Severe neonatal respiratory distress syndrome treated with the isolated phospholipid fraction of natural surfactant

Ten newborn infants (795-1680 g) with severe respiratory distress syndrome (RDS) were treated with the isolated phospholipid fraction of bovine or porcine surfactant, which was administered via the airways (dose 200 mg/kg), at a median age of 10.5 h. Before receiving surfactant, all the infants were on artificial ventilation (FiO2 0.6-1.0). Within 2 h after surfactant replacement, the arterial-to-alveolar PO2 ratio increased from 0.1 to 0.35. There was a concomitant improvement in lung aeration on the chest roentgenograms and a significant reduction in the right-to-left shunt. Four patients died of cerebral hemorrhage; two of them also had a patent ductus arteriosus. One surviving infant developed bronchopulmonary dysplasia, and another succumbed 8 months later to the sudden infant death syndrome. No antibodies against surfactant were detected in the sera of the survivors. Since our results show a significant improvement in lung function after replacement therapy, the efficacy of this new surfactant preparation should be further tested in randomized clinical trials.     

动态压力-容量曲线在新生儿机械通气中的临床意义

目的：探讨动态压力 容量曲线（动态P-V曲线）在新生儿机械通气中的变化特点,为临床呼吸机的合理使用和病情判断提供借鉴。方法：利用Stephanie呼吸机自动绘制动态P-V曲线,计算25例患儿在机械通气后1,24,48,72 h及撤机前曲线斜率,并同时记录每分钟通气量(MV)、平均气道压（Pmean）、吸入氧浓度（FiO2）;观察异常通气(人机对抗、气道部分及完全梗阻、气道漏气、气管导管脱出气道)时动态P-V曲线形态特点。结果：随着肺部病变的改善,曲线斜率、MV逐渐增高,动态P-V曲线向纵轴移动,Pmean、FiO2逐渐降低。机械通气1,24,48,72 h及撤机前曲线斜率分别为(0.76±0.53),(0.81±0.55),(1.05±0.48),(1.10±0.42),(1.13±0.37) mL/cmH2O,机械通气48,72 h及撤机前斜率与1 h比较,差异有显著性(P＜0.05或P＜0.01)。异常通气时动态P-V曲线形态均有异常改变。结论：机械通气时动态P-V曲线斜率逐渐增大、曲线向纵轴移动的趋势反映了肺部病变的改善,其形态变化对于判断异常通气有重要作用,有助于减少机械通气并发症。［中国当代儿科杂志,2009,11（7）：525-528］     

Management of neonatal respiratory distress syndrome

Significant advances have been made in the management of respiratory distress syndrome over the last number of years. Prenatal corticosteroids for lung maturation and postnatal surfactant replacement therapy have reduced the incidence, severity, and mortality associated with RDS. In this review we will examine the role of a more gentle approach to newborn stabilization and early respiratory care with the aim of improving survival whilst preventing lung injury.     

An uncommon cause of neonatal respiratory distress

We describe a term infant without any features of congenital infection, who presented with respiratory distress at birth. Respiratory distress persisted despite change of antibiotics, and chest radiography showed bilateral diffuse patchy infiltrates. Congenital infections screening obtained on the 10th day of life was reported positive for syphilis. The infant was started on penicillin G and came off oxygen within five days. Although the presentation of congenital syphilis as pneumonitis in the absence of other clinical signs is unusual, in view of the re-emergence of the disease, syphilitic involvement of the lungs should be considered in any infant presenting with persistent diffuse lung disease of unknown etiology.     

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。     

Surfactant replacement therapy in neonatal respiratory distress syndrome

We conducted a prospective, randomized, controlled trial comparing the efficacy of two doses of a reconstituted bovine surfactant (Surfactant TA) in premature infants requiring mechanical ventilation shortly after birth for respiratory distress syndrome. Forty-six infants weighing 1000–1499 g were randomized into two groups: a low-dose group (23 infants given a single dose of 60 mg surfactant lipid/kg) and a high-dose group (23 infants given a single dose of 120 mg/kg). The mean (SD) age at which surfactant was given was 5.5 (±1.2) h in the low-dose group and 6.0 (±1.5) h in the high dose group. Both treatments improved oxygenation (increased arterial-alvcolar PO₂ ratio) with decreased mean airway pressure, the high-dose surfactant having a more beneficial effect in prolonging the response. Infants in the high-dose group had significantly less (P<0.05) incidence of both intraventricular haemorrhage and bronchopulmonary dysplasia. This prospective trial documents that a greater benefit can be obtained by increasing the dose of surfactant (120 mg/kg) beyond 60 mg/kg in the treatment of premature infants with severe respiratory distress syndrome (RDS).Abbreviations RDS respiratory distress syndrome - Surfactant TA Surfactant Tokyo-Akita - 5 kDa 5 kilodaltons - ELISA enzyme-linked immunosorbent assay - PDA patent ductus arteriosus - a/APO₂ arterial-alveolar oxygen tension ratio - MAP mean airway pressure - ^99mIc-DTPA 99m technetium diethylenetriamine pentacetate     

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.     

足月儿呼吸窘迫综合征高危因素及防治

近年来,随着择期剖宫产率等因素增加,足月儿呼吸窘迫的发生率也呈上升趋势,已引起广泛关注.本文从母婴两方面重点综述了发生足月儿呼吸窘迫综合征的高危因素及相关机制.发现选择性剖宫产、胎龄、胎儿性别以及某些妊娠合并症均能影响足月儿呼吸窘迫综合征的发病率.并指出一旦呼吸困难加重,要及时使用呼吸支持和尽早使用肺泡表面活性物质,各种综合措施联合使用可减少足月儿呼吸窘迫综合征的病死率.     

Surfactant replacement therapy for neonatal respiratory distress syndrome

Conclusions Surfactant treatment of RDS improves oxygcnation and ventilation whether given immediately after birth or after the onset of the disease. There is also a decrease in associated morbidity (air leak), and improved survival with no significant short term side effects. Information about long term follow-up is limited, but encouraging. The future should bring better surfactants (recombinant DNA human surfactant) and optimization of timing, multiplicity and size of dose, and technique of ventilation. This will allow for the survival of most of the premature infants beyond 25 weeks gestation with minimal morbidity. Surfactant treatment of RDS will go down as a true landmark in the history of neonatology.     

新生儿急性呼吸窘迫综合征研究进展

新生儿急性呼吸窘迫综合征（ARDS）是新生儿常见的临床危重症,是新生儿致死、致残的主要原因之一。新生儿ARDS病因及发病机制复杂,与各种病理因素导致的继发性肺表面活性物质（PS）缺乏有关,具有炎症性特点。新生儿ARDS作为一种临床综合征,与其他疾病难以鉴别。该病的治疗目前缺乏特效手段,仍是以呼吸支持、PS替代、体外膜肺氧合治疗、营养支持及液体管理等对症及综合治疗为主。该文就新生儿ARDS的病因分类、临床特点、诊断治疗策略等方面的研究进展做一综述。     

新生儿呼吸窘迫综合征的防治

新生儿呼吸窘迫综合征 (NRDS)又称新生儿肺透明膜病 (HMD) ,是发达国家和发展中国家儿童在围生期患病率和病死率均高的疾病。多发生于早产儿 ,是由于缺乏肺表面活性物质 (PS)所引起。临床表现为出生后不久即出现进行性呼吸困难和呼吸衰竭 ;病理以肺泡壁上附有嗜伊红透明膜和肺不张为特征。根据 2 0世纪 80年代北美统计 ,全部活产儿中其发生率为 0 5 %～ 1 0 % ,早产儿发生率为10 %～ 16 % ;NRDS占全部新生儿死亡原因的 30 % ,占早产儿死亡原因的 5 0 %～ 70 %。国内湖北省妇幼保健院 10年内统计资料表明在活产婴儿中其发生率为 0 31…