1
|
Shi ZN, Zhang X, Du CY, Zhao B, Liu SG. Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome. World J Clin Cases 2024; 12:5366-5373. [PMID: 39156082 PMCID: PMC11238696 DOI: 10.12998/wjcc.v12.i23.5366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/25/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Neonatal respiratory distress syndrome (NRDS) is one of the most common diseases in neonatal intensive care units, with an incidence rate of about 7% among infants. Additionally, it is a leading cause of neonatal death in hospitals in China. The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant. AIM To explore the effect of pulmonary surfactant (PS) combined with noninvasive positive pressure ventilation on keratin-14 (KRT-14) and endothelin-1 (ET-1) levels in peripheral blood and the effectiveness in treating NRDS. METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included. Of these, 64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation. The expression of KRT-14 and ET-1 in the two groups was compared. The deaths, complications, and PaO2, PaCO2, and PaO2/FiO2 blood gas indexes in the two groups were compared. Receiver operating characteristic curve (ROC) analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS. RESULTS The observation group had a significantly higher effectiveness rate than the control group. There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions, such as bronchial dysplasia, cyanosis, and shortness of breath. After treatment, the levels of PaO2 and PaO2/FiO2 in both groups were significantly higher than before treatment, while the level of PaCO2 was significantly lower. After treatment, the observation group had significantly higher levels of PaO2 and PaO2/FiO2 than the control group, while PaCO2 was notably lower in the observation group. After treatment, the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels. The observation group had a reduction of KRT-14 and ET-1 levels than the control group. ROC curve analysis showed that the area under the curve (AUC) of KRT-14 was 0.791, and the AUC of ET-1 was 0.816. CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy. KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.
Collapse
Affiliation(s)
- Ze-Ning Shi
- Department of Pediatrics, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Xin Zhang
- Department of Anesthesiology, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Chun-Yuan Du
- Department of Gynecology and Obstetrics, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Bing Zhao
- Department of Anesthesiology, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Shu-Gang Liu
- Department of Pediatrics, Army Military Medical University Officer School Affiliated Hospital, Shijiazhuang 050000, Hebei Province, China
| |
Collapse
|
2
|
Aghaei M, Talari FS, Mollahosseini A, Keramati M. Validation of a high-performance liquid chromatography method for determining lysophosphatidylcholine content in bovine pulmonary surfactant medication. Biomed Chromatogr 2024; 38:e5926. [PMID: 38881378 DOI: 10.1002/bmc.5926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024]
Abstract
Pulmonary surfactant replacement therapy is a promising improvement in neonatal care for infants with respiratory distress syndrome. Lysophosphatidylcholine (LPC) is an undesirable component that can hinder surfactant proteins from enhancing the adsorption of surfactant lipids to balance surface tensions by creating a saturated coating on the interior of the lungs. A novel normal-phase liquid chromatography method utilizing UV detection and non-toxic solvents was developed and validated for the first time to analyze LPC in the complex matrix of pulmonary surfactant medication. The analytical method validation included evaluation of system suitability, repeatability, intermediate precision, linearity, accuracy, limit of detection (LOD), limit of quantification (LOQ), stability and robustness. The method yielded detection and quantification limits of 4.4 and 14.5 μg/ml, respectively. The calibration curve was modified linearly within the LOQ to 1.44 mg/ml range, with a determination coefficient of 0.9999 for standards and 0.9997 for sample solutions. Given the lack of reliable published data on LPC analysis in pulmonary surfactant medications, this newly developed method demonstrates promising results and offers advantages of HPLC methodology, including simplicity, accuracy, specificity, sensitivity and an exceptionally low LOD and LOQ. These attributes contribute to considering this achievement as an innovative method.
Collapse
Affiliation(s)
- Mahsa Aghaei
- ARC Bioassay (Iran Food and Drug Administration Accredited QC Laboratory of Biopharmaceutical Products), Tehran, Iran
- Department of Chemistry, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Faezeh Shirgaei Talari
- ARC Bioassay (Iran Food and Drug Administration Accredited QC Laboratory of Biopharmaceutical Products), Tehran, Iran
| | - Afsaneh Mollahosseini
- Research Laboratory of Spectrometry & Micro and Nano Extraction, Department of Chemistry, Iran University of Science and Technology, Tehran, Iran
| | - Malihe Keramati
- Department of Nanobiotechnology, New Technologies Research Group, Pasteur Institute of Iran, Tehran, Iran
| |
Collapse
|
3
|
Sabzevari F, Eslamian M, Karami Robati F, Bahmanbijari B, Daei Parizi Z, Jamali Z. Comparison of the efficacy of two natural surfactants (BERAKSURF and BLES) in the treatment of respiratory distress syndrome among preterm neonates. BMC Pediatr 2023; 23:608. [PMID: 38036980 PMCID: PMC10691073 DOI: 10.1186/s12887-023-04406-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The benefit of surfactant replacement therapy for respiratory distress syndrome (RDS) has been demonstrated. However, some surfactants are expensive and usually inaccessible. Consequently, the Iranian Survanta was produced, but its effect on complications and mortality of RDS is unknown. This study aimed to compare the therapeutic outcomes of Iranian surfactant (beraksurf) and BLES (bovine lipid extract surfactant) on RDS treatment among preterm neonates. METHODS This triple blinded randomized controlled trial study was performed on 128 eligible neonates diagnosed with RDS in Afzalipour hospital in Kerman, Iran. Diagnosis of RDS, gestational age of 28-34 weeks and weight ≥ 1 kg were considered as inclusion criteria. Congenital anomalies such as congenital cyanotic heart diseases, digestive system anomalies and chromosome abnormalities were the exclusion criteria Neonates were randomly assigned into two equal groups: (1) those treated with BLES (n = 64) and (2) those treated with beraksurf (n = 64). Complications including patent ductus arteriosus (PDA), sepsis, intraventricular hemorrhage (IVH), pneumothorax, pulmonary hemorrhage, mortality, and also, the number of days required for invasive mechanical ventilation (using ventilator) and non-invasive continuous positive airway pressure (CPAP) were evaluated for all neonates. The risk ratio (RR) was calculated at 95% of confidence intervals (CI). RESULTS Compared with BLES group, the RR estimate among neonates in beraksurf group was 0.89 (0.66-1.20) for PDA, 0.71 (0.23-2.13) for IVH, 0.44 (0.14-1.36) for sepsis, 0.35 (0.13-0.93) for pneumothorax, 0.33 (0.12-0.86) for pulmonary hemorrhage, and 0.55 (0.28-1.05) for mortality. CONCLUSIONS Despite advances in the use of exogenous surfactants for the treatment of neonatal respiratory distress syndrome; There are still some controversial topics in this field. The results obtained in the present study showed that the two types of surfactant (BERAKSURF and BLES) have similar efficacy for the treatment and short-term outcomes in preterm infants with respiratory distress syndrome. Therefore, due to the cost-effectiveness of BRAKSURF compared to BLES, We recommend choosing BERAKSURF in terms of treatment.
Collapse
Affiliation(s)
- Fatemeh Sabzevari
- Department of Pediatrics, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahdie Eslamian
- Department of Pediatrics, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.
| | - Fatemeh Karami Robati
- Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Bahareh Bahmanbijari
- Department of Pediatrics, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Daei Parizi
- Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Jamali
- Department of Pediatrics, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
4
|
Jang W, Choi YS, Kim JY, Yon DK, Lee YJ, Chung SH, Kim CY, Yeo SG, Lee J. Artificial Intelligence-Driven Respiratory Distress Syndrome Prediction for Very Low Birth Weight Infants: Korean Multicenter Prospective Cohort Study. J Med Internet Res 2023; 25:e47612. [PMID: 37428525 PMCID: PMC10366668 DOI: 10.2196/47612] [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: 03/28/2023] [Revised: 05/04/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Respiratory distress syndrome (RDS) is a disease that commonly affects premature infants whose lungs are not fully developed. RDS results from a lack of surfactant in the lungs. The more premature the infant is, the greater is the likelihood of having RDS. However, even though not all premature infants have RDS, preemptive treatment with artificial pulmonary surfactant is administered in most cases. OBJECTIVE We aimed to develop an artificial intelligence model to predict RDS in premature infants to avoid unnecessary treatment. METHODS In this study, 13,087 very low birth weight infants who were newborns weighing less than 1500 grams were assessed in 76 hospitals of the Korean Neonatal Network. To predict RDS in very low birth weight infants, we used basic infant information, maternity history, pregnancy/birth process, family history, resuscitation procedure, and test results at birth such as blood gas analysis and Apgar score. The prediction performances of 7 different machine learning models were compared, and a 5-layer deep neural network was proposed in order to enhance the prediction performance from the selected features. An ensemble approach combining multiple models from the 5-fold cross-validation was subsequently developed. RESULTS Our proposed ensemble 5-layer deep neural network consisting of the top 20 features provided high sensitivity (83.03%), specificity (87.50%), accuracy (84.07%), balanced accuracy (85.26%), and area under the curve (0.9187). Based on the model that we developed, a public web application that enables easy access for the prediction of RDS in premature infants was deployed. CONCLUSIONS Our artificial intelligence model may be useful for preparations for neonatal resuscitation, particularly in cases involving the delivery of very low birth weight infants, as it can aid in predicting the likelihood of RDS and inform decisions regarding the administration of surfactant.
Collapse
Affiliation(s)
- Woocheol Jang
- Biomedical Engineering, Kyung Hee University, Yongin-si, Republic of Korea
| | - Yong Sung Choi
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Ji Yoo Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Lee
- Department of Obstetrics and Gynecology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Chae Young Kim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jinseok Lee
- Biomedical Engineering, Kyung Hee University, Yongin-si, Republic of Korea
| |
Collapse
|
5
|
Liu J, Zhang X, Wang Y, Li J, Yan W, Qin SJ, Ren XL, Fu W. The Outcome- or Cost-Effectiveness Analysis of LUS-Based Care or CXR-Based Care of Neonatal Lung Diseases: The Clinical Practice Evidence from a Level Ⅲ NICU in China. Diagnostics (Basel) 2022; 12:diagnostics12112790. [PMID: 36428848 PMCID: PMC9689125 DOI: 10.3390/diagnostics12112790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/13/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the effect of managing neonatal lung disease with lung ultrasound (LUS) or chest X-ray (CXR) monitoring on health outcomes and cost-effectiveness. METHODS The data obtained from the NICU of the Beijing Chaoyang District Maternal and Child Healthcare Hospital were used as the study group, as LUS has completely replaced CXR in managing newborn lung disease in the hospital for the past 5 years. The primary outcomes of this study were the misdiagnosis rate of respiratory distress syndrome (RDS), the using status of mechanical ventilation, the incidence rate of bronchopulmonary dysplasia (BPD) and the survival rate in hospitalized infants. The secondary outcomes included the use pulmonary surfactant (PS), and the mortality rate of severe diseases (such as pneumothorax, pulmonary hemorrhage and RDS, etc.). RESULTS Managing neonatal lung disease with LUS monitoring may enable the following effects: The frequency of ventilator use reducing by 40.2%; the duration of mechanical ventilation reducing by 67.5%; and the frequency of ventilator weaning failure being totally avoided. A misdiagnosis rate of 30% for RDS was also avoided. The dosage of PS was significantly reduced by 50% to 75%. No BPD occurred in the LUS-based care group for 5 years. The fatality rates of RDS, pneumothorax and pulmonary hemorrhage decreased by 100%. The poor prognosis rate of VLBW infants decreased by 85%, and the total mortality rate of hospitalized infants decreased by 90%. Therefore, the cost of LUS-based care was inevitably saved. CONCLUSIONS Diagnosing and managing neonatal lung diseases with LUS monitoring have significant benefits, and this technology should be widely promoted and applied around the world.
Collapse
Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
- Correspondence:
| | - Xin Zhang
- Department of Neonatology and NICU, Zhumadian Central Hospital of Henan Province, Zhumadian 463003, China
| | - Yan Wang
- Department of Neonatology and NICU, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
| | - Jie Li
- Department of Neonatology and NICU, Zaozhuang Maternal and Child Healthcare Hospital of Shandong Province, Zaozhuang 277100, China
| | - Wei Yan
- Department of Ultrasound, Zhumadian Central Hospital of Henan Province, Zhumadian 463003, China
| | - Sheng-Juan Qin
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing 100021, China
| | - Xiao-Ling Ren
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing 100021, China
| | - Wei Fu
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing 100021, China
| |
Collapse
|
6
|
Association between bronchopulmonary dysplasia and early respiratory morbidity in children with respiratory distress syndrome: a case-control study using nationwide data. Sci Rep 2022; 12:7578. [PMID: 35534599 PMCID: PMC9085740 DOI: 10.1038/s41598-022-11657-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) can cause respiratory morbidity beyond the neonatal period. We aimed to analyze the association of BPD on childhood lower respiratory illness (LRI) and asthma among patients diagnosed with respiratory distress syndrome (RDS). This case–control study analyzed data between 2002 and 2015 from a nationwide database. We included 55,066 children with RDS. Two-year LRI and asthma at ages 3 and 5 were assessed. Readmission for LRIs within 2 years of birth occurred in 53.9% and 37.9% of the BPD (n = 9470) and non-BPD (n = 45,596) cases, respectively. In the BPD group, the median number of hospitalizations, mechanical ventilation and oxygen use rates were significantly higher, while the hospitalization duration was significantly longer (P < 0.001 for all). The relative risk of BPD was 1.42 (1.39–1.45) on total readmission and 6.53 (5.96–7.15) on intensive care unit readmission. Asthma prevalence was significantly higher in BPD group (57.6% vs. 48.9% at age 3 and 44.3% vs. 38.2% at age 5, P < 0.001). In children with RDS, BPD could affect repetitive and worse LRI as an independent risk factor for respiratory morbidity during the first 2 years of life. BPD may also be a crucial risk factor for asthma in preschoolers.
Collapse
|
7
|
Wu Y, Zhao S, Yang X, Yang C, Shi Z, Liu Q, Wang Y, Qin M, Zhang L. Ultrasound Lung Image under Artificial Intelligence Algorithm in Diagnosis of Neonatal Respiratory Distress Syndrome. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1817341. [PMID: 35387221 PMCID: PMC8977311 DOI: 10.1155/2022/1817341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/13/2022]
Abstract
In order to analyze the application of ultrasonic lung imaging diagnosis model based on artificial intelligence algorithm in neonatal respiratory distress syndrome (NRDS), an ultrasonic lung imaging diagnosis model based on a deep residual network (DRN) was proposed. In this study, 90 premature infants in the hospital were selected as the research object and divided into the experimental group (45 cases) and control group (45 cases) according to whether or not they have NRDS. DRN was compared with the deep residual network (DRWSR) based on wavelet domain, deep residual network detection with normalization framework (Fisher-DRN), and distorted image edge detection preprocessor (DIEDP). Then, it was applied to the diagnosis of NRDS. The clinical data and ultrasound imaging results of infants with NRDS and ordinary premature infants were compared. The results showed that the gestational age, birth weight, and Apgar scores of the NRDS group were remarkably lower than those of ordinary children (P < 0.05). In addition, the segmentation accuracy, image feature extraction accuracy, algorithm convergence, and time loss of the DRN algorithm were better than the other three algorithms, and the differences were considerable (P < 0.05). In children with NRDS, the positive rate of abnormal pleural line, disappearance of A line, appearance of B line, and alveolar interstitial syndrome (AIS) test in the results of lung ultrasound examination in children with NRDS were all 100%. The lung consolidation became 70.8%, and the white lung-like change was 50.1%, both of which were higher than those of ordinary preterm infants, and the differences were considerable (P < 0.05). The diagnostic model of this study predicted that the AUC area of grade 1-2, grade 2-3, and grade 3-4 NRDS were 0.962, 0.881, and 0.902, respectively. To sum up, the ultrasound lung imaging diagnosis model based on the DRN algorithm had good diagnostic performance in children with NRDS and can provide useful information for clinical NRDS diagnosis and treatment.
Collapse
Affiliation(s)
- Yuhan Wu
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China
| | - Sheng Zhao
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China
| | - Xiaohong Yang
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China
| | - Chunxue Yang
- Department of Ultrasound, Caidian District People's Hospital of Wuhan, Hubei Province 430100, China
| | - Zhen Shi
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China
| | - Qin Liu
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China
| | - Yubo Wang
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China
| | - Meilan Qin
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China
| | - Li Zhang
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China
| |
Collapse
|
8
|
Duan X, Li J, Chen L, Shi Y, Chen X, Xue T, Liu C, Wang X, Qiu Q, Yu Z, Qiang B, Wu H, Wu T, Zhang L, Chen Z, Jigme D, Xu A, Mima Z, Da Z, Ren M, Gesang D, Pubu Z, Li C, Lv Y, Zhou H, Zhang X, Dawa Z, Gongjue W, Wang L, Wu L, Li X. Surfactant Therapy for Respiratory Distress Syndrome in High- and Ultra-High-Altitude Settings. Front Pediatr 2022; 10:777360. [PMID: 35311054 PMCID: PMC8930851 DOI: 10.3389/fped.2022.777360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study is to investigate the therapeutic effect of surfactant replacement therapy (SRT) on respiratory distress syndrome (RDS) in premature infants in the Qinghai-Tibet Plateau. MATERIALS AND METHODS This multi-center retrospective cohort study collected and screened reasonable clinical data of 337 premature infants with RDS from 10 hospitals in the Qinghai-Tibet Plateau from 2015 to 2017. We grouped the cases by rationally analyzing their baseline characteristics, using logistic analysis to evaluate each factor's effect on the prognosis of the infants, and comparing the short-term improvement in blood gas and mortality after SRT treatment at different altitudes, in high-altitude (1,500-3,500 m) and ultra-high-altitude (3,500-5,500 m) groups. RESULTS Independent of altitude, the mortality rate of children with RDS in the SRT group was significantly lower than that of children in the non-SRT group (both P < 0.05). The effect of SRT on preterm infants with RDS in the high-altitude group [odds ratio (OR) = 0.44, 95% confidence interval (CI) = 0.22-0.87, P = 0.02] was better than that in the infants in the ultra-high-altitude group (OR = 0.26, 95% CI = 0.13-0.58, P < 0.01), with death rates of 34.34 and 49.71%, respectively. Similarly, after SRT, the improvement of PaO2/FiO2 and pH of children at high altitude was significantly better than those of children at ultra-high altitude (all P < 0.01). CONCLUSIONS SRT plays a prominent role in curing infants with RDS in both high- and ultra-high-altitude regions, although with better effects at high rather than ultra-high altitude. This study provides a basis for further large-scale studies on SRT for RDS treatment at high altitudes.
Collapse
Affiliation(s)
- Xudong Duan
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.,Plateau Medical Research Center of China Medical University, Shenyang, China
| | - Jiujun Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.,Plateau Medical Research Center of China Medical University, Shenyang, China
| | - Long Chen
- Department of Neonatology, Children's Hospital Affiliated Chongqing Medical University, Chongqing, China
| | - Yuan Shi
- Department of Neonatology, Children's Hospital Affiliated Chongqing Medical University, Chongqing, China
| | - Xianyang Chen
- BaoFeng Key Laboratory of Genetics and Metabolism, Beijing, China.,Zhongguancun Biological and Medical Big Data Center, Beijing, China
| | - Teng Xue
- Zhongguancun Biological and Medical Big Data Center, Beijing, China.,Zhongyuanborui (Hengqin, Zhuhai) Key Laboratory of Genetics and Metabolism, Zhuhai, China
| | - Chongde Liu
- Department of Neonatology, Qinghai Women and Children's Hospital, Xining, China
| | - Xiaorong Wang
- Department of Neonatology, Qinghai Women and Children's Hospital, Xining, China
| | - Quanfang Qiu
- Department of Pediatrics, Lhasa People's Hospital, Lhasa, China
| | - Zhen Yu
- Department of Pediatrics, Lhasa People's Hospital, Lhasa, China
| | - Bacuozhen Qiang
- Department of Pediatrics, Lhasa People's Hospital, Lhasa, China
| | - Hong Wu
- Department of Pediatrics, People's Hospital of Tibet, Tibet, China
| | - Tianqi Wu
- Department of Pediatrics, People's Hospital of Tibet, Tibet, China
| | - Lihong Zhang
- Department of Pediatrics, Linzhi People's Hospital, Tibet, China
| | - Zhangsheng Chen
- Center of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Dobje Jigme
- Department of Pediatrics, Naqu People's Hospital, Tibet, China
| | - Aili Xu
- Department of Pediatrics, Shigatse People's Hospital, Tibet, China
| | - Zhuoga Mima
- Department of Pediatrics, Shigatse People's Hospital, Tibet, China
| | - Zhen Da
- Department of Pediatrics, Second People's Hospital of Tibet, Tibet, China
| | - Min Ren
- Department of Pediatrics, Second People's Hospital of Tibet, Tibet, China
| | - Deji Gesang
- Department of Pediatrics, Shannan People's Hospital, Tibet, China
| | - Zhaxi Pubu
- Department of Pediatrics, Shannan People's Hospital, Tibet, China
| | - Chun Li
- Department of Pediatrics, Changdu People's Hospital, Tibet, China
| | - Yanchao Lv
- Department of Pediatrics, Changdu People's Hospital, Tibet, China
| | - Haoquan Zhou
- Department of Pediatrics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.,Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China
| | - Xue Zhang
- Department of Pediatrics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.,Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China
| | - Zhuoma Dawa
- Department of Pediatrics, People's Hospital of Ali District, Tibet, China
| | - Wujin Gongjue
- Department of Pediatrics, People's Hospital of Ali District, Tibet, China
| | - Li Wang
- Department of Pediatrics, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Li Wu
- Department of Pediatrics, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xuelian Li
- Department of Pediatrics, Daping Hospital, Third Military Medical University, Chongqing, China
| |
Collapse
|
9
|
Huang L, Liang H, Liu L, Lin Y, Lin X. Effects of Pulmonary Surfactant Combined with Noninvasive Positive Pressure Ventilation on KRT-14 and ET-1 Levels in Peripheral Blood and Therapeutic Effects in Neonates with Respiratory Distress Syndrome. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4117800. [PMID: 38617025 PMCID: PMC11015946 DOI: 10.1155/2021/4117800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 04/16/2024]
Abstract
This study is aimed at exploring the effect of pulmonary surfactant (PS) combined with noninvasive positive pressure ventilation on the levels of Keratin-14 (KRT-14) and Endothelin-1 (ET-1) in peripheral blood and the therapeutic effect of neonatal respiratory distress syndrome (NRDS). Altogether 137 cases of neonates with respiratory distress syndrome treated in our hospital from April 2016 to July 2018 were collected. Among them, 64 cases treated with noninvasive positive pressure ventilation were considered as the control group, and 73 cases treated with PS combined with noninvasive positive pressure ventilation were considered as the observation group. The expression of KRT-14 and ET-1 in the two groups was compared. The therapeutic effect, death, complications, and blood gas indexes PaO2, PaCO2, and PaO2/FiO2 in the two groups were compared. Receiver operating characteristic curve (ROC) was applied to analyze the diagnostic value of KRT-14 and ET-1 in the therapeutic effect of NRDS. The effective rate of the observation group was higher than that of the control group. After treatment, PaO2 and PaO2/FiO2 in both groups were notably higher than that before treatment, while PaCO2 was notably lower than that before treatment. And after treatment, the levels of PaO2 and PaO2/FiO2 in the observation group were remarkably higher than that in the control group; PaCO2 was notably lower than that in the control group. After treatment, the levels of KRT-14 and ET-1 in the two groups were remarkably lower than those before treatment, and the levels of KRT-14 and ET-1 in the observation group were considerably lower than those in the control group after treatment. ROC curve showed that the area under the curve (AUC) of KRT-14 was 0.791, and the AUC of ET-1 was 0.816. PS combined with noninvasive positive pressure ventilation can notably improve the therapeutic effect of NRDS. KRT-14 and ET-1 levels may be potential therapeutic diagnostic indicators.
Collapse
Affiliation(s)
- Lihan Huang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361003, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003 Fujian Province, China
| | - Hong Liang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361003, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003 Fujian Province, China
| | - Longbin Liu
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361003, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003 Fujian Province, China
| | - Yucong Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361003, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003 Fujian Province, China
| | - Xinzhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361003, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003 Fujian Province, China
| |
Collapse
|
10
|
Wang L, Zhang F, Li J, Liu Z, Kou Y, Song Y, Xu H, Wang H, Wang Y. Using pulmonary artery acceleration time to evaluate pulmonary hemodynamic changes on preterm infants with respiratory distress syndrome. Transl Pediatr 2021; 10:2287-2297. [PMID: 34733669 PMCID: PMC8506067 DOI: 10.21037/tp-21-341] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pulmonary artery acceleration time (PAAT) is a reliable and non-invasive method for assessing pulmonary hemodynamics. To date, few studies have used PAAT to assess preterm infants, especially those with respiratory distress syndrome (RDS). This study aimed to assess changes in PAAT among preterm infants with RDS undergoing pulmonary surfactant (PS) therapy or not, and determine its potential effects on the pulmonary vascular disease (PVD) outcomes of preterm infants with RDS in the late postnatal period. METHODS The risk of RDS was reviewed in 62 preterm infants with a gestational age of 26-31 weeks. The infants receiving PS therapy were allocated to the PS group, and the others were allocated to the control group. PAAT, right ventricular ejection time (RVET), and other ultrasonic parameters at 3 different time points after birth were studied and compared. RESULTS Infants in the PS group had a significantly lower PAAT (52.7±5.9 vs. 59.6±8.7; P=0.001) and PAAT/RVET (0.30±0.03 vs. 0.33±0.03; P=0.001) than those in the control group at 36 weeks postmenstrual age (PMA). No significant increases in PAAT/RVET were detected at 3 different times for the PS group (P=0.117), but both PAAT and PAAT/RVET increased significantly with time after birth in the control group (P<0.001). CONCLUSIONS Preterm infants with RDS might still have PVD in the late postnatal period and thus require long-term follow-up observation. PAAT appears to be a reliable non-invasive screening measure for evaluating pulmonary hemodynamics in preterm infants with RDS and late PVD.
Collapse
Affiliation(s)
- Liling Wang
- Department of Pediatric Cardiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fengjuan Zhang
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jiahui Li
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhijie Liu
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yan Kou
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yanting Song
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Haiyan Xu
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Haiyan Wang
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yulin Wang
- Department of Pediatric Cardiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
11
|
Yang HB, Min JY, Byun J, Ko D, Kim HY, Min KB, Jung SE. Incidence of necrotizing enterocolitis in South Korea from 2007 to 2017. J Perinatol 2021; 41:1092-1099. [PMID: 33864007 DOI: 10.1038/s41372-021-01053-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 11/22/2020] [Accepted: 03/29/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the trends of the incidence of and mortality from necrotizing enterocolitis (NEC) in South Korea. METHODS Claim data were extracted with diagnosis code, including all stage of NEC. Kaplan-Meier curves for cumulative mortality rates are presented by birth weight (Bwt) and gestational age (GA). RESULT The total number of NEC cases was 5840. The ratio of males to females was 1.2:1. There were 11.9 cases per 10,000 births. There were approximately 10 cases per 1000 preterm births and 50 per 1000 very preterm births. The mortality of patients born under 37 weeks decreased from 38.7% in 2007 to 20.9% in 2017. Male sex, lower GA, and lower Bwt were risk factors for mortality. CONCLUSIONS NEC incidence and mortality have been decreasing over time in South Korea. Male sex, lower GA, and Bwt were risk factors for mortality.
Collapse
Affiliation(s)
- Hee-Beom Yang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Young Min
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Jeik Byun
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Dayoung Ko
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, College of Medicine, Seoul National University, Seoul, Korea.
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Korea.
| | - Sung Eun Jung
- Department of Pediatric Surgery, College of Medicine, Seoul National University, Seoul, Korea
| |
Collapse
|
12
|
Shin JE, Yoon SJ, Lim J, Han J, Eun HS, Park MS, Park KI, Lee SM. Pulmonary Surfactant Replacement Therapy for Respiratory Distress Syndrome in Neonates: a Nationwide Epidemiological Study in Korea. J Korean Med Sci 2020; 35:e253. [PMID: 32808509 PMCID: PMC7431283 DOI: 10.3346/jkms.2020.35.e253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/10/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pulmonary surfactant (PS) replacement therapy, as a safe and effective treatment for respiratory distress syndrome (RDS) may have further increased with the extended insurance coverage since 2011 in Korea. Thus, this study aimed to investigate the epidemiologic data of PS replacement therapy for RDS in Korea and to analyze the complications associated with RDS. METHODS We included 19,442 infants who were treated with PS and diagnosed with RDS (International Classification of Diseases-10 codes: P22.0) between 2014 and 2018 from the Health Insurance Review and Assessment database. Birth certificate data from Statistics Korea were used to estimate the incidence of RDS. RESULTS The average incidence of RDS within the study period was 0.99% among live births. Repeated doses of PS were administered to 1,688 infants (8.7%), ranging from 2 doses in 929 infants (4.8%) to 9 doses in 1 infant (0.01%). The incidence of RDS in term infants markedly increased over 5 years from 0.2% to 0.34%. The incidence was similarly increased among the preterm infants. The RDS mortality rate was 6.3% and showed a decreasing trend according to year. The mortality rate was significantly higher in the lower gestational age group. A decreasing trend was observed in the incidence of the complications, such as patent ductus arteriosus, intraventricular hemorrhage, and bronchopulmonary dysplasia, except for pneumothorax in term infants. The complications were also higher in the lower gestational age group and the lower birth weight group. However, pneumothorax was the most frequent complication in the term infant group and in infants with birth weight ≥ 2,500 g. CONCLUSION Advancements in neonatal care and extended insurance coverage have increased the use of PS replacement therapy for RDS. This, in turn, decreased neonatal mortality and the incidence of the associated complications. The appropriate therapeutic strategy for RDS should be decided according to the gestational age and lung pathology.
Collapse
Affiliation(s)
- Jeong Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Joohee Lim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jungho Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Seon Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
13
|
Miao J, Xie H, Zhang Y, Guo X, Cui M. Continuous positive pressure ventilation combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome. Pak J Med Sci 2020; 36:647-651. [PMID: 32494249 PMCID: PMC7260922 DOI: 10.12669/pjms.36.4.1963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To analyze the clinical effect of nasal continuous positive airway pressure (CPAP) combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome (NRDS). METHODS Eighty-two NRDS patients who received treatment from August 2017 to June 2019 in our hospital were selected and divided into a control group and an observation group using random number table, 41 in each group. The control group was treated with CPAP, and the observation group was treated with pulmonary surfactant injection besides CPAP. The therapeutic effect, blood gas index, mechanical ventilation parameters and occurrence of complications were compared between the two groups. RESULTS The total response rate of the observation group was 90.24%, which was significantly higher than 70.73% of the control group, and the difference had statistical significance (P<0.05). After treatment, the improvement of blood gas indexes of the observation group was better than that of the control group. The hospitalization time and duration of oxygen treatment of the observation group were shorter than those of the control group, and the hospitalization cost was higher than the control group (P<0.05). The difference of incidence of complications between the two groups was statistically significant (P<0.05). CONCLUSION Endotracheal injection of pulmonary surfactant combined with CPAP in the treatment of NRDS can enhance the efficacy, promote the recovery of blood gas index, and reduce the parameters of mechanical ventilation and the incidence of complications, which is conducive to improving the respiratory function of the newborn. The therapy is worth application in the treatment of NRDS patients.
Collapse
Affiliation(s)
- Jing Miao
- Jing Miao, Department of Pediatrics, Binzhou People’s Hospital, Shandong, 256610, China
| | - Haitao Xie
- Haitao Xie, Department of Pediatrics, Binzhou People’s Hospital, Shandong, 256610, China
| | - Yanping Zhang
- Yanping Zhang, Department of Pediatrics, Binzhou People’s Hospital, Shandong, 256610, China
| | - Xiaohui Guo
- Xiaohui Guo, Department of Pediatrics, Binzhou People’s Hospital, Shandong, 256610, China
| | - Min Cui
- Min Cui, Department of Pediatrics, Binzhou People’s Hospital, Shandong, 256610, China
| |
Collapse
|