高频振荡通气治疗重度新生儿呼吸窘迫综合征13例疗效观察

目的观察应用高频振荡通气(HFOV)治疗重度新生儿呼吸窘迫综合征(NRDS)的疗效。方法对13例重度新生儿呼吸窘迫综合征患儿采取HFOV治疗并予以严密疗效观察。结果 13例患儿使用高频呼吸机治疗后疾病好转9例,4例家长放弃治疗后死亡。结论选择HFOV通气模式及设置合理的参数是重度新生儿呼吸窘迫综合征患儿抢救成功的关键。     

肺表面活性物质替代治疗对支气管肺发育不良发病的影响

目的　探讨肺表面活性物质 (PS)替代治疗对支气管肺发育不良 (BPD)发生率的影响。　方法　采用单剂 Exosurf气管内治疗 2 5例新生儿呼吸窘迫综合症 (NRDS)患儿 ,并与同期未用 PS治疗的 2 5例 NRDS患儿进行前瞻性非随机对照研究 ,统计 BPD的发生情况。　结果　 PS运用组机械通气及氧疗时间较未用 PS组明显缩短 ,机械通气的天数由 (13± 9) d下降为 (6± 4) d,氧疗天数由(2 1± 9) d下降为 (9± 6 ) d,差异有显著性意义。BPD的发生率由 40 %下降至 2 0 % ,差异无显著性意义。　结论　 PS治疗 NRDS患儿能缩短机械通气的时间及氧疗天数 ,但是否减少 BPD的发生率 ,尚需进一步操讨     

Insure技术治疗新生儿呼吸窘迫综合征的临床疗效

目的观察Insure技术治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法 2010年1月至2011年12月深圳市宝安区福永人民医院新生儿科收治NRDS患儿36例为对照组,2012年1月至2013年12月收治NRDS患儿42例为观察组。观察组采用Insure技术进行抢救治疗;对照组采用给予肺泡表面活性物质(PS)后持续有创正压通气治疗。观察两组治疗前后动脉血气变化情况、相关并发症的发生率、呼吸机使用时间及胸部X线改善情况。结果两组治疗后5、10hPaO2较治疗前显著升高,PaCO2显著降低,差异均有统计学意义(P0.05)。治疗前及治疗后5、10h两组患儿的PaO2、PaCO2比较差异均无统计学意义(P0.05)。观察组新生儿出现肺气漏、呼吸机相关性肺炎的发生率分别为2.38%(1/42),9.52%(4/42),均低于对照组16.67%(6/36),27.78%(10/36),差异无统计学意义(P0.05)。观察组患儿呼吸机上机时长为(3.29±1.08)d,显著短于对照组(5.45±0.89)d,两组比较差异有统计学意义(P0.05)。观察组治疗12h肺野透亮度改善率为90.5%(38/42),对照组为91.7%(33/36),两组比较差异无统计学意义(P0.05)。结论采用Insure技术治疗NRDS疗效满意,可减少呼吸机使用时长及相关并发症的发生。     

高频振荡通气联合肺表面活性物质治疗新生儿胎粪吸入综合征的效果

目的 探讨高频振荡通气联合肺表面活性物质( pulmonary surfactant,PS)治疗新生儿胎粪吸入综合征(meconium aspiration syndrome,MAS)的临床疗效.方法 回顾性分析2008年6月至2011年6月本院新生儿重症监护病房收治的53例MAS患儿的临床资料,根据治疗措施不同分为常频通气组23例,高频通气组18例,高频通气+PS组12例.方差分析及卡方检验比较3组通气治疗2、12、24、48 h后肺氧合功能指标和呼吸机参数指标如氧合指数、动脉/肺泡氧分压比值(arterial oxygen/alveolar oxygen ratio,a/ApO2)和吸入氧浓度(inspired oxygen fraction,FiO2)的变化,以及患儿的呼吸机使用时间、住院时间、症状变化及转归情况.结果 3组患儿机械通气前氧合指数、a/ApO2和FiO2差异无统计学意义.机械通气治疗2和48 h后,常频通气组氧合指数分别为(23.79±7.27)和(15.04±4.76)mm Hg;a/ApO2分别为0.11±0.04和0.31±0.07;FiO2分别为0.74±0.16和0.47±0.21.高频通气组氧合指数分别为(21.13±6.29)和(11.73±4.54) mm Hg;a/ApO2分别为0.14±0.06和0.35±0.06;FiO2分别为0.68±0.14和0.41±0.11.高频通气+PS组氧合指数分别为(18.35±5.68)和(7.85±5.06)mm Hg; a/ApO2分别为0.17±0.03和0.40±0.02;FiO2分别为0.59±0.13和0.29±0.16.与常频通气组比较,高频通气组治疗后氧合指数、a/ApO2和FiO2有所好转,高频通气+PS组在时限和程度上比高频通气组好转更明显,差异均有统计学意义(P均＜0.05).常频通气组患儿机械通气时间为(7.2±0.6)d,住院时间为(22.2±4.5)d,氧疗时间为(15.4±2.4)d;高频通气组较之缩短,分别为(4.2±1.4)、(15.6±3.4)和(11.8±5.3)d;高频通气+ PS组最短,分别为(2.9±0.5)、(11.8±4.3)和(7.4±2.2)d,差异均有统计学意义(P均＜0.05).结论 早期高频振荡通气联合PS治疗新生儿MAS的效果好于单纯的常频或高频通气.     

不同机械通气方式治疗胎粪吸入综合征的随机对照研究

目的　比较不同机械通气方式对胎粪吸入综合征（MAS）患儿的治疗作用及并发症的发生。方法　河北省儿童医院新生儿科重症监护室2006年7月至2008年7月收治的84例氧合指数（OI） ≥ 15的重症胎粪吸入综合征患儿随机分为3组：A组25例患儿采用高频振荡 （HFOV）模式治疗;B组29例患儿采用同步间歇正压联合容量保证 （SIPPV+VG）模式治疗;C组30例采用间歇指令通气（IMV）模式治疗。比较3组治疗前后各时间点OI、动脉/肺泡氧分压比值（a/APO2）的变化,并对3组患儿的氧暴露时间、机械通气时间,以及肺气漏、呼吸机相关性肺炎、Ⅲ度以上颅内出血等并发症的发生率进行比较。结果　A组与B组在机械通气24 h后OI和a/APO2值均与0 h差异有统计学意义（P < 0.05）,而C组直到72 h方与0 h时差异有统计学意义（P < 0.05）。A组与B组各时间点相比差异均无统计学意义。A组与B组相比,氧暴露时间和上呼吸机时间均无统计学差异（P > 0.05）,但是A组与C组、B组与C组相比在统计学上差异均有统计学意义（P < 0.05）。不仅如此,A组与C组、B组与C组相比,肺气漏与呼吸机相关性肺炎的发生率差异均有统计学意义（P < 0.05）。Ⅲ度以上颅内出血的发生率3组相比差异无统计学意义（P > 0.05）。结论 　HFOV、SIPPV+VG通气模式与IMV比较,可以较快改善MAS的氧合,缩短氧暴露时间和呼吸机使用时间,降低肺气漏和呼吸机相关性肺炎的发生,可作为更有效、更安全的抢救性治疗手段。     

早产儿动脉导管未闭的床边外科治疗

目的:对早产儿动脉导管未闭行床边手术治疗的患儿进行回顾性分析,探索早期行床边外科治疗的可行性和优越性。方法:7例动脉导管未闭(PDA)早产儿,男4例,女3例,均合并呼吸窘迫综合征(RDS),在新生儿监护室(NICU)内行动脉导管未闭结扎术。并对手术注意点、术后呼吸机使用情况、术后并发症进行分析。结果:全组无手术死亡,均治愈出院。其中6例于术后3—5天撤离呼吸机,1例于术后30天撤离呼吸机。全组无气胸、喉返神经损伤、乳糜胸等术后并发症,无高血压、术后并发感染等情况。复查心脏B超均未见分流信号,心功能正常。结论:合并呼吸窘迫综合征的早产儿在药物治疗不能关闭PDA或无法使用消炎痛等药物及时关闭PDA时,早期行动脉导管未闭结扎术效果好,能缩短呼吸机使用时间及减少并发症的发生。重症早产儿的PDA宜采用床边外科治疗。     

早产儿支气管肺发育不良症的早期诊断和治疗

目的　探讨早产儿支气管肺发育不良症 (BPD)的早期诊断和治疗。　方法　对 1994年 1月～ 1999年 1月在我院 NICU住院的 12例 BPD患儿的发病、临床诊断和应用地塞米松治疗进行观察和总结 ,并对所有患儿在出院后 6～ 12个月内进行了随访。　结果　经用地塞米松治疗 ,12例患儿全部治愈出院 ,住院时间 31～ 6 7(5 0± 14) d。随访 1年 ,11例预后良好 ,1例仍反复呼吸道感染。BPD是患呼吸窘迫综合征 (RDS)的极低出生体重儿应用机械通气治疗后的常见合并症。患 RDS的早产儿中 ,发生 BPD者 ,其胎龄及出生体重明显低于未发生 BPD者 (P<0 .0 0 1) ;而其机械通气的最高吸气峰压和吸入氧浓度亦明显高于未发生 BPD者 (P<0 .0 1)。　结论　对易感儿在治疗过程中应严密观察临床征象和辅助检查 ,尽早做出诊断 ,及时应用地塞米松治疗可取得较好的效果。     

肺表面活性物质联合机械通气治疗新生儿肺出血疗效观察

目的观察肺表面活性物质联合机械通气治疗新生儿肺出血的临床疗效。方法 2012年1月至2015年10月深圳市龙华新区人民医院新生儿科收治新生儿肺出血患儿102例,随机分为对照组和观察组各51例。两组患儿均给予气管插管,呼吸机辅助呼吸。对照组气管内注入血凝酶、肾上腺素;观察组气管内注入血凝酶、猪肺磷脂注射液。观察两组患儿治疗后6、12、24、48h肺出血面积、肺出血持续时间、机械通气时间、不良反应及临床疗效。结果两组治疗后12、24、48h与治疗前肺出血面积相比较,差异有统计学意义(P0.05)。观察组治疗后12、24、48h肺出血面积显著低于对照组,差异有统计学意义(P0.05)。观察组患儿肺出血持续时间、机械通气时间比对照组明显缩短,差异有统计学意义(P0.05)。观察组治愈率为84.31%(43/51),显著高于对照组66.67%(34/51),差异有统计学意义(P0.05)。两组患儿均未发生明显不良反应。结论机械通气联合肺表面活性物质可以显著减少肺出血面积,缩短肺出血持续时间和机械通气时间,提高治愈率,值得在临床大力推广应用。     

INSURE策略治疗新生儿呼吸窘迫综合征28例疗效观察简

目的 观察INSURE策略治疗新生儿呼吸窘迫综合征（NRDS）的有效性与安全性.方法 将确诊NRDS并同意使用肺表面活性物质（PS）的患儿56例按入院顺序分为两组,采用INSURE策略治疗（观察组）和给予PS后常频通气治疗（对照组）每组各28例.比较治疗后两组呼吸功能、上机时间、用氧时间、并发症及转归.结果 治疗后48 h观察组氧合指数较对照组明显增高,两组比较差异有统计学意义（P＜0.05）.观察组呼吸机相关性肺炎（VAP）发生率明显低于对照组,差异有统计学意义（P＜0.05）,氧疗时间明显缩短,差异有统计学意义（P＜0.05）.两组上机时间、气胸、坏死性小肠结肠炎、支气管肺发育不良的发生率比较,差异无统计学意义（P＞0.05）.结论 INSURE策略能较好地改善NRDS患儿氧合功能及通气,减少VAP的发生,缩短用氧时间.     

INSURE技术在极低和超低出生体重儿呼吸支持中的应用价值——83例临床分析

目的 探讨INSURE技术在极低及超低出生体重早产儿呼吸支持中的临床应用价值.方法 本研究为回顾性分析.清华大学第一附属医院2010年6月至2012年8月收治的有呼吸困难且需要呼吸支持的极低及超低出生体重儿83例,依据呼吸支持方法的不同分为INSURE组41例与机械通气组42例.INSURE组患儿生后尽快予以气管插管、气管内滴入肺表面活性物质、拔管后经鼻持续气道正压通气.机械通气组患儿生后予气管插管、气管内用或不用肺表面活性物质、不拔除气管导管直接连接呼吸机辅助通气.卡方检验、两独立样本t检验及秩和检验比较2组患儿治疗后1h、12h动脉血气改善情况,呼吸窘迫综合征、呼吸机相关性肺炎、气漏、慢性肺疾病、颅内出血、视网膜病变、脑白质软化等疾病的发生情况,以及呼吸机使用时间、用氧时间、住院时间、住院费用等.结果 (1)组内治疗前后氧合情况比较:INSURE组患儿治疗后1h动脉血氧分压为(78.7±11.5) mm Hg(1 mm Hg=0.133 kPa),高于治疗前[(50.1±10.8) mm Hg],而二氧化碳分压低于治疗前[(48.3±8.9) mm Hg与(54.9±11.5) mm Hg],差异均有统计学意义(t分别为9.737、-3.428,P均＜0.05).机械通气组患儿治疗后1h动脉血氧分压为(80.2±10.0) mm Hg,高于治疗前[(51.3±9.8) mm Hg],而二氧化碳分压低于治疗前[(45.6±9.5) mm Hg与(57.1±12.8) mmHg],差异均有统计学意义(t分别为10.093、-4.526,P均＜0.05).(2)组间氧合情况比较:INSURE组与机械通气组治疗后1h动脉血氧分压、二氧化碳分压相比差异无统计学意义(P均＞0.05);INSURE组治疗后12 h动脉血氧分压、二氧化碳分压分别为(89.4±11.5) mm H g、(44.2±5.9) mm Hg,与机械通气组[分别为(90.2±10.8) mm Hg、(39.1±7.3) mm Hg]相比差异也无统计学意义(t分别为0.093、0.126,P均＞0.05).(3)组间疾病发生情况比较:INSURE组患儿呼吸机相关性肺炎、气漏、颅内出血和慢性肺疾病的发生率分别为7.3％(3/41)、4.9％(2/41)、4.9％(2/41)和4.9％(2/41),均低于机械通气组[分别为34.1％(14/42)、16.7％(7/42)、19.0％(8/42)和11.9％(5/42)],差异均有统计学意义(x2分别为27.470、8.651、8.814和4.275,P均＜0.05).INSURE组患儿呼吸机使用时间、用氧时间、住NICU时间分别为5 d(3～7 d)、8 d(5～11 d)和16d(11～25 d),短于机械通气组[分别为8 d(4～12 d)、12 d(8～22 d)和21 d(12～35 d)],差异均有统计学意义(Z分别为-1.947、-2.013和-1.782,P均＜0.05). 结论 极低及超低出生体重儿应用INSURE技术进行呼吸支持,创伤小、并发症少、用氧时间短、费用低、安全性高.     

极低出生体重早产儿动脉导管未闭的治疗

目的探讨极低出生体重早产儿有临床表现的动脉导管未闭的治疗方法方法 本研究为前瞻性队列研究.2008年1月1日至2010年12月31日间出生体重＜1500 g的确诊有临床表现的动脉导管未闭早产儿78例,其中42例采用口服吲哚美辛治疗者作为治疗组,36例未治疗者为对照组.观察吲哚美辛的疗效、副作用以及对早产儿的近远期预后.结果治疗组及对照组在性别比例、胎龄、动脉导管直径、合并心力衰竭、败血症、新生儿呼吸窘迫综合征、脑室内出血的差异均无统计学意义(P均＞0.05).治疗组治疗后动脉导管关闭33例,关闭率为78.6%,高于对照组,自发关闭9例,关闭率25.0%,差异有统计学意义(χ2=22.39,P=0.000).治疗组治疗前后的血肌酐、血小板差异无统计学意义(P均＞0.05).治疗组较对照组有较少的脑室内出血发生比例(z=1.167,P=0.030)、较短的总用氧时间[分别为(8.0±5.5) d和(13.3±9.3) d,t=2.225,P=0.032]及住院时间[(39.0±7.7) d和(43.6±10.6) d,t=2.229,P=0.029],且支气管肺发育不良、坏死性小肠结肠炎的发生情况组间差异无统计学意义(P均＞0.05).治疗组中有5例药物治疗失败后使用胸腔镜钳闭动脉导管,术后3例发生肺部感染,1例出现胸腔积液,无死亡及气胸发生.结论极低出生体重早产儿有临床表现的动脉导管未闭应积极干预,口服吲哚美辛可有效关闭动脉导管,胸腔镜钳闭动脉导管可作为药物治疗失败后的一种选择.

Abstract：

Objective To investigate the treatment of symptomatic patent ductus arteriosus (PDA) in very low birth weight preterm infants. Methods From January 1, 2008 to December 31, 2010, 78 very low birth weight preterm infants (birth weight＜1500 g) were diagnosed as symptomatic PDA. Among which, 42 cases administered orally with indomethacin (0.2 mg/kg, every 12 hrs for three times) were taken as treatment group, while five cases in this group who failed to indomethacin treatment were interrupted with video-assisted thoracoscopic surgery. And 36 cases who did not receive treatment for ductus arteriosus were taken as control group. The clinical outcomes, complications and prognosis of these patients were observed. Results There were no significant differences between the gentle percentage, gestational age, diameter of ductus arteriosus, rate of complicated with heart failure, sepsis, neonatal respiratory distress syndrome and intraventricular hemorrhage of two groups (P>0.05, respectively). The ductus arteriosus closed in 33 patients of treatment group (78.6%) and in nine patients of control group (25.0%)(χ2=22.39,P=0.000). There were no significant differences in serum creatinine level and platelet count between before and after the treatment in treatment group(P>0.05). Compared with control group, the treatment group had lower incidence of intraventricular hemorrhage (z=1.167, P=0.030), shorter duration of oxygen therapy [(8.0±5.5) d vs (13.3±9.3) d, t=2.225, P=0.032] and shorter hospital stay [(39.0±7.7) d vs (43.6±10.6) d, t=2.229, P=0.029]; while the incidence of bronchopulmonary dysplasia and necrotizing enterocolitis were similar (P>0.05). The five cases of PDA who received video-assisted thoracoscopic surgery were successfully interrupted with no residual shunt left, while three of them had lung infections and one had pleural effusion, but no pneumothorax and infant death associated with surgery occurred. Conclusions Symptomatic PDA of very low birth weight preterm infants should be treated actively. Oral indomethacin was an effective and safe method to cure the PDA in these infants. Surgical ligation under video-assisted thoracoscopic surgery after failure of indomethacin treatment might be a good option.     

High-frequency ventilation in the management of very-low-birth-weight infants with pulmonary hemorrhage

Severe hypoxic respiratory failure secondary to massive pulmonary hemorrhage (MPH) in preterm infants could be fatal. The aim of this study was to assess the efficacy of high-frequency ventilation (HFV) as a rescue therapy for respiratory failure secondary to MPH in very-low-birth-weight (VLBW) infants. Prospectively we followed up all VLBW infants with pulmonary hemorrhage between January 1993 and December 1996 in our neonatal intensive care unit at King Khalid University Hospital. Seventeen VLBW infants with severe hypoxic respiratory failure secondary to MPH were treated with HFV. Ten (59%) infants responded to HFV and survived, while the other 7 (41%) did not respond and expired. Patent ductus arteriosus was considered the most common associated condition in 10 infants (59%). There were no statistically significant differences between the responders and the nonresponders in regard to gestational age, birth weight, sex ratio, % inborn, and primary diagnosis. However, preintervention peak inspiratory pressure (pip), arterial-alveolar ratio (a/A ratio) and oxygenation index (OI) were higher in the nonresponders ( p = 0.02, p = 0.03, and p = 0.003, respectively), while pip, F IO(2), pa CO(2), a/A ratio and OI were significantly lower than the nonresponders 3 hours postintervention ( p = 0.008, p = 0.006, p = 0.0002, p = 0.0005, and p = 0.0007, respectively). In conclusion, HFV might be an effective and lifesaving mode of treatment in VLBW infants with respiratory failure secondary to MPH; therefore, prospective randomized controlled trials are needed to confirm these findings.     

Regulation of cerebral blood flow velocity in nonasphyxiated, very low birth weight infants with hyaline membrane disease

Previous studies of cerebral blood flow (CBF) and blood flow velocity regulation in stressed neonates, both term and preterm, have suggested that CBF is pressure passive. These studies are in conflict with data obtained from fetal and newborn animals. To determine if autoregulation of CBF is present in preterm infants, we studied eight very low birth weight infants (gestational age, 29.1 +/- 1.5 weeks; birth weight, 1117 +/- 278 g), all of whom had hyaline membrane disease that necessitated mechanical ventilation. None of the infants suffered from perinatal asphyxia, intraventricular hemorrhage, or patent ductus arteriosus. All infants demonstrated appropriate changes in cerebral blood flow velocity (CBFV) in response to changes in arterial oxygen content and pCO2. CBFV was not affected by changes in systemic mean arterial blood pressure. The data indicate that nonasphyxiated very low birth weight infants regulate their CBF in a manner similar to that observed in adults.     

Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all?

Although a moderate-sized patent ductus arteriosus (PDA) needs to be closed by the time a child is 1-2 years old, there is great uncertainty about whether it needs to be closed during the neonatal period. Although 95% of neonatologists believe that a moderate-sized PDA should be closed if it persists in infants (born before 28 weeks) who still require mechanical ventilation, the number of neonatologists who treat a PDA when it occurs in infants who do not require mechanical ventilation varies widely. Both the high likelihood of spontaneous ductus closure and the absence of randomized controlled trials, specifically addressing the risks and benefits of neonatal ductus closure, add to the current uncertainty. New information suggests that early pharmacologic treatment has several important short-term benefits for the preterm newborn. By contrast, ductus ligation, while eliminating the detrimental effects of a PDA on lung development, may create its own set of morbidities that counteract many of the benefits derived from ductus closure.     

Placental transfusion: umbilical cord clamping and preterm infants.

OBJECTIVE: To investigate the clinical effects of early versus late cord clamping in preterm infants. STUDY DESIGN: A total of 32 premature infants were prospectively randomized. The following parameters were measured: Initial spun hematocrit (Hct), hemoglobin (Hgb), red blood cell (RBC) counts, frequency of blood transfusions, peak serum bilirubin, mean blood pressure (MBP), oxygen index, intraventricular hemorrhage, and significant patent ductus arteriosus (PDA). RESULTS: Over the 4-week study period, the delayed cord clamping (DCC) group exhibited a decrease in the frequency of blood transfusion (p < 0.001) and also a decrease in albumin transfusions over the first 24 hours (p < 0.03). MBP in the first 4 hours was higher in the DCC group (p < 0.01), and there were statistically significant increases in Hct (21%), Hgb (23%), and RBC count (21%) compared with the early cord clamping group. The risks of patent ductus arteriosus, hyperbilirubinemia, or intraventricular hemorrhage were similar in both groups. Late clamping of the umbilical cord had little or no effect on the oxygen index. CONCLUSION: DCC significantly reduced the requirement for blood and albumin transfusion. It also increased the initial Hct, RBC count, Hgb levels, and MBP.     

Evidence-based use of indomethacin and ibuprofen in the neonatal intensive care unit

Indomethacin and ibuprofen are potent inhibitors of prostaglandin synthesis. Neonates have been exposed to these compounds for more than 3 decades. Indomethacin is commonly used to prevent intraventricular hemorrhage (IVH), and both drugs are prescribed for the treatment or prevention of patent ductus arteriosus (PDA). This review examines the basis for indomethacin and ibuprofen use in the neonatal intensive care population. Despite the call for restrained use of each drug, the most immature infants are likely to need pharmacologic approaches to reduce high-grade IVH, avoid the need for PDA ligation, and preserve the opportunity for an optimal outcome.     

Outcome of very low birth weight infants exposed to antenatal indomethacin for tocolysis.

OBJECTIVE: Beginning in October 1995, and for several years thereafter, our institution used indomethacin as a first-line tocolytic drug. Our purpose is to compare the outcomes of very low birth weight infants who were exposed to antenatal indomethacin with those who were not exposed to this therapy. STUDY DESIGN: We used our center's component of the NICHD Neonatal Research Network's Generic Data Base which recorded the outcomes of all live born infants weighing less than 1500 g over a 5-year period. We abstracted data concerning neonatal morbidity (death, Grades III to IV intraventricular hemorrhage (IVH), necrotizing enterocolitis and patent ductus arteriosus), as well as other factors including gestational age, birth weight, antenatal corticosteroid treatment and maternal hypertension or pre-eclampsia. Univariate analysis was performed using Fisher's exact test. Multivariate analysis using logistic regression was performed to control for confounding factors. RESULTS: A total of 85 infants who were exposed to antenatal indomethacin were compared to 464 infants who were not exposed to the drug. In the univariate analysis, antenatal indomethacin exposure was not associated with a significant increase in the incidence of necrotizing enterocolitis or patent ductus arteriosus. The incidence of Grades III to IV IVH was 17.9% in those infants exposed to antenatal indomethacin compared to 7.1% in the nonexposed infants (p=0.008). The incidence of neonatal death in the exposed infants was 27.7 versus 16.4 in the nonexposed infants (p=0.02).After controlling for antenatal corticosteroids, maternal pre-eclampsia, gestational age and birth weight, antenatal indomethacin was significantly associated with an increased incidence of IVH, but not neonatal death. CONCLUSION: Antenatal indomethacin was associated with significantly higher rates of IVH. Additional studies assessing the potential risks of indomethacin tocolysis are needed before it is used as a first-line tocolytic therapy.     

Neonatal outcome after exposure to indomethacin in utero: a retrospective case cohort study

OBJECTIVE: This study was undertaken to determine the clinical outcome for neonates who were exposed to indomethacin during gestation. STUDY DESIGN: We identified 124 infants with in utero exposure to indomethacin and matched them to 124 infants whose mothers did not receive indomethacin. The two groups were matched for gestational age at birth, sex, and exposure to antenatal betamethasone. Sixty-two of the indomethacin-exposed infants were born within 48 hours of last exposure. These infants were also compared with their matched controls. RESULTS: There were no significant differences between the indomethacin-exposed infants and control infants in birth weight, Apgar scores, frequency of cesarean section deliveries, and multiple gestation. The incidence of respiratory distress syndrome, need for surfactant treatment, patent ductus arteriosus, necrotizing enterocolitis, and intraventricular hemorrhage was similar between the indomethacin-exposed group and the control group. Indomethacin-exposed infants who were born within 48 hours of last exposure had similar incidence of respiratory distress syndrome but greater need for surfactant treatment (P=.02) compared with controls. All other complication rates were similar. CONCLUSION: Indomethacin exposure in our study was not associated with increased neonatal complications for infants delivered within or beyond 48 hours of last exposure.     

Neonatal outcome of temporizing treatment in early-onset preeclampsia

OBJECTIVE: To assess the effect of prolongation of pregnancy on neonatal outcome by means of hemodynamic treatment in patients with early-onset preeclampsia. STUDY DESIGN: A retrospective case-controlled study of 222 liveborn infants of patients with early-onset (24--31 weeks) preeclampsia, who underwent temporizing hemodynamic treatment. Of the two control groups of liveborn preterm infants of non-preeclamptic mothers one group was matched with the study group for gestational age on admission (group I), one for gestational age at birth (group II). Primary outcome measures were neonatal and infant mortality and variables of neonatal morbidity. RESULTS: Median gestation in the study group of preeclamptic patients was prolonged from 29.3 to 31.3 weeks. No difference in neonatal or infant mortality was observed between infants from preeclamptic mothers and in the control groups. The study population showed better results than control group I with regard to admission to NICU (P<0.01), mechanical ventilation (P<0.001) and intracranial hemorrhage (P<0.01). Control group II had better results than the study group with respect to birthweight (P<0.001), bronchopulmonary dysplasia (P<0.01), patent ductus arteriosus (P<0.01), and retinopathy (P<0.01). CONCLUSION: Prolongation of gestation in patients with early-onset preeclampsia may reduce neonatal morbidity, but neonates of the same gestational age without a preeclamptic mother still have a better prognosis.     

The effects of indomethacin tocolysis on the postnatal response of the ductus arteriosus to indomethacin in extremely low birth weight infants.

BACKGROUND: Antenal indomethacin reportedly decreases the responses of a symptomatic patent ductus arteriosus (sPDA) to postnatal indomethacin treatment. Whether a similar exposure affects the responses to indomethacin prophylaxis is unknown. OBJECTIVE: To evaluate the clinical responsiveness of ductus arteriosus to indomethacin prophylaxis and to the treatment of sPDA in extremely low birth weight (ELBW) infants following indomethacin tocolysis. METHODS: Retrospective cohort study of 58 ELBW infants whose mothers received indomethacin tocolysis (study) and 58 ELBW infants whose mothers did not (controls), matched by gender, gestational age (GA), birth weight and postnatal sPDA management (prophylaxis or early treatment). RESULTS: Indomethacin was used as a tocolytic at a median dose of 250 mg, for a duration of 2 days, and ending 1 day before delivery. Study and control mothers were comparable in demographics, antenatal steroid use, cesarean delivery, but were different in the incidence of preeclampsia and preterm labor. Study and control infants were similar in birth weight, GA, indomethacin prophylaxis, early sPDA treatment, mortality, necrotizing enterocolitis, severe intraventricular hemorrhage and stage 3-5 retinopathy of prematurity. Seventeen of 43 study and 16 of 43 control infants who received indomethacin prophylaxis developed sPDA and were combined with early treatment sPDA infants (15 to each group). Two of 32 study and two of 31 control infants underwent surgical ligation whereas the remaining were treated with indomethacin. Sixteen of 30 (53%) and 13 of 29 (45%) were successfully treated and did not require ligation. Study infants were divided according to their mothers' indomethacin total dose (28 infants received 225 mg). Both subgroups were demographically and clinically comparable and their response to indomethacin prophylaxis and treatment were similar. CONCLUSION: In ELBW infants, exposure to indomethacin tocolysis does not affect the clinical responsiveness of the ductus arteriosus to prophylaxis or that of the sPDA to indomethacin treatment.