Respiratory distress in a special care baby unit in Nigeria

Although respiratory distress is common among African newborn infants in special care, respiratory distress syndrome, which is the commonest cause of respiratory distress in other races, has been reported as uncommon among African infants. A prospective study of 312 consecutive newborn Nigerian infants admitted to a special care unit revealed 103 (33%) with respiratory distress. In 100 cases studied there was transient tachypnoea of the newborn ( TTN ) in 40% while specific diseases such as pneumonia and septicaemia, severe aspiration syndromes and respiratory distress syndrome (RDS) accounted for 25%, 19% and 12%, respectively. TTN and RDS occurred mostly among preterm infants with moderate perinatal asphyxia while severe aspiration syndrome was found among term infants with severe birth asphyxia. The study suggests that prevention and/or improved management of perinatal asphyxia and infections should reduce the incidence and mortality associated with neonatal respiratory distress.     

Contribution of interleukin-6 in distinguishing between mild respiratory disease and neonatal sepsis in the newborn infant

The purpose of this study was to investigate if early samples of interleukin-6 (IL-6) could distinguish early bacterial sepsis from respiratory diseases in the newborn. IL-6 and C-reactive protein (CRP) were measured at onset of symptoms in newborns evaluated for sepsis during the first week of life. Five groups of children were investigated: proven sepsis, clinical sepsis, respiratory distress syndrome (RDS), transient tachypnoea of the newborn (TTN) and controls. IL-6 was also analysed at the time when CRP was at its maximum level. The results showed that initial IL-6 distinguished proven and clinical sepsis from TTN, but not from RDS. Initial CRP was of no value for diagnosis. Our conclusion is that early IL-6 makes it possible to avoid antibiotics in children with TTN and contributes to the diagnosis of sepsis faster than CRP.     

Expression of water and ion transporters in tracheal aspirates from neonates with respiratory distress

Aim:  The aim of the study was to determine whether neonatal respiratory distress is related to changes in water and ion transporter expression in lung epithelium.
Methods:  The study included 32 neonates on mechanical ventilation: 6 patients with normal lung X-rays (control group), eight with respiratory distress syndrome (RDS), eight with transient tachypnea of the newborn (TTN), 10 with abnormal lung X-rays (mixed group). The protein abundance of water channel AQP5, epithelial sodium channel (ENaC; α-, β- and γ-ENaC) and Na⁺, K⁺-ATPase α1 were examined in tracheal aspirates using semiquantitative immunoblotting.
Results:  β-ENaC level was significantly lower in RDS group compared with infants with TTN and infants in the control group. AQP5 expression was significantly higher in TTN compared with the infants with RDS and all other infants with abnormal lung X-rays.
Conclusion:  Neonatal respiratory distress is associated with changes in β-ENaC and AQP5 expression. The lower β-ENaC expression may be one of the factors that predispose to the development of RDS. The higher AQP5 expression may provide the possibility for reabsorption of postnatal lung liquid, which contributes to quick recovery of infants with TTN.     

Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery

AIM: To establish whether the timing of delivery between 37 + 0 and 41 + 6 wk gestation influences neonatal respiratory outcome in elective caesarean delivery, following uncomplicated pregnancy, thus providing information that can be used to aid planning of elective delivery at term. METHODS: All pregnant women who were delivered by elective caesarean delivery at term during a 3-y period were identified from a perinatal database and compared retrospectively with pregnant women matched for week of gestation, who were vaginally delivered. Maternal characteristics, neonatal outcome, incidence of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) were analysed. During this time, 1284 elective caesarean section deliveries occurred at or after 37 + 0 wk of gestation. RESULTS: Neonatal respiratory morbidity risk (odds ratio, OR), including RDS and TTN, was significantly higher in the infant group delivered by elective caesarean delivery compared with vaginal delivery (OR 2.6; 95% CI: 1.35-5.9; p < 0.01). While TTN risk in caesarean delivery was not increased (OR 1.19; 95% CI: 0.58-2.4; p > 0.05), the RDS risk was significantly increased (OR 5.85; 95% CI: 2.27-32.4; p < 0.01). This RDS risk is greatly increased in weeks 37 + 0 to 38 + 6 (OR 12.9; 95% CI: 3.57-35.53; p < 0.01). After 39 + 0 wk, there was no significant difference in RDS risk. CONCLUSIONS: Infants born by elective caesarean delivery at term are at increased risk for developing respiratory disorders compared with those born by vaginal delivery. A significant reduction in neonatal RDS would be obtained if elective caesarean delivery were performed after 39 + 0 gestational weeks of pregnancy.     

Effect of placenta previa on neonatal respiratory disorders and amniotic lamellar body counts at 36–38 weeks of gestation

Background

Pregnancies with placenta previa are significantly associated with preterm delivery and cesarean section. Therefore particular attention should be paid to the incidence of neonatal respiratory disorders in pregnancies with placenta previa.

Aims

The purpose of this study is to examine the relationship between placenta previa and neonatal respiratory disorders, including respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN), and to evaluate the impact of placenta previa on the amniotic lamellar body count (LBC) values.

Methods

We analyzed the data from 186 registered elective cesarean cases without fetal or maternal complications at 36–38 weeks of gestation. Amniotic fluid samples were analyzed immediately without centrifugation, and the LBC was measured using a platelet channel on the Sysmex XE-2100.

Results

RDS was present in four neonates (2.2%) and TTN in 12 neonates (6.5%). The rate of TTN was significantly higher and the LBC values were significantly lower in the placenta previa group than in the control group (P = 0.002 and P = 0.024). The adjusted odds ratio for neonatal TTN was 7.20 (95% confidence interval: 6.58–7.88) among females with placenta previa. In placenta previa, warning bleeding was a significant factor protecting against neonatal respiratory disorders (P = 0.046).

Conclusions

Placenta previa in itself is a risk factor for neonatal TTN. When an elective cesarean section is performed in cases with uncomplicated placenta previa, special care should be taken to monitor for neonatal TTN even at 36–38 weeks of gestation.     

Stable microbubble test on tracheal aspirate for the diagnosis of respiratory distress syndrome

BACKGROUND: Exogenous surfactant should be used as early as possible in the presence of respiratory distress syndrome (RDS), but diagnosis may only become clear late in the course of the disease. The stable microbubble test (SMT) in the tracheal aspirates could help in the decision to give early surfactant to preterm babies with respiratory distress. OBJECTIVES: The objective of this study was to evaluate the accuracy of the SMT on tracheal aspirate for the diagnosis of RDS in newborns requiring mechanical ventilation. METHODS: The test was performed on specimens obtained from 74 infants requiring mechanical ventilation, through routine suctioning. RESULTS: Patients with RDS and meconium aspiration syndrome (MAS) had a significantly lower stable microbubble count than non-RDS and non-MAS patients. Preterm infants without RDS had a significantly higher microbubble count than preterm babies with RDS and a similar count to that of term babies. Considering a cutoff point of 120 microbubbles/mm(2) for the diagnosis of RDS, the sensitivity of the microbubble test was 96.3% (95% CI: 79.1-99.8) and the specificity 97.6% (95% CI: 85.9-99.9). CONCLUSIONS: The SMT on tracheal aspirates is accurate for RDS diagnosis and may be useful to support the decision to give surfactant to newborns on mechanical ventilation.     

产前应用糖皮质激素预防足月择期剖宫产儿呼吸窘迫综合征系统评价和Meta分析

目的：系统评价产前应用糖皮质激素（GC）预防足月择期剖宫产新生儿呼吸窘迫综合征（RDS）的有效性和安全性。 方法：计算机检索PubMed、Embase、Cochrane图书馆、ClinicalTrials.gov、中国生物医学文献服务系统（CBM）、万方数据库、中国知网（CNKI）和维普期刊数据库（VIP）,纳入足月妊娠择期剖宫产的孕妇产前给予GC预防新生儿RDS的RCT,试验组产前给予GC治疗（药物种类、剂量、给药途径、疗程不作限制）,对照组给予安慰剂或为空白对照。采用主题词与自由词相结合的方式进行检索,检索时间均为建库至2018年4月19日。主要结局指标为新生儿RDS发生率和新生儿病死率,次要指标为新生儿暂时性呼吸增快（TTN）发生率、新生儿呼吸困难发生率、因呼吸困难入住NICU率、新生儿败血症发生率、产妇感染率及不良反应发生率。按照Cochrane手册推荐的RCT的偏倚风险评估工具评价纳入文献的偏倚风险。采用RevMan5.3软件进行Meta分析。 结果：共纳入4篇RCT文献3 893例单胎新生儿。4篇文献质量中等。Meta分析显示,试验组和对照组新生儿RDS发生率差异有统计学意义（OR=0.45,95%CI：0.24～0.83）,新生儿病死率差异无统计学意义;试验组和对照组TTN发生率（OR=0.41,95%CI：0.29～0.59）、新生儿因呼吸困难入住NICU率（OR=0.42,95%CI：0.29～0.63）和新生儿呼吸困难发生率（OR=0.34,95%CI：0.22～0.53）差异均有统计学意义。1篇文献报告了新生儿败血症发生率和产妇感染率,两组差异均无统计学意义。产前应用GC,并未引起母亲严重的不良反应率。 结论：基于现有临床证据,产前使用1疗程的GC可以降低足月单胎择期剖宫产儿RDS风险。     

Plasma endothelin-1 like immunoreactivity levels in neonates

We attempted to determine the plasma endothelin-1-like immunoreactivity (ET-1) levels and to evaluate its physiological significance in 29 neonates: 5 with respiratory distress syndrome (RDS), 3 with transient tachypnoea of the newborn (TTN), 4 with neonatal asphyxia, 5 with bronchopulmonary dysplasia (BPD) following RDS, 7 healthy preterm infants and 5 healthy full-term infants. Plasma ET-1 levels in infants with RDS were significantly higher than those in healthy full-term infants through the 1st week of life. Plasma ET-1 levels in infants with neonatal asphyxia were high on the first 2 days of life and then gradually decreased to those of healthy full-term infants. Plasma levels in infants with TTN were the same as those in healthy full-term infants. Plasma ET-1 levels in infants with BPD were high when compared with those in healthy preterm infants during the first 2 months of life. This study showed that plasma levels were markedly elevated for a long time in the infants with respiratory distress. We speculate that plasma ET-1 may be a specific marker for pulmonary endothelium injury in infants with respiratory distress.     

Epidemiology of respiratory distress of newborns

The present prospective study was conducted to find out the incidence, etiology and outcome of respiratory distress (RD) in newborns. All newborns (n=4505), delivered at this hospital over a period of 13 months, were observed for respiratory problems. Relevant antenatal, intranatal and neonatal information was noted. Cases were investigated for the cause of respiratory distress and followed up for the outcome. The overall incidence of RD was 6.7% Preterm babies had the highest incidence (30.0%) followed by post-term (20.9%) and term babies (4.2%). Transient tachypnea of newborn (TTN) was found to be the commonest (42.7%) cause of RD followed by infection (17.0%), meconium aspiration syndrome (10.7%), hyaline membrane disease (9.3%) and birth asphyxia (3.3%). TTN was found to be common among both term and preterm babies. While Hyaline membrane disease (HMD) was seen mostly among preterms, and Meconium aspiration syndrome (MAS) among term and post-term babies. Overall case fatality ration for RD was found to be 19%, being highest for HMD (57.1%), followed by MAS (21.8%) and infection (15.6%). Our results indicate that RD is a common neonatal problem. TTN accounts for a large proportion of thhese cases. MAS and infection also contribute significantly and are largely preventable. Without adequate ventilatory support HMD and MAS carry high mortality.     

The Role of Lung Ultrasound in Diagnosis of Respiratory Distress Syndrome in Newborn Infants

Background:

Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and mortality. The risk of developing RDS decreases with both increasing gestational age and birth weight.

Objectives:

The aim of this study was to evaluate the value of lung ultrasound in the diagnosis of respiratory distress syndrome (RDS) in newborn infants.

Materials and Methods:

From March 2012 to May 2013, 100 newborn infants were divided into two groups: RDS group (50 cases) and control group (50 cases). According to the findings of chest x-ray, there were 10 cases of grade II RDS, 15 grade III cases, and 25 grade IV cases in RDS group. Lung ultrasound was performed at bedside by a single expert. The ultrasound indexes observed in this study included pleural line, A-line, B-line, lung consolidation, air bronchograms, bilateral white lung, interstitial syndrome, lung sliding, lung pulse etc.

Results:

In all of the infants with RDS, lung ultrasound consistently showed generalized consolidation with air bronchograms, bilateral white lung or alveolar-interstitial syndrome, pleural line abnormalities, A-line disappearance, pleural effusion, lung pulse, etc. The simultaneous demonstration of lung consolidation, pleural line abnormalities and bilateral white lung, or lung consolidation, pleural line abnormalities and A-line disappearance co-exists with a sensitivity and specificity of 100%. Besides, the sensitivity was 80% and specificity 100% of lung pulse for the diagnosis of neonatal RDS.

Conclusions:

This study indicates that using an ultrasound to diagnose neonatal RDS is accurate and reliable too. A lung ultrasound has many advantages over other techniques. Ultrasound is non-ionizing, low-cost, easy to operate, and can be performed at bedside, making this technique ideal for use in NICU.     

胎膜早破与足月新生儿呼吸窘迫综合征的相关分析

目的 明确胎膜早破(PROM)与足月新生儿呼吸窘迫综合征(RDS)的相关性.方法 采用病例对照研究的方法,选择2008年1月-2010年12月出生后在本院新生儿重症监护中心住院、胎龄在37周以上、诊断为RDS的患儿205例为病例组,同期入院、主要诊断为新生儿黄疸(除外感染因素所致者)的410例足月新生儿为对照组.对所有纳入对象的临床资料进行回顾性分析,记录相关信息,包括有无PROM、患儿性别、分娩方式、出生体质量、羊水污染等,探讨PROM与足月儿RDS的关系.结果 1.RDS组RPOM所占比例(30.2％,62/205例)明显高于对照组(15.5％,63/410例),差异有统计学意义(x2=12.276,P＜0.001).2.经单因素分析,PROM、选择性剖宫产、男性、小于胎龄儿、羊水量少、妊娠期血糖偏高及糖尿病、羊水Ⅲ度污染、宫内窘迫、出生时窒息等因素均与足月儿RDS具有相关性(Pa＜0.05),均为RDS的危险因素,而孕母年龄≥35岁、脐带绕颈、胎盘早剥与RDS均无相关性(Pa＞0.05).3.经Logistic回归分析:PROM、选择性剖宫产、男性、妊娠期血糖异常及糖尿病、出生时窒息等与足月儿RDS密切相关.结论 PROM与足月儿RDS密切相关,是足月儿RDS的高危因素之一.     

Correlation between transient tachypnea of the newborn and wheezing attack

Background: Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns. Although associated with some morbidity, it is generally believed that once TTN resolves, there is no further increased risk for respiratory disease. However, in limited studies frequency of wheezing attacks is found to be increased in patients who had TTN diagnosis during the newborn period, in comparison to patients who had no respiratory problem. Thus, the question arises as to whether TTN is an innocent disease. Methods: This study was done retrospectively. We recorded the demographic characteristics of 103 infants born between 17 October 2003 and 17 October 2004 at Zeynep Kamil Hospital and hospitalized because of TTN in the neonatal intensive care unit. In the second phase, we telephoned the parents of the 103 infants and asked about wheezing attacks. A total of 103 other infants, born during the same period, with no health problems during the newborn period, were included in the study as the control group and the same procedures were applied to them. Results: The rate of wheezing attack among patients with TTN diagnosis was found to be significantly higher than that in patients who had no TTN diagnosis (P < 0.01). TTN was found to be an independent risk factor for wheezing attack (OR, 2.378; 95% CI, 1.20–4.70). Conclusion: In conclusion, we established that TTN is an independent risk factor for wheezing. In addition we also hypothesized that genetic and environmental interactions synergistically predisposed these children for future wheezing.     

Pulmonary surfactant protein A in sera for assessing neonatal lung maturation

To examine whether surfactant protein A (SP-A) in postnatal serum can predict the development of respiratory distress syndrome (RDS), we analyzed the relationship between serum concentrations of SP-A and the risk of RDS using sera from neonates within 24 h after birth. A total of 104 blood samples including 23 samples from newborn infants with RDS were obtained. SP-A content in sera was measured with an enzyme-linked immunosorbent assay system consisting of a standard of native SP-A and two monoclonal antibodies against human SP-A. The level of serum SP-A increased with advancing gestation. Since the mean level of serum SP-A in patients with RDS (3.8 ng/ml) was significantly lower than those without RDS (12.0 ng/ml) (P<0.001), we calculated the diagnostic index values at various cutoff points and chose cutoff values to predict the risk of RDS. Maximum diagnostic value of 85% was obtained at a cutoff point of 3.8 ng/ml (sensitivity 57% and specificity 93%). We also chose a cutoff value of 2.1 ng/ml for definitive diagnosis of RDS, and 8.3 ng/ml for exclusive diagnosis of RDS. The adjusted odds ratios of RDS was significantly elevated when SP-A concentration in serum was under the cutoff values. The presence of SP-A in cord blood serum was also confirmed by immunoblotting analysis. We emphasize the value of SP-A examination in cord blood or postnatal serum from infants who exhibited respiratory difficulties at birth. We believe that our results are consistent with the hypothesis that SP-A is a useful serum marker in predicting the development of RDS.     

胃液稳定微泡实验早期诊断早产儿呼吸窘迫综合征

目的：早产儿呼吸窘迫综合征(RDS)需要做出早期诊断才能指导呼吸机和肺表面活性物质的及时使用。该研究的目的是明确胃液稳定微泡实验(stab le m icrobubb le test,SMT)早期诊断早产儿RDS的价值,为预防性使用肺表面活性物质提供指导。方法：对101例收治于日本岩手医科大学新生儿重症监护室的早产儿,胎龄31±3.5周,(24~35周,)生后30 m in内取胃液做SMT,低倍镜下数出每mm2中直径<15μm的稳定微泡数;1 h内拍胸片,以临床表现及X线结果作为诊断早产儿RDS的金标准。计算SMT早期诊断早产儿RDS的敏感度、特异度及阳性、阴性预测值,观察以SMT结果指导肺表面活性物质使用的临床价值。结果：101例早产儿中诊断为RDS者31例,其中微泡数<10个/mm2者22例,10~20个/mm2者7例,>20个mm2者2例;非RDS者共70例,其中<10个/mm2者仅1例,10~20个/mm2者2例,>20个mm2者67例。以胃液微泡数<10个/mm2作为界值,SMT预测并早期诊断RDS的敏感度及特异度分别为70.97%和98.57%,阳性预测值及阴性预测值分别为95.65%和88.46%;以胃液微泡数<20个/mm2作为界值,SMT预测并早期诊断RDS的敏感度及特异度分别为93.55%和95.71%,阳性预测值及阴性预测值分别为90.63%和97.10%。微泡数<10个/mm2者均接受肺表面活性物质替代治疗,临床效果显著。结论：SMT法简便、快速、经济,敏感度高,特异性好,能预测并早期诊断早产儿RDS,有助于指导肺表面活性物质的预防性使用,有极高的临床应用价值,值得在国内推广。     

Comparison of chest radiography and static respiratory compliance in the assessment of the severity of pulmonary diseases in newborns with respiratory distress

In 55 newborn infants with respiratory distress syndrome (RDS) we compared chest radiographs and static respiratory compliance to see which of the two methods would best characterize the severity of pulmonary disease. There was a significant correlation between radiological score and compliance (r_s=−0.5776,n=55,p<0.001). Healthy newborns, newborns with RDS who did not need artificial ventilation and those newborns who needed respirator treatment had significantly different values of radiological score and compliance. RDS may be differentiated into groups of diagnoses. Newborns with HMD could be separated from those with wet lung syndrome or aspiration pneumonia by analyzing the radiogram or measuring the compliance. When survivors are compared with those newborns who died, the static respiratory compliance alone could predict the final outcome.     

Evaluation of surfactant function at birth determined by the stable microbubble test in term and near term infants with respiratory distress

Surfactant function using the stable microbubble test (SMT) was investigated in term or near term infants with respiratory distress. Newborn infants 34 weeks gestation with an initial clinical hypothesis of transient tachypnoea of the newborn (TTN) needing supplemental oxygen and controls were included. Gastric aspirates were collected immediately after birth for SMT. The first chest X-ray films were examined by three independent radiologists and according to their interpretation the babies were divided into a TTN, a respiratory distress syndrome of the newborn (RDS), or a poorly-defined X-ray group. A total of 32 infants with respiratory distress and 32 controls with similar gestational age and birth weight were studied. The median and interquartile range (IQR) of the stable microbubble (SMB) count was significantly lower (P<0.001) for the respiratory distress group than for the control group (17; range 6–33 versus 120; range 79–275). The proportion of babies with less than 35 stable microbubbles/mm² (SMB/mm²) was significantly different for the whole respiratory distress group (24/32–75%) and for the TTN (9/13–69%), the RDS (5/5–100%), and the poorly-defined (10/12–83%) groups as compared with the controls (2/32–6%; P<0.05). A total of 24/26 babies (92%) who needed oxygen for 24 h but only 1/6 (17%) of them who needed <24 h had a bubble count of less than 35 SMB/mm² (P<0.05). Conclusion: the results suggest that deficiency or dysfunction of the surfactant system is involved in the majority of cases of respiratory distress in near term and possibly term babies. The stable microbubble test can enable clinicians to take an earlier decision to give surfactant to term or near term infants with more severe and progressive respiratory distress.Abbreviations RDS respiratory distress syndrome of the newborn - SMB stable microbubbles - SMT stable microbubble test - TTN transient tachypnoea of the newborn     

Restricted versus Standard Maintenance Fluid Volume in Management of Transient Tachypnea of Newborn: A Clinical Trial

Objective: The incidence of Transient Tachypnea of Newborn (TTN) is higher in infants born by cesarean section than with  vaginal delivery. Treatment of transient tachypnea of newborn is supportive. The purpose of this study was to assess the effect of restricted fluid volume intake on the course of respiratory distress in patients with TTN. Methods: This is a quasi-experimental clinical trial of 83 neonates diagnosed with TTN admitted to a neonatal intensive care unit in south west Iran. In this study the effect of restriction of maintenance fluid volume in the course of respiratory distress in newborns with transient tachypnea was assessed. Findings: In the standard fluid volume intake group 18 (42.8%) cases needed nasal continuous positive airway pressure (NCPAP) and one (2.38%) case mechanical ventilation, and in restricted fluid volume intake group 13 (32.5%) cases needed NCPAP and two (5%) cases mechanical ventilation. 54.82% of cases were supported with oxyhood in the standard fluid volume and 62.5% in the restricted fluid volume intake group. Differences in duration of the needed NCPAP and oxygen hood between the two groups were significant. Fluid restriction had no adverse effect on the urine specific gravity or weight loss of the studied newborns. Conclusion: Limited fluid administered to newborns with transient tachypnea of newborn is safe and resulted in shorter duration of respiratory support.Key Words: Transient Tachypnea of Newborn, Specific Gravity, Fluid, Newborns, Cesarean Section     

Evaluation of Diagnostic Value of Procalcitonin as a Marker of Neonatal Bacterial Infections

Objective

This study tried to assess sensitivity, specificity, positive and negative predictive value of procalcitonin for diagnosis of neonatal bacterial infections.

Methods

This prospective cross sectional study was carried out during an 18-month period in NICU and neonatal wards of Besat Hospital in Hamedan province, Iran. 39 symptomatic infants with clinical and laboratory findings in favor of bacterial infection with a positive blood, CSF, and/or supra pubic urine culture entered the study; 32 newborns without any bacterial infection served as control group. Quantitative procalcitonin level ≥0.5 ng/ml was accepted as pathological. Finally sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were calculated for procalcitonin test.

Findings

20 blood cultures, 17 urine cultures and 8 CSF cultures were positive. Sensitivity, specificity, PPV and NPV for procalcitonin test was 76.9%, 100%, 100% and 78% respectively. Diagnostic value of procalcitonin test in accordance with blood culture for mentioned items was 85%, 100%, 100% and 91.4% respectively. Its diagnostic value according to urine culture was: sensitivity 70.6%, specificity 100%, PPV 100% and NPV 86.4%, and according to CSF culture was: sensitivity 75%, specificity 100%, PPV 100% and NPV 94.1% respectively.

Conclusion

The results show that the procalcitonin test has high sensitivity, specificity, PPV and NPV for diagnosis of neonatal infections.     

血浆IL-6与IL-27在鉴别早产儿急性呼吸窘迫综合征与呼吸窘迫综合征的初步研究北大核心CSCD

目的 探讨血浆白细胞介素(interleukin,IL)-6、IL-27在鉴别早产儿急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)及新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)中的价值。方法 前瞻性纳入2021年3~11月重庆医科大学附属儿童医院新生儿诊治中心具有呼吸窘迫表现的早产儿,根据诊断结果分为ARDS组(n=18)及NRDS组(n=20)。采用酶联免疫吸附试验法检测患儿血浆IL-6和IL-27水平,受试者工作特征(receiver operating characteristic,ROC)曲线分析各指标诊断ARDS的价值。结果 ARDS组血浆IL-6及IL-27水平均高于NRDS组(P<0.05)。ROC曲线分析显示:当IL-6取56.21 pg/m L时,曲线下面积、灵敏度和特异度分别为0.867、61.1%、95.0%;当IL-27取135.8 pg/m L时,曲线下面积、灵敏度和特异度分别为0.881、83.3%、80.0%。结论 血浆IL-6和IL-27可作为早期鉴别早产儿ARDS与NRDS的生物学指标。     

Neonatal complications of extreme prematurity in mechanically ventilated infants

Previous data have suggested that neonatal complications amongst preterm ventilated infants increase with decreasing gestational age and thus are likely to be greatest among ventilated infants of less than 28 weeks gestational age. The aim of this study was to test that hypothesis, thus we report the neonatal complications of 175 extremely preterm mechanically ventilated infants (gestational age 28 weeks). Of the infants 152 were ventilated because of respiratory distress syndrome (RDS) or respiratory distress of severe prematurity, 41% of these infants died. Amongst infants with RDS or respiratory distress of extreme prematurity, mortality was significantly increased in infants of gestational age 24 weeks and birth weight 1000 g. In this group 20% developed a pneumothorax, and mortality was inversely related to gestational age. In infants with RDS, 43% developed a periventricular haemorrhage and 37% were still oxygen-dependent at 28 days of age; neither of these complications was significantly related to birth weight or gestational age. Of infants with RDS 38% developed a patent ductus arteriosus and 16% developed retinopathy of prematurity. These data suggest that even amongst very immature infants there has been an impressive reduction in the neonatal complications of mechanical ventilation.