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)

We previously reported that a human analogue of pulmonary surfactant protein-C (SP-C), SP-CL16(6-28), with 23 residues was the most active analogue in a reconstituted lipid mixture and had the shortest chain among the poly-leucine-analogues examined. There has been little research on the chemical components of synthetic lung surfactants (SLSs). In the present study, we attempted to compare SLS with various phospholipids in surface activity. That is, SP-CL16(6-28) plus various phosphatidylglycerols (PG) were tested for surface activity in a Langmuir-Wilhelmy surface balance (WSB) apparatus and pulsating bubble surfactmeter (PBS). Further, SLSs were examined for biological properties using an animal model of surfactant deficiency, infant respiratory distress syndrome (IRDS), in vivo. Palmitoyl-oleoyl-phosphatidylglycerol (POPG)-SLS exhibited minimum and maximum surface tensions of 1.7 mN/m and 28.6 mN/m in WSB and 8.5 mN/m and 36.2 mN/m in PBS, respectively. Moreover, in the IRDS model, POPG-SLS remarkably improved the lung volume (LV) of a premature lagomorph fetus at LV30 cmH2O and LV5 cmH2O. That is, a significant improvement equal to the LV of a full-term fetus was observed. The level of LV exhibited respiratory improvement equivalent to surfactant-TA. SLS seemed comparable in surface activity with Surfacten (Surfactant-TA), a modified surfactant preparation which has been used for the treatment of RDS.
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PMID:Effects of the human pulmonary surfactant protein-C (SP-C), SP-CL16(6-28) on surface activities of surfactants with various phospholipids. 1239 83

Fifteen randomized studies in Crowley's analysis compared a group of patients receiving, a single course of steroids versus placebo between 24 and 34 weeks of gestation. It clearly demonstrated the benefit of a single course of steroids in the prevention of the prematurity-related complications with a decrease in neonatal mortality, a decrease in the incidence of respiratory distress syndrome, a reduction in the incidence of intraventricular haemorrhage and a reduction in necrotizing enterocolitis (NP 1). Because only bethamethasone has proved its efficiency in the reduction of neonatal mortality (NP 2) and antenatal exposition to betamethasone is associated with a decrease in the risk of periventricular leukomalacia in children born prematurely (NP 3) it seems preferable to use betamethasone rather than dexamethasone. Antenatal administration of repeated courses compared with single course of steroids improves fetal lung function with a decrease of RDS notably if the children is born before 28 weeks of gestation (NP 2) but numerous animal studies reported adverse effects of repeated courses. Several studies in women having received of repeated courses steroids report a decrease in birth weight and head circumference at birth but with a 3 years follow up similar to that of children exposed to a single course (NP 3). In conclusion the benefit of a single course of steroids is indisputable for the prevention of the prematurity-related complications but there is today a strong concern about the benefit/risk ratio in relation to the prescription of repeated courses of steroids.
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PMID:[Corticosteroid for fetal lung maturation: indication and treatment protocols]. 1245 32

The purpose of this retrospective study was to evaluate the mode of delivery on neonatal outcome of twins weighing <1500 grams. We reviewed the effect of birth order, presentation, and method of delivery on neonatal outcome in twin gestation under 1500 grams at Princess Badeea' Teaching Hospital in North Jordan over the 6 years from 1994 to 1999. During the study period, there were 51 475 deliveries of which 695 were twin. One hundred and eight (108) sets of twins weighing <1500 grams were included in the study (15.5%), of which 41 were in vertex-vertex presentation, 40 in vertex-nonvertex, and 27 with first twin in nonvertex presentation. The second twin was characterised by a higher incidence of respiratory distress syndrome (82% vs. 70%; P = 0.02), more neonatal mortality (23% vs. 17.6%), and lower Apgar scores at 1 and 5 minutes. Cesarean delivery for vertex-vertex presentation did not improve the neonatal outcome. Rather, the incidence of RDS was significantly greater in this group delivered by caesarean section (65.6% vs. 42%; P = 0.012). For nonvertex presentation, those delivered by caesarean section had a lower incidence of neonatal mortality. We conclude that there was no advantage in caesarean delivery after multivariate analysis to correct for differences in birthweight between the groups. The differences in the neonatal outcome of nonvertex twin presentation was accounted for by the differences in birthweight, rather than in mode of delivery.
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PMID:The effect of mode of delivery on neonatal outcome of twins with birthweight under 1500 grams. 1551 93

Variation in energy expended by preterm infants may be due to infant maturity and history of resolved acute lung disease (respiratory distress syndrome [RDS]) as well as growth, caloric intake, and activity. Indirect calorimetry was used in this exploratory, short-term longitudinal study to estimate energy expenditure (EE) from measures of inspired and expired O2 and CO2. The sample included 35 assessments for 10 preterm infants (5 with and 5 without RDS history). Lung disease history (resolved RDS, no RDS diagnosis), weight gain (g/d) from the day on which birth weight had been regained to the study day, mean activity level, the number of the assessment (1-6), and the interaction of lung disease history and time were included in a linear mixed model for repeated measures. Time was an index of postconceptional and postnatal age; all 3 were highly correlated. Because of high correlation with weight gain, caloric intake was not included in the analytic model. Lung disease history, mean activity level, and time were significant contributors to EE. A more precise measure of medical status than absence or presence of lung disease history, evenly spaced repetitions of EE assessment, and exploration of contexts in which the infants exhibit a higher activity level are needed in a replication study with a larger sample.
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PMID:Exploration of the contribution of biobehavioral variables to the energy expenditure of preterm infants. 1558 62

Advances in prenatal and perinatal treatment of preterm and VLBW infants have dramatically increased the survival rate of these infants. Some interventions decrease long term sequelae associated with preterm birth, making them more cost-effective than other treatments. This paper reviews the cost-effectiveness of therapies targeted to protect the preterm brain. Birth in a center with a NICU improves survival and decreases the rate of severe neurologic disability. Administration of antenatal steroids increases survival and decreases rates of periventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, respiratory distress syndrome, and severe disability. Administration of antenatal steroids decreases costs per additional survivor. Addition of surfactant to the treatment of PT infants has also decreased treatment costs. Administration of surfactant is beneficial for symptomatic RDS but recognizes a greater benefit when given to infants younger than 30 weeks gestation prophylactically. Treatment with prophylactic indomethacin decreases the rate of intraventricular hemorrhage and results in cost savings in survivors. Postnatal administration of dexamethasone can lead to severe disability when administered before 7 to 10 days of life. Postnatal dexamethasone does not increase survival or decrease rates of chronic lung disease.
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PMID:Preterm birth: a cost benefit analysis. 1569 1

The treatment of severe respiratory distress in infants (e.g. respiratory distress syndrome--RDS, meconium aspiration syndrome--MAS and pulmonary haemorrage) with HFOV can cause sometimes a volume delivery (VTHF) exceeding the anatomical dead space, with the possibility of an increased risk of volutrauma, implicated in the pathogenesis of chronic lung disease (CLD). The authors examined the possible correlations between VTHF and the severity of respiratory distress in order to limit the risk of ventilator-induced lung injury (VILI). Thirty-five infants in HFOV because of respiratory distress were studied. The median VTHF registered was 2.25 ml/Kg (range: 1.3-3.4) with a significant correlation to some parameters espression of severity of the respiratory distress: arterial/Alveolar ratio (a/AO2) (r = 0.519), oxygen index (OI) (r = 0.512) and mean airway pressure (MAP) (r = 0.543).
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PMID:Correlations between volume delivery (VTHF) in course of high frequency oscillatory ventilation (HFOV) and severity of respiratory distress. 1570 Jul 36

This prospective study was designed to perform lamellar body count of amniotic fluid to evaluate fetal lung maturity. Lamellar body counts of 80 amniotic fluid samples from 80 pregnant women (28-40 weeks of gestation) were evaluated. After delivery, each infant was evaluated for any evidence of respiratory distress syndrome. Standard clinical and radiographic criteria were used to diagnose respiratory distress syndrome, and the diagnosis was confirmed by reviewing newborn records. Twenty (25%) infants delivered within 24 hours of sample collection developed RDS. Lamellar body count more than 50,000/microl predicted pulmonary maturity. Seventeen out of 20 respiratory distress syndrome cases had been predicted correctly. The negative predictive value of lamellar body count>50,000/microl was 93% and positive predictive value was 48% and the sensitivity for prediction of RDS was 85% and specificity was 70%. Lamellar body count can be used as a favourable predictor of fetal lung maturity because it is quick, simple and universally available. Also it can be used as an extremely inexpensive, reliable screening test for evaluating fetal lung maturity.
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PMID:Amniotic fluid lamellar body count and its sensitivity and specificity in evaluating of fetal lung maturity. 1614 29

We aimed to study, retrospectively, the neonatal outcome of 45 preterm neonates with intraventricular hemorrhage (IVH) who were delivered vaginally with intravenous meperidine (n = 23) or epidural analgesia (n = 22). Neonates in the epidural group had a better outcome in terms of a first-minute Apgar score of 7 or less, in 31% vs 69% (P = 0.001); 5-min Apgar score of 7 or less, in 18% vs 82% (P = 0.003); a lower incidence of respiratory distress syndrome (RDS; 23% vs 30%; P = 0.03); a lower dopamine requirement during the first neonatal week (13% vs 72%; P = 0.01); and a higher survival rate (91% vs 58%, respectively; P = 0.008). It is concluded that preterm neonates with IVH had a better outcome when delivered to mothers receiving epidural analgesia as compared to those receiving intravenous meperidine.
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PMID:The outcome of preterm neonates with intraventricular hemorrhage delivered with intravenous meperidine or epidural analgesia. 1728 24

In this review, the authors assess major outcomes resulting from head-to-head comparison trials of animal-derived surfactants with previous and newer synthetic surfactants and among them. They also pay special attention to issues of study design and quality of the trials reviewed. Animal-derived surfactants that contain surfactant proteins (Survanta, Infasurf, and Curosurf) perform clinically better than Exosurf, a synthetic surfactant containing only phospholipids, primarily in outcomes related to acute management of respiratory distress syndrome (RDS; faster weaning and pneumothorax) but not in overall mortality or incidence of bronchopulmonary dysplasia (BPD). Trials comparing various animal-derived surfactants that provide different amounts of surface protein B (SP-B) or phospholipids have shown minor differences in outcomes related to the management of RDS or none at all. The exception is the suggestion of better survival using a high initial dose of Curosurf when compared with Survanta. This observation is based on analysis of trials of relatively lesser quality that have included a smaller number of infants than other surfactant comparisons, however. Data from recent trials comparing a new-generation synthetic surfactant that contains a peptide mimicking the action of SP-B, Surfaxin, have shown that it performs better than Exosurf (faster weaning and less BPD) and at least as well as the animal-derived surfactants Survanta and Curosurf. The ideal surfactant comparison trial to demonstrate which surfactant is better has yet to be conducted. Future surfactant comparison trials should pay particular attention to study design, be appropriately sized, and include long-term follow-up.
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PMID:Animal-derived surfactants versus past and current synthetic surfactants: current status. 1739 36

In 1929 Kurt von Neergaard performed experiments suggesting the presence of pulmonary surfactant and its relevance to the newborn's first breath. Almost 25 years later, Richard Pattle, John Clements and Chris Macklin, each working on the effects of nerve gases on the lungs, contributed to the understanding of the physiology of pulmonary surfactant. About 5 years later Mary Ellen Avery and Jere Mead published convincing evidence that preterm neonates dying of hyaline membrane disease (respiratory distress syndrome, RDS) had a deficiency of pulmonary surfactant. The first trials of nebulized synthetic (protein-free) surfactant to prevent RDS were published soon after Patrick Bouvier Kennedy (son of President John F Kennedy) died of this disorder after treatment in Boston. These trials were unsuccessful; however, Goran Enhorning and Bengt Robertson in the early 1970s demonstrated that natural surfactants (containing proteins) were effective in an immature rabbit model of RDS. Soon after this Forrest Adams showed that a natural surfactant was also effective in an immature lamb model. Working with him was Tetsuro Fujiwara who 2 years later, after returning to Japan, published the seminal article reporting the responses of 10 preterm infants with RDS to a bolus of modified bovine surfactant. During the 1980s there were numerous randomized controlled trials of many different natural and synthetic surfactants, demonstrating reductions in pulmonary air leaks and neonatal mortality. Subsequently natural surfactants were shown to be superior to the protein-free synthetic products. Recently there have been a number of randomized trials comparing different natural surfactant preparations. Commercially available bovine surfactants may have similar efficacy but there is some evidence that a porcine surfactant used to treat RDS with an initial dose of 200 mg per kg is more effective than a bovine surfactant used in an initial dose of 100 mg per kg. Bovine and porcine surfactants have not been compared in trials of prophylaxis. Very recently a new synthetic surfactant with a surfactant protein mimic has been compared with other commercially available natural and synthetic surfactants in two trials. The new surfactant may be superior to one of the older protein-free synthetic surfactants but there is no evidence of its superiority over established natural products and it is currently not approved for clinical use. A number of other new synthetic surfactants have been tested in animal models or in treatment of adults with ARDS, but so far there have been no reports of treatment of neonatal RDS. Natural surfactants work best if given by a rapid bolus into the lungs but less invasive methods such as a laryngeal mask, pharyngeal deposition or rapid extubation to CPAP have showed promise. Unfortunately, delivery of surfactant by nebulization has so far been ineffective. Surfactant treatment has been tried in a number of other neonatal respiratory disorders but only infants with meconium aspiration seem to benefit although larger and more frequent doses are probably needed to demonstrate improved lung function. A surfactant protocol based upon early treatment and CPAP is suggested for very preterm infants. Earlier treatment may improve survival rates for these infants; however, there is a risk of increasing the prevalence of milder forms of chronic lung disease. Nevertheless, surfactant therapy has been a major contribution to care of the preterm newborn during the past 25 years.
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PMID:Surfactants: past, present and future. 1924 Jul 33


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