Inhaled nitric oxide in very preterm infants with severe respiratory distress syndrome

AIM: To test the hypothesis that inhaled nitric oxide therapy can decrease the incidence of bronchopulmonary dysplasia and death in preterm infants with severe respiratory distress syndrome; to evaluate the possible predictive factors for the response to inhaled nitric oxide therapy. METHODS: Preterm infants (less than 30 weeks' gestation) were randomized to receive during the first week of life inhaled nitric oxide, or nothing, if they presented severe respiratory distress syndrome. Then, the treated infants were classified as non responders and responders. RESULTS: Twenty infants were enrolled in the inhaled nitric oxide therapy group and 20 in the control group. Bronchopulmonary dysplasia and death were less frequent in the inhaled nitric oxide group than in the control group (50 vs. 90%, p=0.016). Moreover, nitric oxide treatment was found to decrease as independent factor the combined incidence of death and BPD (OR=0.111; 95% C.I. 0.02-0.610). A birth weight lower than 750 grams had a significant predictive value for the failure of responding to inhaled nitric oxide therapy (OR 12; 95% C.I. 1.3-13.3). CONCLUSION: Inhaled nitric oxide decreases the incidence of bronchopulmonary dysplasia and death in preterm infants with severe respiratory distress syndrome. Birth weight may influence the effectiveness of inhaled nitric oxide therapy in promoting oxygenation improvement in preterm infants.     

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目的 探讨早期、晚期早产儿与足月儿呼吸窘迫综合征(RDS)的发病趋势和临床特征的差异,为临床合理诊治提供依据。方法 2006年1月至2010年12月在郑州大学第三附属医院住院的963例RDS患儿根据胎龄不同分为早期早产儿组(<34周)679例,晚期早产儿组(34～<37周)204例,足月儿组(≥37周)80例,分别对各组患儿的发病率、入院情况、高危因素、临床诊治、预后及并发症进行比较。结果 RDS的发病率逐年增加,均以早期早产儿占多数,晚期早产儿和足月儿RDS比例有增多趋势;RDS患儿男婴超过女婴(P<0.05),且胎龄和体重越大,男婴比例越高;足月儿RDS组产前糖皮质激素使用率明显低于早产儿组;早产儿发生RDS的高危因素主要有胎膜早破、胎盘异常、母亲妊娠高血压疾病,足月儿发生RDS的高危因素主要是择期剖宫产与感染;晚期早产儿与足月儿RDS的临床诊断和应用肺泡表面活性物质(PS)时间均晚于早期早产儿;足月儿RDS应用机械通气比例明显高于早产儿,其临床治愈率高(P<0.05),在死亡率方面与早产儿组无差别;但并发气胸的比例高于早产儿组(P<0.05)。结论 新生儿呼吸窘迫综合征(NRDS)发病率逐年增高,晚期早产儿和足月儿RDS比例有增多趋势;早期、晚期早产儿与足月儿RDS在性别比例、高危因素、起病特点、治疗反应与并发症方面均存在差异,RDS的诊治需要考虑胎龄因素。足月儿RDS多与择期剖宫产、感染有关,发病相对较晚,容易合并气胸,应引起足够重视。     

Efficacy of phototherapy for hyperbilirubinaemia in infants with the respiratory distress syndrome

Objectives: To evaluate the efficacy of phototherapy for hyperbilirubinaemia in preterm infants with and without the respiratory distress syndrome (RDS).
Methodology: Prospective cohort study of preterm infants cared for at Kandang Kerbau Hospital, Singapore: 170 with RDS and 477 without RDS, sepsis or other complications (control group) presenting with non-haemolytic hyperbilirubinaemia at about the same time were exposed to daylight phototherapy when bilirubin concentrations exceeded 255 μmol/L or 222 μmol/L if <48h of age. Bilirubin values were monitored 6-hourly during exposure, and daily for at least 2 days postphototherapy.
Results The infants were comparable in birthweight, gestational age, postnatal age, haemoglobin, haematocrit and bilirubin values, at start. The response to phototherapy of the infants with RDS was comparable to that of the well preterm infants; the duration of exposure was 50.1 ± 1.6 (mean ± s.e.m.) versus 50.1 ± 1.4 h, 24-hour decline rate 25.71 ± 1.29% versus 26.32 ± 0.65, and overall decline rate 0.96± 0.03%/h versus 0.95±0.02%/h.
Conclusion The presence of RDS did not affect the efficacy of phototherapy for neonatal hyperbilirubinaemia in preterm infants.     

容量保证机械通气在呼吸窘迫综合征早产儿中应用

目的 比较容量保证(VG)与压力控制(PC)两种机械通气模式在呼吸窘迫综合征(RDS)早产儿中的应用效果。方法 前瞻性选择2017年03月至2021年04月NICU收治的胎龄<32周或出生体质量<1 500g,需要有创机械通气的RDS早产儿作为研究对象,按简单随机法分为VG组和PC组。比较两组拔管前的呼吸机参数及动脉血气,有创机械通气时间、总呼吸支持时间及平均住院时间,并发症发生率及病死率。结果 最终RDS早产儿79例完成研究,男46例、女33例,平均胎龄(30.1±1.2)周,平均出生体质量(1 239.0±158.0)g,VG组36例、PC组43例。与PC组比较,VG组在拔管前的平均气道压较低,有创机械通气时间、总呼吸支持时间以及平均住院时间均缩短,差异有统计学意义(P<0.05)。结论 在RDS早产儿的机械通气治疗中,VG通气可能是一种更加安全有效的通气方式,但仍需要大样本、多中心的临床试验证实。     

Mean platelet volume in neonatal respiratory distress syndrome

The aim of this study was to investigate the differences in mean platelet volume (MPV) between neonates with and without neonatal respiratory distress syndrome (RDS). Eighty-three premature infants who were admitted to the neonatal intensive care unit were included in the study. Forty-four of these infants were diagnosed as having RDS and the other 39 infants were non-RDS patients. Infants born to mothers with pre-eclampsia, or a drug history that had negative effects on platelet count, perinatal hypoxia, sepsis and necrotizing enterocolitis were excluded. Blood collection was done on the first and third days of life. There were no demographic, gestational or platelet count differences between groups, but MPV was higher in RDS patients and this difference was statistically significant ( P = 0.011). High platelet volumes in RDS patients is probably related to young platelet production and may be a result of increased platelet consumption in pulmonary damage due to RDS.     

早产儿呼吸窘迫综合征遗传学研究进展

呼吸窘迫综合征( respiratory distress syndrome,RDS)是早产儿常见的呼吸系统疾病危重症,肺表面活性物质缺乏是其主要发病机制。近年来研究表明,遗传易患性参与早产儿RDS的发病。该文对近年来国内外关于早产儿RDS的遗传易患性及相关候选基因的研究进展作一综述。     

早产儿呼吸窘迫综合征的呼吸支持策略及研究进展

新生儿呼吸窘迫综合征（respiratory distress syndrome,RDS）多见于早产儿,胎龄越小,发病率越高。近年的大规模随机对照研究突出了产房内开始的持续气道正压通气（continuous positive airway pressure,CPAP）在RDS防治中的重要作用,对于生后有自主呼吸的早产儿,产房内应用CPAP优于气管插管,而顶防性应用肺表面活性物质（pulmonary surfactant,PS）不再具有优势。2013版欧洲新生儿RDS防治指南推荐有患RDS风险的早产儿生后均应立即接受CPAP支持,初设呼气末正压至少6cmH2O（1cmn20=0．098kPa）;对于患RDS的早产儿,最理想的处理是生后CPAP以及早期解救性PS应用。而需要气管插管的早产儿应尽早接受PS替代治疗。不能耐受CPAP的患儿更换通气模式为无创正压通气可能降低拔管失败率。目前有多种策略来缩短机械通气时间并增加无创通气的成功率。患RDS的极早产儿应常规接受咖啡因治疗以提高撤机成功率,并降低支气管肺发育不良的发生率。生后1～2周后仍不能脱离呼吸机者,需接受小剂量递减地塞米松治疗,但应避免生后1周内应用地塞米松以及较大剂量应用。     

Plasma carnitine levels in preterm infants with respiratory distress syndrome

BACKGROUND: Antenatal carnitine administration has been shown to induce fetal lung maturity by increasing pulmonary surfactant in animal and human studies. In this study, the aim was to investigate the status of carnitine in maternal and neonatal plasma of preterm infants with respiratory distress syndrome (RDS) in the first hours of life. METHODS: Maternal plasma carnitine levels were determined before delivery and neonatal plasma carnitine levels were determined within 2 h of birth in preterm infants (< 34 weeks gestational age) who developed RDS in the first 6 h of life and in the control group. RESULTS: The mean neonatal plasma free carnitine level was significantly lower in preterm infants with RDS than in the control group (28.3 +/- 8.8 micromol/L and 36.9 +/- 18.4 micromol/L, respectively; P < 0.05) while the mean maternal plasma-free carnitine levels were similar in both groups. CONCLUSIONS: Low neonatal plasma carnitine levels in preterm infants with RDS may be due to decreased maternal-fetal transfer of carnitine or to increased consumption of carnitine in fetal lung tissue for surfactant synthesis. This could be a contributing factor in the pathogenesis of respiratory distress syndrome in preterm infants.     

Serum free T4 and thyroid stimulating hormone levels in preterm infants and relationship between these levels and respiratory distress syndrome

BACKGROUND: There have been few studies of the thyroid stimulating hormone (TSH) surge in extremely low-birthweight (ELBW) infants, and the relationship between thyroid hormones and respiratory distress syndrome (RDS) has yet to be clarified. The present study sought to determine the serum levels of free T4 (fT4) and TSH in ELBW infants and to examine the relationship between these levels and the development of RDS. METHODS: The authors measured serum fT4 and TSH levels soon after birth in 449 preterm infants, who were born at 22-36 weeks of gestation, and determined the associations between these levels, the incidence of RDS, and the recognized clinical factors associated with RDS. RESULTS: Serum fT4 and TSH levels, and the fT4/TSH ratio, in the group at 22-24 weeks of gestation were significantly lower than those in the group at 28-36 weeks. The levels and ratio increased significantly with increasing gestational age. There were significant correlations between the serum fT4 level and the birthweight, Apgar score, and gender, and between the serum TSH level and the gestational age, mode of delivery, and birthweight. No significant relationship between the incidence of RDS and the serum levels of fT4 and TSH was observed. CONCLUSION: The authors' results suggest that the serum levels of fT4 and TSH in ELBW infants are very low, and that these levels are not correlated with the occurrence of RDS.     

沐舒坦不同给药方式预防早产儿呼吸窘迫综合征疗效观察

目的：沐舒坦具有促进肺表面活性物质合成和分泌的作用。近年来已有较多学者将其用于预防早产儿呼吸窘迫综合征(RDS),取得了较好的临床疗效。该研究旨在比较静脉和雾化两种不同途径使用沐舒坦预防早产儿RDS的疗效。方法：将我院产科出生的早产儿(胎龄28～37周)随机分为静脉给药组、雾化吸入组两个用药组及未用沐舒坦的对照组,静脉给药组于出生后立即从脐静脉注射沐舒坦15mg/kg,随后静脉点滴每日30mg/kg,分2次给药;雾化给药组给予氧气驱动雾化吸入沐舒坦每日30mg/kg,分2次给药,均用药2d;对照组不使用沐舒坦。比较3组RDS的发生率、并发症及住院6h血气分析结果。结果：①静脉给药组RDS的发生率为7.5%,雾化给药组为5.0%,对照组为24.4%,两用药组间比较差异无显著性,但均低于对照组(P<0.05)。②两用药组住院6h的血气分析结果与对照组比较差异有显著性(P<0.05),两用药组间比较差异无显著性。③两用药组并发症发生率明显低于对照组(P<0.05),两用药组间比较差异无显著性。结论：新生儿早期使用沐舒坦预防RDS,具有一定疗效,无论是经静脉还是雾化给药,均能获得相同的效果。     

重度新生儿呼吸窘迫综合征死亡危险因素分析

目的探讨重度新生儿呼吸窘迫综合征（respiratory distress syndrome,RDS）导致死亡的主要危险因素。方法回顾性分析2010年1月至2011年12月我院NICU诊断为重度RDS的66例早产儿的病例资料。按患儿结局分为死亡组和存活组进行分析。结果重度RDS死亡24例,病死率36．36％。死亡组患儿机械通气时间、碱剩余中位数、pH最小值、PaO2／FiO2最小值、平均胎龄、平均出生体重、1min Apgar评分、5min Apgar评分均低于存活组（P均〈0．05）。死亡组机械通气FiO2〉60％时间中位数、合并宫内窘迫比例、多胎比例、新生儿急性生理学评分围生期补充-Ⅱ（sore for neonatal acute physiology perinatal extension versionⅡ,SNAPPE-Ⅱ）均高于存活组（P均〈0．05）,两组机械通气并发症比较差异无统计学意义（P〉0．05）。对相关变量行Logistic回归分析,重度RDS死亡独立危险因素为出生体重、1minApgar评分和SNAPPE-Ⅱ评分,OR值为0．990、0．141和1．240。对SNAPPE—II评分进行受试者工作特征曲线分析,曲线下面积为0．86,与0．5相比差异有统计学意义（P=0．000）。分界点SNAPPE-Ⅱ评分=24．50时对应的正确预测指数最大（Youden指数=0．70）。结论重度RDS死亡独立危险因素为出生体重、1minApgar评分和SNAPPE—Ⅱ评分;SNAPPE-Ⅱ评分对重度RDS死亡风险预测准确性中等,其为24．50时预测准确性最大。     

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??Objective To investigate the different clinical characteristics of neonatal respiratory distress syndrome??NRDS?? in infants of various gestational ages and to provide a new basis for clinical treatment. Methods A total of 80 cases of NRDS infants in the First Affiliated Hospital of Harbin Medical University from March 2012 to March 2014 were divided into two groups according to gestational age: early preterm infants group??< 34 weeks??42 cases, M group????and nearly full-term group??≥ 34 weeks??38 cases, N group??.Lung surface active substances (PS) replacement and auxiliary ventilation were used, and the general situation??risk factors??treatment condition??prognosis and complications in each group were analyzed. Results The morbidity of NRDS in the male was higher than in the female. The onset time of M group was earlier than N group. In M group it was due to the fact that glucocorticoid was not used and premature birth . In N group it was due to caesarean section. The higher incidence of NRDS in M group was due to premature rupture of membranes and placental abnormality. The lower incidence of NRDS in M group was due to pregnancy hypertension, diabetes, intrauterine distress and abnormal umbilical cord . The PS use time in M group was less than N group. The secondary utilization rate in M group was higher than the N group. The distress degree of M group was higher, and assisted ventilation time and complications were more, compared to N group. Conclusion There are different clinical characteristics of NRDS in infants of various gestational ages. Correct guidance should be given during pregnancy and childbirth and appropriate treatment should be chosen.     

High serum cardiac troponin T concentrations in preterm infants with respiratory distress syndrome

In preterm infants with respiratory distress syndrome (RDS), cardiac function is negatively influenced by the severity of the lung disease. On day 2 of life, cardiac troponin T (cTnT), biochemical marker of myocardial injury, was measured in 46 preterm infants (gestational age < or =32 wk), 26 with RDS and 20 without: median (range) 0.38 (0.02-1.57) microg/L vs 0.13 (0.02-0.85) microg/L, respectively. CONCLUSION: High cTnT concentrations in preterm infants with RDS suggest the presence of myocardial damage in this group of high-risk patients.     

Chlamydia trachomatis in neonatal respiratory distress of very preterm babies: biphasic clinical picture

We observed 12 very preterm infants (10 males) with a peculiar respiratory syndrome characterized by early onset soon after birth and by a biphasic course. The severe first phase was characterized by a clinical pattern mimicking the idiopathic respiratory distress syndrome of prematurity. Gradually, respiratory symptoms decreased and assisted ventilation with oxygen therapy was reduced. In the second phase, a significant worsening of respiratory signs and the appearance of apneic spells were observed. Chest X-ray showed hypoexpansion of the lungs and the prevalence of a fine reticular pattern. Chlamydia trachomatis was identified in this second phase in conjunctival and pharyngeal swabs and/or on tracheal aspirates. Our data suggest that in the very preterm infants, chlamydial infection shows different clinical and laboratory features if compared with Chlamydia trachomatis pneumonia of infants born at term.     

新生儿呼吸窘迫综合征呼吸治疗的选择

目的 针对近期收治的1例生后即气管插管内导入PS治疗后出现双侧肺通气不均的NRDS患者，检索当前最佳证据, 并对其进行评价，以指导临床正确合理地使用。方法 首先提出临床问题，然后对MEDLINE (1993～2008年)、tripdatabase(1993～2008)、Cochrane Lib(2008 Issue 2)进行检索，并对检索到的证据进行评价。检索词为preterm infant、respiratory distress syndrome、pulmonary surfactant and ventilation。结果 共检索到系统评价8篇，临床指南3篇，随机对照试验9篇。结论 临床指南、系统评价和随机对照试验为我们选择和运用最佳治疗方案提供了有力证据。     

Development of chronic lung disease in preterm infants treated with surfactant

BACKGROUND: Chronic lung disease (CLD) is generally known to develop among preterm infants who have severe respiratory distress syndrome (RDS) at birth. Many clinical trials have established the efficacy of surfactant replacement therapy to treat RDS at birth with differing doses. In this study, the preterm infants diagnosed to have RDS at birth and treated with one or two doses of surfactant, depending on the severity of the RDS, were studied to evaluate the effect of surfactant on the later development of CLD. METHODS: A retrospective examination of case records of preterm infants who were born at < or = 28 weeks gestation period were studied. The subjects received a natural surfactant product (survanta) between September 1994 and April 1996 at the Monash Medical Center, Australia. RESULTS: Despite less severe initial lung disease, the subsequent respiratory outcome of infants who received one dose of surfactant, showed a trend towards being poorer compared to those who were diagnosed as having severe RDS at birth and received two doses of surfactant. At the corrected gestational age of 36 weeks, 54% of those infants began with mild RDS required oxygen, while only 44% of those who started with a severe RDS required supplemental O2. CONCLUSION: This study reports the infants with severe RDS at birth had responded slightly better or equally, compared to those with mild RDS, in terms of later development of CLD under surfactant treatment proportional to the severity.     

沐舒坦治疗新生儿呼吸窘迫综合征的疗效观察

目的　 观察沐舒坦治疗新生儿呼吸窘迫综合征的疗效。 方法 　对 66例符合条件的研究对象进行分层随机分配 ,在上呼吸机的同时 ,治疗组 (34例 )予沐舒坦针剂 (每次 7 5mg/kg) ,对照组 (32例 )则予生理盐水 ,两组输注时间均大于5min ,均每 6h一次 ,连用 7d。实验观察期达 2 8d ,期间观察用药后 2 4、36、48、60、72、84、96h ,各研究对象MAP、PaO2 /FiO2 的变化以及患儿并发症的发生率、两组死亡发生率。 结果 　治疗组与对照组MAP在开始用药后 60h、72h、84h、96h差异有统计学意义 ,P均<0 0 5。两组PaO2 /FiO2 在 60h、72h ,84h ,96h亦差异显著 ,有统计学意义 ,P均 <0 0 5。治疗组及对照组脑室周围 -脑室内出血 (SHE -IVH)发生率分别为 2 9 41%、5 6 2 5 % ,χ2 =4 861,P <0 0 5 ,相对危险度降低率 (RRR) :47 72 % ,需治疗人数 (NNT) :3 7;支气管肺发育不良 (BPD)、气胸、死亡发生率治疗组较对照组均有下降 ,其RRR、NNT均提示有临床意义。 结论 　沐舒坦在用药 60h后能显著改善NRDS的肺换气功能及降低机械通气时的平均气道压力 ,显著减少NRDS患儿中SHE IVH的发生率 ,降低BPD、死亡、气漏的发生率     

微创应用肺表面活性物质治疗早产儿呼吸窘迫综合征失败的高危因素分析

目的 探讨肺表面活性物质微创给药方式（MISA）治疗早产儿呼吸窘迫综合征（RDS）失败的高危因素及其对早产儿的影响。方法 回顾性分析2017年7月1日至2018年12月31日京津冀地区8家三级医院新生儿重症监护病房应用MISA给予牛肺表面活性物质（PS）治疗胎龄≤ 32周,且临床考虑为RDS早产儿（n=148）的基本信息、围产期情况、用药情况、合并症、临床转归等病例资料。根据MISA治疗是否失败（MISA失败定义为MISA后72 h内需要机械通气）分为MISA失败组（n=16）和MISA成功组（n=132）。应用logistic回归分析MISA失败的高危因素及其对早产儿的影响。结果 MISA失败率为10.8%（16/148）。logistic回归分析结果显示用药前RDS > Ⅱ级发生率高、用药前平均动脉压低、用药前脉压差大、首次给药剂量低、注药时间及总操作时间长是MISA失败的危险因素（分别OR=5.983、1.210、1.183、1.055、1.036、1.058,P < 0.05）。控制上述高危因素后行logistic回归分析结果显示MISA失败组BPD的发生率高（OR=8.537,P < 0.05）。结论 给药前RDS程度重、血压监测平均动脉压低、脉压差大是MISA失败的独立危险因素;首次PS给药剂量低、注药时间及总操作时间长可能增加MISA失败的风险;MISA失败可能导致早产儿BPD发生率增加。     

Surfactant improves oxygenation in infants and children with pneumonia and acute respiratory distress syndrome

AIM: Pneumonia in childhood may be associated with surfactant dysfunction and severe acute respiratory distress syndrome (ARDS). The aim of this study was to investigate the effects of surfactant treatment on oxygenation in 8 infants (age range: 1 mo to 13 y) with severe respiratory failure owing to viral, bacterial or Pneumocystis Carinii pneumonia. METHODS AND RESULTS: Instillation of a modified porcine surfactant (Curosurf) improved gas exchange immediately. Median paO2/FiO2 increased from 66 to 140 mmHg (8.8-18.7 kPa; p < 0.01) within 1 h of surfactant treatment. Seven of the 8 patients received multiple surfactant doses. Four patients (50%) died 3-62 d after surfactant treatment. However, 6 patients (75%) were immunodeficient, so that the observed mortality rate was mainly due to the underlying disease. CONCLUSION: Surfactant dysfunction probably plays a role in the pathophysiology of severe paediatric ARDS triggered by pneumonia, as it was found that surfactant instillation rapidly improved gas exchange in the majority of the affected infants in our study. Larger randomized controlled studies are necessary to evaluate the effects of surfactant treatment on morbidity and mortality.     

The effects of early postnatal dexamethasone therapy on pulmonary outcome in premature infants with respiratory distress syndrome: a two-year follow-up study

AIM: To evaluate the pulmonary outcome at corrected age of 2 y on preterm infants who participated in a double-blind trial of early postnatal dexamethasone therapy (< 12 h after birth) for the prevention of chronic lung disease. METHODS: Clinical respiratory status, blood gases, acid-base balance and pulmonary function were evaluated at corrected age of 2 y in 116 preterm infants (59 infants in the control group; 57 in the dexamethasone-treated group). In the dexamethasone-treated group, dexamethasone was administered intravenously every 12 h in tapering doses: 0.25 mg/kg on days 1 through 7, 0.12 mg/kg on days 8 through 14, 0.05 mg/kg on days 15 through 21, and 0.02 mg/kg on days 21 through 28. RESULTS: The clinical and laboratory characteristics in the perinatal period were comparable between the groups. At the time of follow-up (mean +/- SD corrected age was 25.1 +/- 4.8 mo for the control group and 24.6 +/- 5.1 mo for the dexamethasone-treated group), there was a slightly lower mean body weight and body length, and a lower psychomotor developmental index in the dexamethasone-treated group than in the control group (10.9 +/- 2.1 vs 11.5 +/- 1.9 kg, 84.4 +/- 6.1 vs 85.9 +/- 5.8 cm, and 82 +/- 24 vs 89 +/- 26, respectively); however, these differences were not statistically significant. There were no significant differences between the control and dexamethasone-treated groups in clinical respiratory status, blood gases, acid-base balance or in lung mechanics (V(T): 9.5 +/- 2.0 vs 9.4 +/- 1.9 ml/kg; V(min): 0.23 +/- 0.04 vs 0.23 +/- 0.03 l/min/kg; C(RS): 13.1 +/- 3.9 vs 12.6 +/- 3.6 ml/kPa/kg; R(RS): 1.56 +/- 0.64 vs 1.62 +/- 0.58 kPa/l/s, respectively). CONCLUSION: There was no apparent adverse respiratory outcome associated with early postnatal dexamethasone therapy.