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Query: UMLS:C0476273 (respiratory distress)
 19,632 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We examined 26 preterm infants with respiratory distress syndrome in a randomized controlled prospective study to determine whether early postnatal dexamethasone therapy (< 2 h; 0.5 mg/kg per day) over 5 days in addition to substitution of surfactant (100 mg/kg) facilitates extubation and the course of RDS. Control (n = 12) and treated (n = 14) groups were comparable in birthweight (mean +/- SD: 1219 +/- 292 versus 1446 +/- 442 g), gestational age (29.3 +/- 2.2 versus 30.6 +/- 2.7 weeks), prenatal characteristics and initial respiratory and blood gas parameters. In both groups one infant died. Infants in the dexamethasone group responded better to surfactant (12/14 versus 3/12; p < 0.01), were extubated earlier (6.6 versus 14.2 days; p < 0.02) and required less time on supplemental oxygen (4.2 versus 12.5 days; p < 0.02). Pulmonary complications tended to be lower in the dexamethasone group (1/14 versus 4/12), as was the frequency of retinopathy (2/14 versus 6/12; p < 0.05). We conclude that early postnatal dexamethasone therapy improves response to surfactant therapy resulting in better weaning and earlier extubation in premature infants.
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PMID:Influence of early postnatal dexamethasone therapy on ventilator dependency in surfactant-substituted preterm infants. 881 20

The incidence of neonatal extracorporeal membrane oxygenation (ECMO) is decreasing nationally. This decrease is presumed to be a result of the emergence of alternative technologies such as high-frequency oscillatory ventilation (HFOV), nitric oxide (NO), and surfactant therapy as well as others. The purposes of the present report were to determine just how rapidly the demographics of ECMO are changing and to determine the impact of competing technologies on ECMO use. The authors reviewed their entire ECMO experience of 455 cases (370 neonatal, 38 pediatric, and 47 cardiac). The neonatal cases also were separated into diagnostic groups: MAS (meconium aspiration syndrome), PPHN (persistent pulmonary hypertension of the newborn), RDS (respiratory distress syndrome), and sepsis. To allow statistical comparison, the patients were divided into four chronological groups, of equal 3-year duration, spanning the 12 years that ECMO has been available. The results of the analysis demonstrated four principle findings. (1) The total number of patients receiving ECMO per year was declining (P = .0001). This decline was attributable to a reduction in the total number of neonatal patients, with the exception of cases of congenital diaphragmatic hernia. (2) The complexity of each ECMO run was increasing, as evidenced by substantial increases in mean ECMO duration per patient and an increase in the incidence of patient complications on ECMO (P = .0001). (3) There has been a significant decrease in the overall survival rate for patients treated with ECMO (P = .0001). (4) The ECMO population mix has shifted away from straightforward neonatal cases and toward the more complex pediatric and cardiac cases. This demographic shift has occurred as a result of improvements in pre-ECMO management of neonatal patients, and is primarily responsible for the findings noted above. However, there also has been a worsening of condition severity within each diagnostic group, which also is partly responsible for the changes noted. If these trends continue, pediatric, cardiac, and CDH patients will likely account for the majority of ECMO patients. Consequently, existing ECMO centers must be prepared to adapt to the changing demographics by evolving programs that support pediatric, cardiac, and adult patients, in addition to neonates. Furthermore, the complexity associated with transporting these unstable older patients and the likelihood that the number of active ECMO centers will decline may require remaining ECMO centers to develop long-distance ECMO transport capabilities.
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PMID:ECMO in evolution: the impact of changing patient demographics and alternative therapies on ECMO. 886 46

Although survival data on very low birth weight (VLBW) infants from developing countries indicates that mortality rates are high, there is considerable disagreement on the relative contribution of respiratory distress syndrome to neonatal morbidity and mortality. With improving facilities for newborn care, it is now possible to provide basic respiratory support to some babies with RDS in selected centres. We prospectively evaluated the profile and outcome of newborn infants with respiratory distress admitted to the newborn services at Aga Khan University Hospital in Karachi. The overall mortality for newborns with documented RDS was 81/200 (41 per cent), and was highest (70 per cent) for babies weighing < 1000 g at birth. Univariate and logistic regression analysis of factors significantly associated with high risk of dying despite respiratory support, included low apgar score at one minute (P = 0.003), admission AaDO2 value > 400 (P = 0.001), development of acute renal failure (Relative risk 6.2, 95 per cent confidence interval 1.0-40.0), intraventricular haemorrhage (RR 2.6, 95 per cent CI 1.3-5.2) and pneumothorax (RR 3.7, 95 per cent CI 1.8-7.7). Our data highlight the importance of the immediate postnatal period in infants with RDS and suggest that close attention to early stabilization of VLBW infants with RDS, may further reduce the mortality associated with this disorder.
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PMID:Profile and outcome of the respiratory distress syndrome among newborns in Karachi: risk factors for mortality. 923 33

The addition of replacement surfactant therapy to current neonatal intensive care techniques has brought about a significant reduction in the severity of, and mortality from, moderate-to-severe RDS in premature infants. Although exogenous surfactant is relatively easy to administer, its use should be limited to those skilled in handling critically-ill infants on ventilators. While its introduction has been a major step forward, it is not the whole answer to the vexing problem of respiratory distress syndrome.
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PMID:Replacement surfactant therapy. 934 68

A retrospective study of cesarean hysterectomies at the Department of Obstetrics and Gynecology in Novi Sad was conducted for the period 1968-1993. There were 129,127 deliveries, whereas cesarean section was performed in 10,485 (8.12%) cases. There were 55 cesarean hysterectomies (0.042%), while in 0.52% they were performed during cesarean section. Elective hysterectomy was performed in 7 (12.73%) cases because of neoplastic process and uterine myoma, while in 48 (87.27%) cases it was performed for heavy bleeding. Most often bleeding occurred due to complications of placenta previa, uteroplacental apoplexy, premature placental ablation, uterine rupture and atony. Total hysterectomy was performed in 30 (54.54%) cases and subtotal hysterectomy in 25 (45.45%) cases. Bilateral adnexectomy was performed in 3 (5.45%) cases. Urinary bladder injury occurred in 4 (7.27%) patients, wound infection in 11 (20.00%) patients, urinary infection in 3 (5.45%) and pelvic peritonitis in 1 (1.82%) patient. One maternal death (1.82%) occurred due to DIC (disseminated intravascular coagulation). Out of 57 delivered newborns 20 (35.10%) died in the perinatal period. There were 13 stillbirths (22.80%), whereas 7 newborns (12.30%) died in the early neonatal period due to prematurity and RDS (respiratory distress syndrome).
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PMID:[Cesarean hysterectomy im modern obstetrical practice from 1968 to 1993]. 947 33

We compared the postnatal changes (days 1-28) in red blood cell glutathione and plasma sulfhydryl content in preterm babies developing chronic lung disease (CLD, n = 13) to those in babies with respiratory distress syndrome (RDS, n = 13) and control babies (n = 21). There were no initial differences in these measurements between the three groups. However, on day 28 in CLD and RDS the red blood cell glutathione was decreased compared to the control babies (p < 0.05). In CLD, there was a significant correlation between reduced/oxidized glutathione and (i) maximal FiO2 (r = -0.69, p < 0.05) and (ii) minimal a/A ratio (r = +0.73, p < 0.005). On day 28, although the plasma sulfhydryl level did not differ between the groups, the sulfhydryl/total protein ratio was decreased in CLD (p < 0.05). The late decrease in both glutathione and sulfhydryl/total protein ratio in babies with CLD suggests that oxidative stress is still ongoing at 28 days after birth and that the antioxidant capacity of their blood is still diminished at this time.
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PMID:Red blood cell glutathione and plasma sulfhydryls in chronic lung disease of the newborn. 947 17

This study compared plasma levels of albumin, transferrin, and ceruloplasmin in well preterm babies (n = 21) with those with respiratory distress syndrome (RDS, n = 13) and chronic lung disease (CLD, n = 13) over the first 28 postnatal days. Plasma lipid peroxidation, total radical trapping capacity (TRAP assay), and iron binding antioxidant capacity were also measured. In RDS and CLD albumin levels were decreased on days 1, 4 and 10; on day 10 albumin was lower in CLD compared to RDS (p < .05). After day 10 the levels were similar in all groups. The transferrin levels showed a similar trend. Ceruloplasmin levels did not differ, except for a higher day 28 level in CLD (p < .05). Albumin levels significantly decreased with increasing FiO2 and duration of oxygen therapy (within patient r = -0.30, p < .05 and r = -0.51, p < .005, respectively). On day 10, increasing oxygen therapy increased plasma lipid peroxidation (r = +0.49, p < .01), which was also significantly related to lower plasma protein levels (r = -0.42, p < .01). Lower plasma albumin and transferrin lowered the TRAP and iron binding antioxidant capacity, respectively (r = +0.36, p < .05, and r = +0.41, p < .005). Prediction of CLD using day 10 albumin levels had a specificity of 94%, but a sensitivity of only 50%. The interaction between oxygen toxicity and high ventilation pressures in immature babies appears to lower plasma proteins by increasing pulmonary permeability. The lower plasma albumin level was not useful in predicting the development of CLD; however, the fall in plasma transferrin and albumin will further decrease the preventive and chain-breaking antioxidant capacity of plasma of these ill babies.
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PMID:Plasma proteins in acute and chronic lung disease of the newborn. 968 Jan 78

The Diabetes Mellitus is the pathology that frequently is associated to the pregnancy and it is responsible for perinatal mobility specially by the respiratory distress syndrome since exists delay in the conversion of myoinositol-phosphatidyl inositol-phosphatidyl glycerol. To demonstrate the reliability of the DO tho 650 nm with standard of 20 in the determination of fetal lung maturity of the infant of diabetic mother. There were included 143 patient with pregnancy > or = 37 weeks with amenorrhea reliable and gestational age confirmed by ultrasound, of those 94 corresponded to gestational Diabetes Mellitus, 49 to pregestational (46 non insulin-dependent and 3 insulin-dependent). In all of them amniotic fluid studies was perform at 37 week and the resolution of the pregnancy was when DO to 650 nm showed fetal lung maturity. It was found a correlation among the DO to 650 nm of 20 and absence of RDS in 130 cases (true positive); there were seven cases with immaturity results by DO that they did not express RDS (false negative) and six cases with results that showed immaturity by DO and there were manifestations of RDS (true negative). We did not find results of false positive. The frequency of RDS was of 4.9% with a positive predictive value of the 100% an negative predictive value of 46%, a specificity of 100% and a sensitivity of 94%. An interesting finding was the fact that six cases true negative cases had poor maternal metabolic control of different degrees. For our results can be deduced that DO to 650 nm with standard of .20 it is reliable for the diagnosis of fetal lung maturity in the pregnancies complicated with Diabetes Mellitus, in addition to be an easy elaboration test and low cost.
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PMID:[Reliability of optic density at 650 nm in determining lung maturity in children of diabetic mothers]. 982 5

Indications for administration of surfactant to infants with established respiratory distress syndrome (RDS; rescue therapy) remains an area of continued investigation. Current recommendations vary from use in infants who are intubated and have an aAPO2 <0.22 to use in infants receiving >/=40% oxygen administered in a hood when the PaO2 is <80 TORR (aAPO2 approximately <0.36). This commentary is written in response to the article by Verder et al, in this issue of Pediatrics, who evaluated early versus late treatment of RDS in 60 preterm infants <30 weeks' gestation receiving nasal continuous positive airway pressure (CPAP). Early-treated infants (aAPO2, 0.22 to 0.35; mean, 0.26) had a lower incidence of mechanical ventilation or death (21%) than did late-treated infants (63%), who did not receive surfactant treatment until the aAPO2 was <0.22 (0.15 to 0.21; mean, 0.16). The authors conclude that although approximately half of infants <30 weeks' gestation with RDS can be treated with nasal CPAP alone, early treatment with surfactant when the aAPO2 is 0.22 to 0.36 reduced significantly the need for mechanical ventilation. Limitations of applicability of the study to widespread use include determination of PO2 values from transcutaneous measurements, which may vary from those obtained from arterial samples and affect significantly aAPO2 ratios. Likewise, use of nasal CPAP significantly affects oxygenation, and interpretation of results cannot be extrapolated to intubated infants or those receiving oxygen delivered under a hood. Nonetheless, the use of the aAPO2 ratio and early administration of surfactant are supported by this study.
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PMID:Indications for surfactant therapy--the aAPO2 coming of age. 992 70

Some infants, despite being born at low gestations (< 28 weeks gestational age) do not develop RDS and are not surfactant treated. The changes in lung function during the neonatal period in such infants have not been explored, hence it is unknown whether they are similar to those of surfactant treated infants with RDS of similar gestational age. Such data would facilitate assessment of the impact of surfactant administration on the lung function abnormalities of very immature infants with RDS. We, therefore, compared the results of neonatal lung function measurements from immature infants with RDS who received surfactant to those from infants with non-RDS respiratory distress not so treated and matched to the RDS infants for gestational age and within 10% of birthweight. Compliance and functional residual capacity (FRC) were measured daily for the first five days and then at 1, 2 and 4 weeks in 16 infants, median gestational age 27 weeks (range 25-27 weeks). Although exogenous surfactant administration to the immature infants with RDS was associated with improvements in lung function, the non RDS, non surfactant treated infants had both higher compliance (p < 0.05) and lung volumes (p < 0.01) throughout the perinatal period. These results demonstrate surfactant administration does not fully correct the perinatal lung function abnormalities of very immature infants with RDS.
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PMID:Neonatal lung function in very immature infants with and without RDS. 1064 59


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