Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0476273 (respiratory distress)
 19,632 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study was undertaken to determine retrospectively, in women with the HELLP syndrome, the perinatal effects of corticosteroid administration for promotion of fetal lung maturity. Twenty-seven of 427 women with the HELLP syndrome treated between 1980 and 1991 received a full course of steroids prior to preterm delivery. They were compared to 27 control patients with the HELLP syndrome matched for maternal age, severity of disease, gestational age, race, and sex of the fetus. Respiratory distress requiring mechanical ventilation occurred in 13 of 27 neonates who received steroid administration and in 23 of 27 who did not receive steroids (p < 0.001). The average stay in the neonatal intensive care unit was 29.8 +/- 50.6 days for the steroid-treated group and 45.2 +/- 35.3 days for the group without steroid use (p = NS). The incidence of neonatal deaths, intraventricular haemorrhage type III and IV, necrotizing enterocolitis, and retrolental fibroplasia was greater in the control group but the difference was not statistically significant.
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PMID:Corticosteroids for enhanced fetal lung maturation in patients with HELLP syndrome: impact on neonates. 821 8

The authors present a retrospective epidemiological study on retinopathy of prematurity (ROP), performed on 738 newborns with a gestational age of 34 +/- 2.41 weeks and birth weight of 1971 +/- 351 g. They excluded all cases with severe respiratory distress and other pathological conditions. First stage of ROP shows no correlation with gestational age and birth weight, whereas second and third stages of ROP show an inverse correlation with the above mentioned factors, particularly birth weight. Among neonates with the same gestational age, the incidence of ROP is higher in those "small for date". Regarding the pathogenesis of ROP, the authors outline the importance of perinatal hypoxia.
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PMID:[Epidemiological,and physiopathological findings in retinopathy of prematurity: the authors' personal cases]. 826 57

The results of treatment of severe respiratory distress syndrome in premature infants with gestational age < or = 32 weeks are reported. During the two-year period 1991-92, the department participated in both the Osiris study (Exosurf) and the Curosurf 4 study (Curosurf). Five of the 23 infants treated with Exosurf died and 16 survived without major sequelae. 14 of the 25 infants treated with Curosurf died and six survived without major sequelae. Four of the infants treated with Curosurf developed severe retinopathy of prematurity. During the study period this complication occurred in one additional patient who was not eligible for inclusion in the study. The results show the need to study differences in the physiological effects of surfactants more closely, in order both to improve the basis for selection of surfactant for individual patients, and to define the indications for treatment. The results raise the question of whether such studies should continue to include control patients.
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PMID:[Natural and synthetic surfactant in the treatment of neonatal respiratory distress syndrome]. 820 45

Surfactant administration for respiratory distress syndrome continues to make an impact on neonatal care as large controlled trials are published. Although considered safe, synthetic surfactant administration has been associated with a rare complication in the form of pulmonary hemorrhage. Despite this, significant benefits have been shown. With the approval by the FDA of two surfactant preparations, this treatment is now in widespread use. Although the mortality rate from respiratory distress syndrome and the number of ventilator days are generally decreased, surfactant effect on the incidence of bronchopulmonary dysplasia has been disappointing. Studies of steroid administration for bronchopulmonary dysplasia and steroid side effects have been published in the past year. Steroid use has become widespread for this condition, although many details of its administration and side effects have yet to be worked out. A new area of promise is the use of erythropoietin for anemia of prematurity. Natural historic data on the retinopathy of prematurity have added to our understanding of this condition and have raised new questions on its pathogenesis. Review articles and studies in the area of neonatal encephalopathy stress the need for a more accurate definition of asphyxia and discuss possible prenatal causes of this condition. An extensive review of neonatal jaundice and new recommendations for its treatment in healthy term newborns has been published but remains controversial.
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PMID:Care of the neonate. 842 28

Surfactant administration in premature infants is supposed to induce rapid changes in tissue oxygenation. It might therefore modify the risk of developing retinopathy of prematurity (ROP). We have been using the so-called safety index [equation see text] to calculate the number of infants at low risk to develop ROP stage 3 or higher (SI > or = 1) after administration of two preparations of a surfactant. The study population consisted of 255 prematures of < or = 2000 g birth weight treated with surfactant for respiratory distress syndrome in Switzerland between 1991 and 1993. Of these infants, 29 received a natural surfactant (Curosurf), and 226 infants were treated with the synthetic surfactant Exosurf. Reduction of fraction inspired oxygen (FiO2) was significant within 3 and 6 h and was more pronounced in infants having received natural surfactant. An SI > or = 1 was calculated in 106 of the 226 infants (47%) treated with Exosurf. Only one of these infants developed ROP stage 3 in one eye (no ROP in the fellow eye) whereas 12 infants with ROP stages 3 or 4 had an SI < 1. Seven of the 29 infants treated with natural surfactant had an SI > or = 1; none of these infants developed ROP > stage 2. According to this survey, the risk of developing severe stages of ROP does not increase in low birth weight infants who have been treated with surfactant. Irrespective of a surfactant therapy, the calculation of the SI is useful for substantially reducing the number of prematures who need intensive ophthalmological follow up.
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PMID:Screening for retinopathy of prematurity after surfactant treatment. 852 21

Beclomethasone dipropionate administered by metered-dose inhaler to ventilated infants with early chronic lung disease was evaluated in a double-blind, placebo-controlled study to determine the feasibility and safety of administration. Patients selected for study were less than 1500 g birthweight, had previous radiographic evidence of respiratory distress syndrome with early changes of bronchopulmonary dysplasia (BPD), were greater than 2 weeks of age, and had failed attempts at extubation. The metered-dose inhaler was connected to the respirator circuit by an in-line spacer device and either saline placebo or beclomethasone was delivered for 7 days or until extubated. Beclomethasone was delivered in a dose calculated to be approximately 1 mg/kg/day in three divided doses. Nineteen infants were enrolled. Nine received placebo and 10 received beclomethasone. No adverse effects on blood pressure, heart rate, respiratory rate, ventilator settings, concentration or duration of oxygen therapy, incidence of retinopathy of prematurity (ROP) or infections, blood glucose, daily weight, or serum cortisol levels before and after adrenal stimulation tests were observed in the beclomethasone group compared with the placebo group. One infant in the placebo and six infants in the steroid group were extubated during the study period (p = 0.03). These data indicate that beclomethasone dipropionate may be administered safely to intubated neonates without adverse effects of hypertension, hyperglycemia, diminished weight gain, or adrenal suppression frequently seen with systemic steroid administration. Beclomethasone may enhance extubation in infants with early BPD, however, further data are required to substantiate this preliminary observation.
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PMID:Trial of beclomethasone dipropionate by metered-dose inhaler in ventilator-dependent neonates less than 1500 grams. 864 87

Eighteen preterm infants severely ill with respiratory distress syndrome who required assisted ventilaton were given modified natural surfactant (Survanta) endotracheally. They had a mean +/- SEM gestational age of 31.2 +/- 0.4 weeks (range 28-34) and a mean +/- SEM birthweight of 1562 +/- 71 g (range 1160-2010). Average time of initial surfactant administration was 15 +/- 1.7 hour (range 5-24). No significant side effects were found during surfactant instillation. Post surfactant, the air entry was improved, oxygenation and arterial/alveolar gradients increased, and the levels of inspired oxygen could be reduced. Some of the radiological abnormalities were resolved. In 13 infants, patent ductus arteriosus became clinically evident, seven of whom received Indomethacin. There were 4 cases of pulmonary air leak, 5 cases of pulmonary hemorrhage and 8 cases of bronchopulmonary dysplasia. Four infants expired, two were due to severe asphyxia/shock and two died of unrelated causes. Among the 14 survivors who came for follow-up, two cases of retinopathy of prematurity had gradually regressed, one had cerebral palsy and delayed development. Surfactant rescue therapy is a supplemental beneficial treatment for severe respiratory distress syndrome while newborn intensive care concept is necessary for efficient diagnosis and treatment of RDS.
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PMID:Surfactant treatment in the neonate with severe respiratory distress syndrome. 870 7

This review examines the 11 randomised clinical trials that have compared different surfactant preparations. Seven trials, enrolling 2488 infants with respiratory distress syndrome (RDS), compared the natural surfactant beractant (Survanta) with the synthetic surfactant colfosceril palmitate (Exosurf Neonatal). Infants treated with beractant had lower oxygen requirements for at least 3 days than those treated with colfosceril palmitate. The infants treated with beractant also had lower risks of neonatal mortality [odds ratio (OR) 0.81; 95% confidence interval (CI) 0.65 to 1.01], retinopathy of prematurity (OR 0.81; 95% CI 0.66 to 0.99), and the combined endpoint of death or bronchopulmonary dysplasia (OR 0.86; 95% CI 0.75 to 0.99), compared with those treated with colfosceril palmitate. Calf lung surfactant extract (CLSE; Infasurf), another natural surfactant, has been compared with colfosceril palmitate in 2 studies: in one as prophylaxis and in the other as rescue therapy. Similar, although nonsignificant, advantages were found for the natural surfactant compared with the synthetic surfactant. In 6 of these 9 trials there was a significant reduction in the odds of pulmonary air leaks (OR 0.53; 95% CI 0.41 to 0.64) for infants treated with natural compared with synthetic surfactants. In 7 trials (3554 infants) comparing natural and synthetic surfactants to treat RDS (6 comparing beractant and colfosceril palmitate, and one CLSE and colfosceril palmitate), there was a significantly reduced risk of neonatal mortality (OR 0.80; 95% CI 0.66 to 0.97) with natural compared with synthetic surfactant treatment. In 2 further trials, different natural surfactant preparations have been compared. Reduced oxygen needs for 24 hours after treatment were found for CLSE and Curosurf (porcine-derived lung surfactant, PLS) when each was compared with beractant. Apparent longer term benefits from these surfactants were not statistically proven. Further trials are needed to be certain of the differences between the various surfactant preparations.
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PMID:Natural vs synthetic surfactants in neonatal respiratory distress syndrome. 880 65

This hypothesis states that magnesium and copper (Cu) deficiency as well as high arterial oxygen pressure may contribute to the pathogenesis of retinopathy of prematurity (ROP), a major cause of blindness in very low birthweight preterm infants. Infants at highest risk have severe respiratory distress with hypoxia and require prolonged oxygen supplements. The retina is a multilayer sheet of neural tissue very rich in polyunsaturated fatty acids (PUFAs), oxygen, and mitochondria, with the highest oxygen consumption of all body tissues. Oxygen free radicals which are generated during metabolism cause lipid peroxidation of the PUFA-rich membranes, impairing retinal function. Magnesium and copper deficiencies provide less protection from oxidative injury which damages neurosensory tissue critical for photodetection. Protective antioxidant enzyme activity is reduced in magnesium and copper deficiency. There is some evidence for a raised level of vasoconstrictor thromboxane A2 (TXA2) in respect to vasodilator prostacyclin (PGI2), which would promote vasoconstriction. Deficiency of magnesium and of copper increase synthesis of TXA2 and decreases synthesis of PGI2. Sustained vasoconstriction leads to vascular occlusion, retinal ischaemia, reactive proliferation of retinal vasculature, and the final stages of ROP. Abundant magnesium and copper may protect the retina from developing ROP.
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PMID:Hypothesis: the possible role of magnesium and copper deficiency in retinopathy of prematurity. 884 91

Neonates of 34 triplet pregnancies were admitted to our neonatal unit over a twelve-year period (1983 to 1995), with an incidence of 1 out of 812 deliveries. Thirty (88%) of the pregnancies were the result of ovulation induction and artificial fertilization: artificial insemination from husband (n = 3), in vitro fertilization (n = 9), and gamete intra-fallopian transfer (n = 6). All except one had antenatal sonographic diagnosis, 79% in the first trimester. The most common pregnancy-related complication was preterm labor (56%). Twenty-seven (79%) were delivered by cesarean section. There were 101 live births (one stillborn). Mean gestation age was 33.6 +/- 2.94 weeks, mean birthweight 1809 +/- 485 g, with 7 extremely low birthweight (< 1000 g [6.8%]). Neonatal complications included respiratory distress syndrome (12%), intraventricular hemorrhage (8.8%), retinopathy of prematurity (8%), sepsis (3%), severe asphyxia (3%), and omphalopagus conjoined twins (1%). The perinatal and neonatal mortality was 49 per 1000 and 59 per 1000, respectively. The introduction of advanced artificial fertilization techniques and ovulation induction agents resulted in a major increase in multifetal gestations. Early prenatal diagnosis, judicious prolongation of gestation, and planned delivery by cesarean section combined with major improvement in neonatal care by experienced neonatologists has improved survival of triplet neonates.
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PMID:Changing epidemiology of triplet pregnancy: etiology and outcome over twelve years. 886 45


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