Lung UltrasouNd Guided surfactant therapy in preterm infants: an international multicenter randomized control trial (LUNG study)

BACKGROUND

The management of respiratory distress syndrome (RDS) in premature newborns is based on different types of non-invasive respiratory support and on surfactant replacement therapy (SRT) to avoid mechanical ventilation as it may eventually result in lung damage. European guidelines currently recommend SRT only when the fraction of inspired oxygen (FiO2) exceeds 0.30. The literature describes that early SRT decreases the risk of bronchopulmonary dysplasia (BPD) and mortality. Lung ultrasound score (LUS) in preterm infants affected by RDS has proven to be able to predict the need for SRT and different single-center studies have shown that LUS may increase the proportion of infants that received early SRT. Therefore, the aim of this study is to determine if the use of LUS as a decision tool for SRT in preterm infants affected by RDS allows for the reduction of the incidence of BPD or death in the study group.

METHODS/DESIGN

In this study, 668 spontaneously-breathing preterm infants, born at 25+0 to 29+6 weeks' gestation, in nasal continuous positive airway pressure (nCPAP) will be randomized to receive SRT only when the FiO2 cut-off exceeds 0.3 (control group) or if the LUS score is higher than 8 or the FiO2 requirements exceed 0.3 (study group) (334 infants per arm). The primary outcome will be the difference in proportion of infants with BPD or death in the study group managed compared to the control group.

DISCUSSION

Based on previous published studies, it seems that LUS may decrease the time to administer surfactant therapy. It is known that early surfactant administration decreases BPD and mortality. Therefore, there is rationale for hypothesizing a reduction in BPD or death in the group of patients in which the decision to administer exogenous surfactant is based on lung ultrasound scores.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT05198375 . Registered on 20 January 2022.

[Prenatal treatment with magnesium sulphate: Initial clinical outcomes in pre-term infants less than 29 weeks and correlation with neonatal magnesium levels]

INTRODUCTION

Antenatal magnesium sulphate (MgSO4) administration has shown to be effective in minimising cerebral palsy and severe motor dysfunction at the age of 2 years. The aim of this study is to analyse the initial clinical outcome of preterm neonates less than 29 weeks who have received prenatal MgSO₄, as well as to determine the relationship between the magnesium dose delivered to the mother and the magnesium concentration in the neonates.

MATERIAL AND METHODS

A prospective cohort study was conducted on neonates of less than 29 weeks gestation admitted to the Neonatal Intensive Care Unit (NICU) of Hospital Universitario de Vigo from December 2012 to July 2015. Comparative analysis was performed on the perinatal outcomes, neonatal morbidity, mortality, and magnesium levels between the groups of neonates exposed to magnesium sulphate and the control group.

RESULTS

A total of 42 neonates were included in the study. The mothers of 28 of them had received MgSO4 as a neuroprotective agent. Statistical significance was obtained in the mortality variable. There were no significant differences in the rest of studied variables. There was a significant correlation between the full dose of MgSO4 received by the mother and the levels of magnesium in the neonate in the first 24hours of life (r² 0.436; P<.001).

CONCLUSIONS

A lower mortality was observed in the group that had been exposed to MgS04. No significant side effects were found as a result of administering of MgS04. The MgS04 dose received by mother has a linear relationship with the magnesium levels obtained in neonates.

[Repair of congenital heart disease in an adult with septal defects and pulmonary stenosis: anesthetic management]

A 66-year-old man with complex congenital heart defects (atrial septal defects, with incomplete cor triatriatum, an aneurysmal sac in the membranous septum, ventricular communication and pulmonary valve stenosis) was scheduled for surgery for progressive dyspnea even at rest. During anesthetic induction, effort was made to avoid increased shunting. Surgery consisted of resection of the cor triatriatum membrane, closure of communications with pericardial patches, pulmonary valve replacement, replacement of the root with a porcine root, and pulmonary artery aneurysmorrhaphy. Severely decreased contractility developed while the patient was still in the operating room; inotropic support with adrenaline and dobutamine was required. Extubation was completed in the postoperative recovery unit with no further complications. Echocardiography showed a left-ventricular ejection fraction of 45%. We found few published reports of cases of complex congenital heart disease treated surgically in adulthood. In such cases, cardiac pathophysiology must be carefully considered, and maneuvers that increase systemic resistance or right-ventricular ejection fraction should be avoided. Postoperative pulmonary vascular resistance should be kept as low as possible.

Congenital defect of the atlas and axis. A cause of misdiagnose when evaluating an acute neck trauma

Congenital absence of the posterior arch of the atlas (C1) is rare and even more presenting with a double spinous apophysis of the axis (C2). It is important to keep in mind these cervical congenital abnormalities when evaluating an acute neck trauma because of the possibility of making an erroneous diagnosis of a fracture. This case report is about a 13-year-old boy in the context of a traffic accident who presented both abnormalities, a combination that to our knowledge has not been reported previously in the literature.