces the use of IPPV and the incidence of bronchopulmonary dysplasia (BPD) without adverse effects. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 1), MEDLINE via PubMed (1966 to 31 January 2016), EMBASE (1980 to 31 January 2016), and CINAHL (1982 to 31 January 2016). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA All trials using random or quasi-random patient allocation of very preterm infants (under 32 weeks' gestation) or less than 1500 grams at birth were eligible. We included trials if they compared prophylactic nasal CPAP started soon after birth regardless of the respiratory status of the infant with 'standard' methods of treatment such as IPPV, oxygen therapy or supportive treatment. We excluded studies where prophylactic CPAP was compared with CPAP along with other interventions. DATA COLLECTION AND ANALYSIS We used the standard methods of Cochrane and its Neonatal Review Group, including independent study selection, assessment of trial quality and extraction of data by two authors. Data were analysed using risk ratio (RR) and the meta-analysis was performed using a fixed-effect model. MAIN RESULTS Seven trials recruiting 3123 babies were included in the meta-analysis. Four trials recruiting 765 babies compared CPAP with supportive care and three trials (2364 infants) compared CPAP with mechanical ventilation. Apart from a lack of blinding of the intervention all studies were of low risk of bias.In the comparison of CPAP with supportive care there was a reduction in failed treatment (typical risk ratio (RR) 0.66, 95% confidence interval (CI) 0.45 to 0.98; typical risk difference (RD) -0.16, 95% CI -0.34 to 0.02; 4 studies, 765 infants, very low quality evidence). There was no reduction in bronchopulmonary dysplasia (BPD) or mortality.In trials comparing CPAP with assisted ventilation with or without surfactant, CPAP resulted in a small but clinically significant reduction in the incidence of BPD at 36 weeks, (typical RR 0.89, 95% CI 0.79 to 0.99; typical RD -0.04, 95% CI -0.08 to 0.00; 3 studies, 772 infants, moderate-quality evidence); and death or BPD (typical RR 0.89, 95% CI 0.81 to 0.97; typical RD -0.05, 95% CI -0.09 to 0.01; 3 studies, 1042 infants, moderate-quality evidence). There was also a clinically important reduction in the need for mechanical ventilation (typical RR 0.50, 95% CI 0.42 to 0.59; typical RD -0.49, 95% CI -0.59 to -0.39; 2 studies, 760 infants, moderate-quality evidence); and the use of surfactant in the CPAP group (typical RR 0.54, 95% CI 0.40 to 0.73; typical RD -0.41, 95% CI -0.54 to -0.28; 3 studies, 1744 infants, moderate-quality evidence). AUTHORS' CONCLUSIONS There is insufficient evidence to evaluate prophylactic CPAP compared to oxygen therapy and other supportive care. However when compared to mechanical ventilation prophylactic nasal CPAP in very preterm infants reduces the need for mechanical ventilation and surfactant and also reduces the incidence of BPD and death or BPD.
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Affiliation(s)
- Prema Subramaniam
- Paediatric Department, Mount Isa Base Hospital, 30/58 Camooweal St, Mount Isa, QLD, Australia, 4825
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Buonocore G, Curstedt T, Halliday HL, Hallman M, Saugstad OD, Speer CP. Sharing Progress in Neonatal (SPIN) Lung and Brain. Neonatology 2016; 109:322-4. [PMID: 27251786 DOI: 10.1159/000444907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Xu H, Dai Q, Xu Y, Gong Z, Dai G, Ding M, Duggan C, Hu Z, Hu FB. Time trends and risk factor associated with premature birth and infants deaths due to prematurity in Hubei Province, China from 2001 to 2012. BMC Pregnancy Childbirth 2015; 15:329. [PMID: 26653182 PMCID: PMC4676169 DOI: 10.1186/s12884-015-0767-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/02/2015] [Indexed: 11/11/2022] Open
Abstract
Background The nutrition and epidemiologic transition has been associated with an increasing incidence of preterm birth in developing countries, but data from large observational studies in China have been limited. Our study was to describe the trends and factors associated with the incidence of preterm birth and infant mortality due to prematurity in Hubei Province, China. Methods We conducted a population-based survey through the Maternal and Child Health Care Network in Hubei Province from January 2001 to December 2012. We used data from 16 monitoring sites to examine the trend and risk factors for premature birth as well as infant mortality associated with prematurity. Results A total of 818,481 live births were documented, including 76,923 preterm infants (94 preterm infants per 1,000 live births) and 2,248 deaths due to prematurity (2.75 preterm deaths per 1,000 live births). From 2001 to 2012, the incidence of preterm birth increased from 56.7 to 105.2 per 1,000 live births (P for trend < 0.05), while the infant mortality rate due to prematurity declined from 95.0 to 13.4 per 1,000 live births (P for trend < 0.05). Older maternal age, lower maternal education, use of assisted reproductive technology (ART), higher income, residence in urban areas, and infant male sex were independently associated with a higher incidence of preterm birth (all p values < 0.05). Shorter gestation, lower birth weight, and lower income were associated with a higher mortality rate, while use of newborn emergency transport services (NETS) was associated with a lower preterm mortality rate (all p values < 0.05). Conclusion An increasing incidence of preterm birth and a parallel reduction in infant mortality due to prematurity were observed in Hubei Province from 2001 to 2012. Our results provide important information for areas of improvements in reducing incidence and mortality of premature birth. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0767-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haiqing Xu
- Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China.
| | - Qiong Dai
- Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China.
| | - Yusong Xu
- Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China.
| | - Zhengtao Gong
- Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China.
| | - Guohong Dai
- Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China.
| | - Ming Ding
- Department of Nutrition, Harvard School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA.
| | - Christopher Duggan
- Department of Nutrition, Harvard School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA. .,Boston Children's Hospita, Boston, Massachusetts, USA.
| | - Zubin Hu
- Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China.
| | - Frank B Hu
- Department of Nutrition, Harvard School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA.
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Sakonidou S, Dhaliwal J. The management of neonatal respiratory distress syndrome in preterm infants (European Consensus Guidelines--2013 update). Arch Dis Child Educ Pract Ed 2015; 100:257-9. [PMID: 25694422 DOI: 10.1136/archdischild-2014-306642] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/29/2015] [Indexed: 11/03/2022]
Affiliation(s)
- S Sakonidou
- Department of Neonatology, King's College Hospital Foundation Trust, London, UK
| | - J Dhaliwal
- Chelsea and Westminster Hospital, London, UK
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Manja V, Lakshminrusimha S, Cook DJ. Oxygen saturation target range for extremely preterm infants: a systematic review and meta-analysis. JAMA Pediatr 2015; 169:332-40. [PMID: 25664703 PMCID: PMC4388792 DOI: 10.1001/jamapediatrics.2014.3307] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE The optimal oxygen saturation (SpO2) target for extremely preterm infants is unknown. OBJECTIVE To systematically review evidence evaluating the effect of restricted vs liberal oxygen exposure on morbidity and mortality in extremely preterm infants. DATA SOURCES MEDLINE, PubMed, CENTRAL, and CINAHL databases from their inception to March 31, 2014, and abstracts submitted to Pediatric Academic Societies from 2000 to 2014. STUDY SELECTION All published randomized trials evaluating the effect of restricted (SpO2, 85%-89%) vs liberal (SpO2, 91%-95%) oxygen exposure in preterm infants (<28 weeks' gestation at birth). DATA EXTRACTION AND SYNTHESIS All meta-analyses were performed using Review Manager 5.2. The Cochrane risk-of-bias tool was used to assess study quality. The summary of the findings and the level of confidence in the estimate of effect were assessed using GRADEpro. Treatment effect was analyzed using a random-effects model. MAIN OUTCOMES AND MEASURES Death before hospital discharge, death or severe disability before 24 months, death before 24 months, neurodevelopmental outcomes, hearing loss, bronchopulmonary dysplasia, necrotizing enterocolitis, and severe retinopathy of prematurity. RESULTS Five trials were included in the final synthesis. These studies had a similar design with a prespecified composite outcome of death/disability at 18 to 24 months corrected for prematurity; however, this outcome has not been reported for 2 of the 5 trials. There was no difference in the outcome of death/disability before 24 months (risk ratio [RR], 1.02 [95% CI, 0.92-1.14]). Mortality before 24 months was not different (RR, 1.13 [95% CI, 0.97-1.33]); however, a significant increase in mortality before hospital discharge was found in the restricted oxygen group (RR, 1.18 [95% CI, 1.03-1.36]). The rates of bronchopulmonary dysplasia, neurodevelopmental outcomes, hearing loss, and retinopathy of prematurity were similar between the 2 groups. Necrotizing enterocolitis occurred more frequently in infants on restricted oxygen (RR, 1.24 [95% CI, 1.05-1.47]). Using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria, we found that the quality of evidence for these outcomes was moderate to low. CONCLUSIONS AND RELEVANCE Although infants cared for with a liberal oxygen target had significantly lower mortality before hospital discharge than infants cared for with a restricted oxygen target, the quality of evidence for this estimate of effect is low. Necrotizing enterocolitis occurred less frequently in the liberal oxygen group. We found no significant differences in death or disability at 24 months, bronchopulmonary dysplasia, retinopathy of prematurity, neurodevelopmental outcomes, or hearing loss at 24 months.
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Affiliation(s)
- Veena Manja
- Division of Cardiology, Department of Medicine, Veterans Affairs Medical Center, Buffalo, New York2Department of Internal Medicine, University at Buffalo, the State University of New York, Buffalo3Department of Clinical Epidemiology and Biostatistics, McM
| | - Satyan Lakshminrusimha
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Women and Children's Hospital of Buffalo and University at Buffalo, the State University of New York, Buffalo
| | - Deborah J Cook
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada5Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Acute Neonatal Respiratory Failure. PEDIATRIC AND NEONATAL MECHANICAL VENTILATION 2015. [PMCID: PMC7193706 DOI: 10.1007/978-3-642-01219-8_47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute respiratory failure requiring assisted ventilation is one of the most common reasons for admission to the neonatal intensive care unit. Respiratory failure is the inability to maintain either normal delivery of oxygen to the tissues or normal removal of carbon dioxide from the tissues. It occurs when there is an imbalance between the respiratory workload and ventilatory strength and endurance. Definitions are somewhat arbitrary but suggested laboratory criteria for respiratory failure include two or more of the following: PaCO2 > 60 mmHg, PaO2 < 50 mmHg or O2 saturation <80 % with an FiO2 of 1.0 and pH < 7.25 (Wen et al. 2004).
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Grasso C, Sciacca P, Giacchi V, Carpinato C, Mattia C, Palano GM, Betta P. Effects of Sustained Lung Inflation, a lung recruitment maneuver in primary acute respiratory distress syndrome, in respiratory and cerebral outcomes in preterm infants. Early Hum Dev 2015; 91:71-5. [PMID: 25549915 DOI: 10.1016/j.earlhumdev.2014.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/22/2014] [Accepted: 12/02/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sustained Lung Inflation (SLI) is a maneuver of lung recruitment in preterm newborns at birth that can facilitate the achieving of larger inflation volumes, leading to the clearance of lung fluid and formation of functional residual capacity (FRC). AIM To investigate if Sustained Lung Inflation (SLI) reduces the need of invasive procedures and iatrogenic risks. STUDY DESIGN 78 newborns (gestational age≤34 weeks, weighing≤2000 g) who didn't breathe adequately at birth and needed to receive SLI in addition to other resuscitation maneuvers (2010 guidelines). SUBJECTS 78 preterm infants born one after the other in our department of Neonatology of Catania University from 2010 to 2012. OUTCOME MEASURES The need of intubation and surfactant, the ventilation required, radiological signs, the incidence of intraventricular hemorrhage (IVH), periventricular leukomalacia, retinopathy in prematurity from III to IV plus grades, bronchopulmonary dysplasia, patent ductus arteriosus, pneumothorax and necrotizing enterocolitis. RESULTS In the SLI group infants needed less intubation in the delivery room (6% vs 21%; p<0.01), less invasive mechanical ventilation (14% vs 55%; p≤0.001) and shorter duration of ventilation (9.1 days vs 13.8 days; p≤0.001). There wasn't any difference for nasal continuous positive airway pressure (82% vs 77%; p=0.43); but there was less surfactant administration (54% vs 85%; p≤0.001) and more infants received INSURE (40% vs 29%; p=0.17). We didn't found any differences in the outcomes, except for more mild intraventricular hemorrhage in the SLI group (23% vs 14%; p=0.15; OR=1.83). CONCLUSION SLI is easier to perform even with a single operator, it reduces the necessity of more complicated maneuvers and surfactant without statistically evident adverse effects.
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Affiliation(s)
- Chiara Grasso
- Department of Pediatrics, Neonatology, NICU, University of Catania, "Policlinico of Catania", Italy
| | - Pietro Sciacca
- Department of Pediatrics, Neonatology, NICU, University of Catania, "Policlinico of Catania", Italy
| | - Valentina Giacchi
- Department of Pediatrics, Neonatology, NICU, University of Catania, "Policlinico of Catania", Italy
| | - Caterina Carpinato
- Department of Pediatrics, Neonatology, NICU, University of Catania, "Policlinico of Catania", Italy
| | - Carmine Mattia
- Department of Pediatrics, Neonatology, NICU, University of Catania, "Policlinico of Catania", Italy
| | - Grazia Maria Palano
- Department of Pediatrics, Neonatology, NICU, University of Catania, "Policlinico of Catania", Italy
| | - Pasqua Betta
- Department of Pediatrics, Neonatology, NICU, University of Catania, "Policlinico of Catania", Italy.
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Kim SM, Park YJ, Chung SH, Choi YS, Kim CH, Bae CW. Early prophylactic versus late selective use of surfactant for respiratory distress syndrome in very preterm infants: a collaborative study of 53 multi-center trials in Korea. J Korean Med Sci 2014; 29:1126-31. [PMID: 25120324 PMCID: PMC4129206 DOI: 10.3346/jkms.2014.29.8.1126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022] Open
Abstract
Pulmonary surfactant (PS) therapy was proven to be highly successful for the treatment of respiratory distress syndrome in premature infants. As a results, early prophylactic (EP) PS therapy has been introduced recently in Europe, the US and Korea. However, no multi-center study was compared EP and late selective (LS) PS therapies in Korea. We performed a retrospective multi-center study to compare the outcomes of EP and LS PS therapies in very preterm infants. We analyzed clinical morbidity and mortality for 1,291 infants in 2010 (LS group) and 1,249 infants in 2011 (EP group); the infants were born <30 weeks of gestation and had birth weight ≤1,250 g, and were chosen from 53 neonatal intensive care units in Korea. Compared to the LS group (22.5%), the overall mortality was better in the EP group (19.9%) and there was no increased need for retreatment.There were additional benefits in the EP group such as fewer associated complications. To the best of knowledge, our study is the first nationwide Korean study to compare the outcomes of EP and LS therapies, and it provides evidences that EP PS therapy is important in very preterm infants to improve for survival and reduce morbidities.
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Affiliation(s)
- Sung Mi Kim
- Department of Pediatrics, Busan St. Mary's Medical Center, Busan, Korea
| | - Young Jin Park
- Department of Pediatrics, Busan St. Mary's Medical Center, Busan, Korea
| | - Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chang Hoon Kim
- Department of Preventive Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Chong-Woo Bae
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
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Kawaza K, Machen HE, Brown J, Mwanza Z, Iniguez S, Gest A, Smith EO, Oden M, Richards-Kortum RR, Molyneux E. Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi. PLoS One 2014; 9:e86327. [PMID: 24489715 PMCID: PMC3906032 DOI: 10.1371/journal.pone.0086327] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/07/2013] [Indexed: 11/21/2022] Open
Abstract
Background Respiratory failure is a leading cause of neonatal mortality in the developing world. Bubble continuous positive airway pressure (bCPAP) is a safe, effective intervention for infants with respiratory distress and is widely used in developed countries. Because of its high cost, bCPAP is not widely utilized in low-resource settings. We evaluated the performance of a new bCPAP system to treat severe respiratory distress in a low resource setting, comparing it to nasal oxygen therapy, the current standard of care. Methods We conducted a non-randomized convenience sample study to test the efficacy of a low-cost bCPAP system treating newborns with severe respiratory distress in the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi. Neonates weighing >1,000 g and presenting with severe respiratory distress who fulfilled inclusion criteria received nasal bCPAP if a device was available; if not, they received standard care. Clinical assessments were made during treatment and outcomes compared for the two groups. Findings 87 neonates (62 bCPAP, 25 controls) were recruited. Survival rate for neonates receiving bCPAP was 71.0% (44/62) compared with 44.0% (11/25) for controls. 65.5% (19/29) of very low birth weight neonates receiving bCPAP survived to discharge compared to 15.4% (1/13) of controls. 64.6% (31/48) of neonates with respiratory distress syndrome (RDS) receiving bCPAP survived to discharge, compared to 23.5% (4/17) of controls. 61.5% (16/26) of neonates with sepsis receiving bCPAP survived to discharge, while none of the seven neonates with sepsis in the control group survived. Interpretation Use of a low-cost bCPAP system to treat neonatal respiratory distress resulted in 27% absolute improvement in survival. The beneficial effect was greater for neonates with very low birth weight, RDS, or sepsis. Implementing appropriate bCPAP devices could reduce neonatal mortality in developing countries.
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Affiliation(s)
- Kondwani Kawaza
- Department of Pediatrics, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Heather E. Machen
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jocelyn Brown
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
| | - Zondiwe Mwanza
- Department of Pediatrics, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Suzanne Iniguez
- Department of Respiratory Care, Texas Children's Hospital, Houston, Texas, United States of America
| | - Al Gest
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - E. O'Brian Smith
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Maria Oden
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
| | | | - Elizabeth Molyneux
- Department of Pediatrics, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
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Smolarova S, Kocvarova L, Matasova K, Zibolen M, Calkovska A. Impact of Updated European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome on Clinical Outcome of Preterm Infants. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 835:61-6. [DOI: 10.1007/5584_2014_39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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OHRP and SUPPORT: lessons in balancing safety and improving the way we care for patients. J Pediatr 2013; 163:1495-7. [PMID: 24050739 DOI: 10.1016/j.jpeds.2013.08.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/14/2013] [Accepted: 08/27/2013] [Indexed: 01/20/2023]
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Bhutta ZA, Giuliani F, Haroon A, Knight HE, Albernaz E, Batra M, Bhat B, Bertino E, McCormick K, Ochieng R, Rajan V, Ruyan P, Cheikh Ismail L, Paul V. Standardisation of neonatal clinical practice. BJOG 2013; 120 Suppl 2:56-63, v. [DOI: 10.1111/1471-0528.12312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2012] [Indexed: 11/27/2022]
Affiliation(s)
- ZA Bhutta
- Division of Women & Child Health; The Aga Khan University; Karachi; Pakistan
| | - F Giuliani
- SCDU Neonatologia; Dipartimento di Scienze Pediatriche e dell'Adolescenza; Università degli Studi di Torino; Torino; Italy
| | - A Haroon
- Division of Women & Child Health; The Aga Khan University; Karachi; Pakistan
| | - HE Knight
- Nuffield Department of Obstetrics & Gynaecology; Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford; UK
| | | | - M Batra
- University of Washington School of Medicine; Seattle; WA; USA
| | - B Bhat
- Department of Family & Community Health; Ministry of Health; Muscat; Sultanate of Oman
| | - E Bertino
- SCDU Neonatologia; Dipartimento di Scienze Pediatriche e dell'Adolescenza; Università degli Studi di Torino; Torino; Italy
| | - K McCormick
- Department of Paediatrics; John Radcliffe Hospital; Oxford; UK
| | - R Ochieng
- Faculty of Health Sciences; Aga Khan University; Nairobi; Kenya
| | - V Rajan
- Ketkar Nursing Home; Nagpur; India
| | - P Ruyan
- Maternal & Child Health Centre; Beijing Obstetrics & Gynaecology Hospital; Capital Medical University; Beijing; China
| | - L Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology; Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford; UK
| | - V Paul
- Department of Paediatrics and WHO Collaborating Centre for Training & Research in Newborn Care; All India Institute of Medical Sciences; New Delhi; India
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Besnard AE, Wirjosoekarto SA, Broeze KA, Opmeer BC, Mol BWJ. Lecithin/sphingomyelin ratio and lamellar body count for fetal lung maturity: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013; 169:177-83. [DOI: 10.1016/j.ejogrb.2013.02.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/23/2013] [Accepted: 02/09/2013] [Indexed: 11/16/2022]
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Mitsiakos G, Kovacs L, Papageorgiou A. Are antenatal steroids beneficial to severely growth restricted fetuses? J Matern Fetal Neonatal Med 2013; 26:1496-9. [PMID: 23560533 DOI: 10.3109/14767058.2013.789852] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Antenatal steroids (AS) have been shown to enhance fetal maturation in preterms and to improve outcome. The aim of this study was to evaluate the efficacy of AS in premature severely intrauterine growth restricted infants. The electronic data of 149 inborn, single infants born 24 to 31 6/7 weeks of GA and with a BW ≤ 3rd percentile were reviewed. Infants with congenital anomalies and syndromes were excluded. We compared the outcome of those who received 2 doses of AS (group A, 87 infants) with those who did not receive AS (group B, 62 infants). Sixty-eight infants in group A and 53 in group B were discharged home alive. AS did not improve the neonatal outcome, with the exception of a better cord pH and 5-min Apgar and we did not observe a significant difference in the Griffith's test at 2 years of corrected age, although there was a trend to a higher incidence of severe global delay in the steroid group. In view of the potential cerebral and CVS risks associated with high circulating steroids, the indications for AS in such a population need to be re-evaluated.
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Abstract
Respiratory distress is recognised as any signs of breathing difficulties in neonates. In the early neonatal period respiratory distress is common, occurring in up to 7% of newborn infants, resulting in significant numbers of term-born infants being admitted to neonatal units. Many risk factors are involved; the increasing number of term infants delivered by elective caesarean section has also increased the incidence. Additionally the risk decreases with each advancing week of gestation. At 37 weeks, the chances are three times greater than at 39-40 weeks gestation. Multiple conditions can present with features of respiratory distress. Common causes in term newborn infants include transient tachypnoea of the newborn, respiratory distress syndrome, pneumonia, meconium aspiration syndrome, persistent pulmonary hypertension of the neonate and pneumothorax. Early recognition of respiratory distress and initiation of appropriate treatment is important to ensure optimal outcomes. This review will discuss these common causes of respiratory distress in term-born infants.
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Affiliation(s)
- Martin O Edwards
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom.
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Rey-Santano C, Mielgo V, Gastiasoro E, Valls-i-Soler A, Murgia X. Effect of surfactant and partial liquid ventilation treatment on gas exchange and lung mechanics in immature lambs: influence of gestational age. PLoS One 2013; 8:e56127. [PMID: 23418521 PMCID: PMC3571983 DOI: 10.1371/journal.pone.0056127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/04/2013] [Indexed: 12/05/2022] Open
Abstract
Objectives Surfactant (SF) and partial liquid ventilation (PLV) improve gas exchange and lung mechanics in neonatal RDS. However, variations in the effects of SF and PLV with degree of lung immaturity have not been thoroughly explored. Setting Experimental Neonatal Respiratory Physiology Research Unit, Cruces University Hospital. Design Prospective, randomized study using sealed envelopes. Subjects 36 preterm lambs were exposed (at 125 or 133-days of gestational age) by laparotomy and intubated. Catheters were placed in the jugular vein and carotid artery. Interventions All the lambs were assigned to one of three subgroups given: 20 mL/Kg perfluorocarbon and managed with partial liquid ventilation (PLV), surfactant (Curosurf®, 200 mg/kg) or (3) no pulmonary treatment (Controls) for 3 h. Measurements and Main Results Cardiovascular parameters, blood gases and pulmonary mechanics were measured. In 125-day gestation lambs, SF treatment partially improved gas exchange and lung mechanics, while PLV produced significant rapid improvements in these parameters. In 133-day lambs, treatments with SF or PLV achieved similarly good responses. Neither surfactant nor PLV significantly affected the cardiovascular parameters. Conclusion SF therapy response was more effective in the older gestational age group whereas the effectiveness of PLV therapy was not gestational age dependent.
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Affiliation(s)
- Carmen Rey-Santano
- Research Unit for Experimental Neonatal Respiratory Physiology, Cruces University Hospital, Barakaldo, Bizkaia, Spain.
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Murgia X, Gastiasoro E, Mielgo V, Ruiz-Del-Yerro E, Alvarez-Diaz FJ, Lafuente H, Valls-I-Soler A, Gomez-Solaetxe MA, Rey-Santano C. Surfactant and perfluorocarbon aerosolization during different mechanical ventilation strategies by means of inhalation catheters: an in vitro study. J Aerosol Med Pulm Drug Deliv 2011; 25:23-31. [PMID: 22044251 DOI: 10.1089/jamp.2011.0886] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Aerosol delivery of surfactant and perfluorocarbon (PFC) is a desirable therapeutic approach for the treatment of various lung diseases in patients undergoing mechanical ventilation. However, the behavior of these substances during aerosolization differs significantly from that of aqueous solutions. In particular, the high vapor pressure of many PFCs tends to result in greater evaporation during mechanical ventilation. METHODS Three PFCs and surfactant were aerosolized during mechanical ventilation by means of three intratracheal inhalation catheters (IC) with different air flow rates (IC-1.23, IC-1.1, and IC-1.4), with their aerosol generating tip placed at the distal end of the endotracheal tube (i.d. 4 mm). The influence of four different ventilation strategies on aerosol production rate and PFC and surfactant recovery was studied. The changes in intrapulmonary pressure produced by the air jets of each IC were measured. RESULTS With IC-1.23 and IC-1.1, the highest rates of aerosol production were achieved using FC75 (2.27±0.18 and 0.76±0.01, respectively) followed by PFOB (1.74±0.06 and 0.56±0.04), PFD (0.82±0.01 and 0.21±0.01), and surfactant (0.42±0.05 and 0.092±0.01). With IC-1.4 modest aerosol production was obtained irrespective of the aerosolized compound. Mechanical ventilation influenced aerosol recovery, with the trend being toward recovering higher percentages of the compounds with lower peak inspiratory pressure (PIP) and lower respiratory rate (RR) settings. The highest percentages of the initial volume were recovered with IC-1.23 (between 65.43%±4.2 FC75 and 90.21%±4.71 surfactant) followed by IC-1.1 (between 46.48%±4.46 FC75 and 73.19%±2.82 PFOB) and IC-1.4 (between 4.65%±4.36 FC75 and 63.24%±9.71 surfactant). Each of three of the ICs were found to increase the intrapulmonary pressure by about 2-3 cmH₂O during mechanical ventilation. CONCLUSIONS Despite of mechanical ventilation, IC-1.23 and IC-1.1 were able to deliver significant amounts of surfactant and perfluorocarbon to the lung model. Changes in PIP and RR directly influence the percentage of surfactant and perfluorocarbon recovered.
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Affiliation(s)
- Xabier Murgia
- Experimental Neonatal Respiratory Physiology Research Unit, Hospital de Cruces, Plaza de Cruces, Barakaldo E-48903, Bizkaia, Spain.
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Roberts CL, Badgery-Parker T, Algert CS, Bowen JR, Nassar N. Trends in use of neonatal CPAP: a population-based study. BMC Pediatr 2011; 11:89. [PMID: 21999325 PMCID: PMC3206424 DOI: 10.1186/1471-2431-11-89] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 10/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is used widely to provide respiratory support for neonates, and is often the first treatment choice in tertiary centres. Recent trials have demonstrated that CPAP reduces need for intubation and ventilation for infants born at 25-28 weeks gestation, and at > 32 weeks, in non-tertiary hospitals, CPAP reduces need for transfer to NICU. The aim of this study was to examine recent population trends in the use of neonatal continuous positive airway pressure. METHODS We undertook a population-based cohort study of all 696,816 liveborn neonates ≥24 weeks gestation in New South Wales (NSW) Australia, 2001-2008. Data were obtained from linked birth and hospitalizations records, including neonatal transfers. The primary outcome was CPAP without mechanical ventilation (via endotracheal intubation) between birth and discharge from the hospital system. Analyses were stratified by age ≤32 and > 32 weeks gestation. RESULTS Neonates receiving any ventilatory support increased from 1,480 (17.9/1000) in 2001 to 2,486 (26.9/1000) in 2008, including 461 (5.6/1000) to 1,465 (15.8/1000) neonates who received CPAP alone. There was a concurrent decrease in mechanical ventilation use from 12.3 to 11.0/1000. The increase in CPAP use was greater among neonates > 32 weeks (from 3.2 to 11.8/1000) compared with neonates ≤32 weeks (from 18.1 to 32.7/1000). The proportion of CPAP > 32 weeks initiated in non-tertiary hospitals increased from 6% to 30%. CONCLUSIONS The use of neonatal CPAP is increasing, especially > 32 weeks gestation and among non-tertiary hospitals. Recommendations are required regarding which infants should be considered for CPAP, resources necessary for a unit to offer CPAP and monitoring of longer term outcomes.
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Affiliation(s)
- Christine L Roberts
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Department of Obstetrics & Gynaecology, Level 2, Building 52, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
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Bertagnon JRD, Rocha MDC, Kuraim GA, Guidara R, Novo NF. Association of newborn diseases with weight/length ratio and the adequacy of weight for gestational age. EINSTEIN-SAO PAULO 2011; 9:288-93. [DOI: 10.1590/s1679-45082011ao2086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 08/11/2011] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To compare the frequencies of newborn diseases in those newborns classified according to a weight/length rate and those classified by the adequacy weight for gestational age. Methods: A retrospective cross-sectional study by record assessment was carried out enclosing all the live newborns at Hospital Geral do Grajaú, from September to December, 2009 (n =577) classified according to the rate weight/length and also to the adequacy weight for gestational age. The 10 and 90 percentiles of the weight/length distribution, now designated as “indices” were calculated leading to the following classification: low index, for newborns below 54.8 g/cm; high index, for those over 75.8 g/cm; and average index, for the remaining newborns. According to the adequacy weight for gestational age the newborns were designated as pre-term for gestational age; term small for gestational age; appropriate term and large term. In this sample there were no small and large pre-term or post-term newborns. Major diseases were related to the index and adequacy extracts by the χ2 test for a contingency table. Results: A significant association was found among low index, pre-term for gestational age newborns and term small for gestational age; between average index and appropriate for gestational age term newborns; and high index with large term appropriate for gestational age newborns (p< 0.001). Hypoglycemia (3.4%) was associated to both low and high indices, to appropriate for gestational age preterm newborns and to small for gestational age term newborns. Sepsis (3.1%) was associated to both low index and pre-term appropriate for gestational age newborns. The respiratory distress syndrome (1.3%) was associated to low index and pre-term appropriate for gestational age newborns. Other respiratory distress syndromes (3.8%) were associated to low and high indices but not to the adequacy for gestational age classification. Jaundice (14.9%) was not associated to the studied classifications. Perinatal asphyxia (12.6%) was associated to low index and pre-term newborns. Conclusion: The weight/length index may represent a contribution to the newborn risk classification being similar to that of the weight for gestational age adequacy, for the studied diseases.
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Affiliation(s)
| | | | | | - Rosângela Guidara
- Hospital Geral do Grajaú Professor Liberato John Alphonse Di Dio, Brazil
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Kwinta P, Pietrzyk JJ. Preterm birth and respiratory disease in later life. Expert Rev Respir Med 2011; 4:593-604. [PMID: 20923339 DOI: 10.1586/ers.10.59] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic respiratory diseases are a common complication of preterm birth, particularly among very immature infants or those suffering from bronchopulmonary dysplasia. Major progress in the treatment of preterm newborns has changed the pattern of late respiratory complications. The major respiratory problem in infancy and early childhood is respiratory exacerbations caused by infections (particularly viral ones), which need hospitalization. The symptoms become mild in school-age children; however, a group of children still present with chronic airway obstruction defined by recurrent episodes of wheezing and decreased lung function tests (decreased forced expiratory volume). For some preterm infants, particularly those with bronchopulmonary dysplasia, obstructive lung disease persists into adulthood. They are very likely to develop chronic obstructive pulmonary disease or similar disease later in life. In these patients, a program of lung function monitoring and pulmonary prophylaxis by means of elimination of specific risk factors in adulthood is advisable.
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Bailey SM, Hendricks-Muñoz KD, Mally PV. Animal Origins of Surfactant: A Survey of Neonatologists’ Perceptions and Practices Regarding Parent Information Sharing. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/21507716.2011.566597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pharmacokinetics and clinical predictors of surfactant redosing in respiratory distress syndrome. Intensive Care Med 2010; 37:510-7. [DOI: 10.1007/s00134-010-2091-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 11/07/2010] [Indexed: 11/24/2022]
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Ladenburger A, Seehase M, Kramer BW, Thomas W, Wirbelauer J, Speer CP, Kunzmann S. Glucocorticoids potentiate IL-6-induced SP-B expression in H441 cells by enhancing the JAK-STAT signaling pathway. Am J Physiol Lung Cell Mol Physiol 2010; 299:L578-84. [PMID: 20693312 PMCID: PMC2957422 DOI: 10.1152/ajplung.00055.2010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 07/30/2010] [Indexed: 01/09/2023] Open
Abstract
The respiratory distress syndrome (RDS) contributes to perinatal morbidity and mortality associated with preterm birth. Surfactant protein B (SP-B) is decreased in RDS. Both maternal antenatal steroid administration and chorioamnionitis reduce the incidence and severity of RDS. An important mediator in chorioamnionitis is IL-6 using the JAK-STAT signaling pathway for signal transduction. We hypothesized that the steroids, betamethasone (BTM) and dexamethasone (DXM), and IL-6 had synergistic effects on SP-B gene expression and STAT3 phosphorylation in H441 cells. DXM and BTM increased SP-B mRNA levels by 16.5 (13.3)-fold and IL-6 alone by 2.3-fold. After 48-h exposure of cells to DXM or BTM, IL-6 caused a significantly greater increase in SP-B mRNA levels (28.1-fold) than IL-6 or glucocorticoids alone. Whereas IL-6 stimulated tyrosine phosphorylation of STAT3 in a time- and dose-dependent way, DXM and BTM had no effect on STAT3 phosphorylation. Both DXM and BTM could potentiate IL-6-induced phosphorylation of STAT3. The synergism of glucocorticoids and IL-6 on SP-B gene expression and the effect of glucocorticoids on IL-6-induced STAT3 phosphorylation could be blocked by a JAK inhibitor. Expression level analysis showed that glucocorticoids increased the expression of the IL-6-binding α-subunit receptor (IL-6R) on mRNA and protein level. Our findings could represent an example of a pulmonary regulation system in which one role of glucocorticoids is to increase the effect of a cytokine by upregulation of its receptor. The described in vitro interaction of IL-6 and glucocorticoids could help explain the clinical observation that prenatal inflammation in preterm babies with antenatal steroid administration can attenuate severity of RDS.
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Canpolat FE, Yurdakök M, Korkmaz A, Yiğit S, Tekinalp G. Adenosine deaminase levels in premature infants with respiratory distress syndrome and bronchopulmonary dysplasia. J Matern Fetal Neonatal Med 2010; 24:703-7. [PMID: 20836741 DOI: 10.3109/14767058.2010.516286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adenosine is produced in the inflammed and damaged lung where it plays roles in the regulation of inflammation and tissue remodeling. Adenosine deaminase (ADA) is an enzyme responsible for the degradation of adenosine. Our aim was to compare the levels of ADA between infants with and without respiratory distress syndrome (RDS) and to determine the relationship between plasma ADA levels and bronchopulmonary dysplasia (BPD). One-hundred and twenty-five premature infants who were admitted to our neonatal intensive care unit were included in the study. Eighty-one of these infants with RDS were study group and the other 44 infants without RDS served as controls. Blood collection was made in the first day of life at the end of 24th-h and was used for laboratory testing. In the RDS group, mean ADA level was 25.5 (± 4.5) U/l, and in controls it was 26.3 (± 5.7) U/l. There was no statistically significant difference (p = 0.326) in these groups although there was a statistically difference of ADA levels between BPD (34.5 ± 5.2 U/l) and non-BPD (24.6 ± 4.1) patients (p = 0.001). There was also a positive relationship between ADA levels and severity of BPD (r = + 0.845, p = 0.01). Perinatal inflammation is the key mechanism of BPD. ADA level in early postnatal life is elevated in infants with BPD and may be related with perinatal inflammation.
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Affiliation(s)
- Fuat Emre Canpolat
- Faculty of Medicine, Department of Pediatrics, Hacettepe University, Ankara, Turkey.
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Saianda A, Fernandes RM, Saldanha J. Uso do método INSURE versus CPAP nasal isolado em recém-nascidos de muito baixo peso com 30 ou menos semanas de gestação. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)30071-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Yang CF, Jeng MJ, Soong WJ, Lee YS, Tsao PC, Tang RB. Acute pathophysiological effects of intratracheal instillation of budesonide and exogenous surfactant in a neonatal surfactant-depleted piglet model. Pediatr Neonatol 2010; 51:219-226. [PMID: 20713286 DOI: 10.1016/s1875-9572(10)60042-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 10/28/2009] [Accepted: 11/16/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chronic lung disease continues to be a major complication in premature infants with severe respiratory distress syndrome (RDS). This is despite having advanced ventilatory care, prenatal corticosteroids, and postnatal surfactant therapies. The combined use of intratracheal corticosteroids and surfactant may not only recruit the lungs, but also alleviate pulmonary inflammation in severe RDS. METHODS Fifteen newborn piglets received repeated pulmonary saline lavage to induce surfactant-depleted lungs, mimicking neonatal RDS. They were randomly divided into three groups: control group receiving no treatment; surfactant (Surf) group, treated with standard intratracheally instilled surfactant (100 mg/kg); and Budesonide plus surfactant (Bude + Surf) group, treated with intratracheally administered mixed suspension of budesonide (0.5 mg/kg) and surfactant (100 mg/kg). Blood samples were taken every 30 minutes for 4 hours. Lung tissue was examined after the experiment. RESULTS Significantly better oxygenation with higher PaO(2) and alveolar-arterial oxygen difference was noted in the Surf and Bude + Surf groups, compared with the control group (p < 0.05), but there were no significant differences between the Surf and Bude + Surf groups. Pulmonary histologic damage was also markedly alleviated in both the Surf and Bude + Surf groups, compared with the control group, and lung injury scores were significantly decreased in the Surf and Bude + Surf groups, compared with the control group (p < 0.05). CONCLUSIONS Intratracheal instillation of surfactant or surfactant plus budesonide can improve oxygenation and pulmonary histologic outcome in neonatal surfactant-depleted lungs. The additional use of budesonide does not disturb the function of the exogenous surfactant. Intratracheal administration of a corticosteroid combined with surfactant may be an effective method for alleviating local pulmonary inflammation in severe RDS.
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Affiliation(s)
- Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Jy Jeng
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pen-Chen Tsao
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ren-Bin Tang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
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Koch L, Frommhold D, Beedgen B, Ruef P, Poeschl J. Prophylactic administration of surfactant in extremely premature infants. Crit Care Res Pract 2010; 2010:235894. [PMID: 20948885 PMCID: PMC2951078 DOI: 10.1155/2010/235894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 01/21/2010] [Accepted: 03/24/2010] [Indexed: 11/17/2022] Open
Abstract
Objective. To investigate whether prophylactic surfactant administration is superior over selective treatment in preterm infants with respiratory distress syndrome (RDS). Methods. In our retrospective analysis, we compared premature infants (23 + 0 to 26 + 6 weeks) receiving 200 mg/kg surfactant (curosurf(®)) within five minutes after birth (prophylactic group, N = 31) with those infants who received surfactant therapy for established RDS (selective group, N = 34). Results. Prophylactic therapy significantly decreased the need for mechanical ventilation (74 hours per patient versus 171 hours per patient, resp.). We observed a reduced incidence of interstitial emphysema (0% versus 9%, resp.), pneumothoraces (3% versus 9%, resp.), chronic lung disease (26% versus 38%, resp.), and surfactant doses per patient (1.3 versus 1.8, resp.), although those variables did not reach significance. Conclusion. We conclude that infants under 27 weeks' gestation profit from prophylactic surfactant administration by reducing the time of mechanical ventilation. This in turn could contribute to reduce the risk for mechanical ventilation associated complications, without any detrimental short-term side effects.
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Affiliation(s)
- Lutz Koch
- Division of Neonatology, Department of Pediatrics, University of Heidelberg Medical School, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - David Frommhold
- Division of Neonatology, Department of Pediatrics, University of Heidelberg Medical School, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Bernd Beedgen
- Division of Neonatology, Department of Pediatrics, University of Heidelberg Medical School, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Peter Ruef
- Division of Neonatology, Department of Pediatrics, University of Heidelberg Medical School, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Johannes Poeschl
- Division of Neonatology, Department of Pediatrics, University of Heidelberg Medical School, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
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Mercanti I, Boubred F, Simeoni U. Therapeutic closure of the ductus arteriosus: benefits and limitations. J Matern Fetal Neonatal Med 2010; 22 Suppl 3:14-20. [PMID: 19925358 DOI: 10.1080/14767050903198132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patency of the ductus arteriosus (PDA), a common complication of preterm birth, has been associated to increased risk for intraventricular cerebral hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia and death. Consequently, prophylactic or curative treatment has been advocated before the critical left-to-right shunting occurs. A host of studies has shown that both pharmacological agents and surgical closure are effective in closing the ductus arteriosus in premature infants. Indomethacin has long been the drug of choice. However, renal and cerebral haemodynamic side effects have been frequently reported. Strategies to minimise adverse effects of indomethacin, such as the association with frusemide, dopamine or the use of low-dose prolonged treatment with indomethacin have failed or shown partial benefit. Other NSAIDs have been investigated. But either the profile of adverse effects was unfavourable, as in the case of mefenamic acid, or their efficacy was less than that of indomethacin for PDA closure. More recently, ibuprofen has been proposed for the treatment of PDA as it was shown to induce less adverse effects on cerebral blood flow, intestinal and renal hemodynamics, while retaining similar efficacy to indomethacin. However, since renal perfusion, GFR and diuresis in early neonatal life strongly depend on the vasodilator effects of PGs on the afferent glomerular arterioles, ibuprofen, as other COX-inhibitors may not be exempt of some renal undesirable effects. While numerous studies have shown that PDA is a risk factor associated with immaturity and with increased incidence of complications of preterm birth, including broncho-pulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis and death, there is little evidence that such association is causative. Moreover, still little evidence exists from even recent randomized controlled trials that the pharmacological closure of PDA benefits to premature infants in terms of clinically significant short-term or medium-term outcomes, beyond a positive effect on DA patency. The use of COX-inhibitors for the prophylaxis or closure of PDA during the first hours or days of life should thus be cautious and based on an individual evaluation of benefit and risk. There is need of a randomized, placebo-controlled trials designed to assess the benefits in terms of mortality and morbidity outcomes of an early, or even very early pharmacological closure of PDA in extremely low gestational age infants.
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Affiliation(s)
- Isabelle Mercanti
- Division of Neonatalogy, Children and Parents Pole, Assistance Publique - Hôpitaux de Marseille & Université de la Méditerranée, Marseille, France
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