Maternal alcohol ingestion and the incidence of respiratory distress syndrome

The risk of respiratory distress syndrome in infants born to mothers with varying quantities of alcohol intake during pregnancy was assessed. In infants less than 37 weeks' gestation, there was a decreasing incidence of respiratory distress syndrome with increasing maternal alcohol consumption (p less than 0.02). In addition, in infants less than 37 weeks' gestation, maternal alcohol ingestion was associated with a decreased risk of respiratory distress syndrome even when adjusted for other factors such as smoking, gestational age, birth weight, Apgar score, and sex of the infant. It is suggested that maternal alcohol ingestion enhances the maturation of the fetal lung.     

Iatrogenic respiratory distress syndrome. An analysis of obstetric events preceding delivery of infants who develop respiratory distress syndrome.

The obstetric events leading to the birth of infants who developed respiratory distress syndrome (RDS) were evaluated. In a retrospective study of 100 consecutive cases it was determined that untimely or unwarranted physician intervention in the pregnancy was responsible for 15 per cent of cases and possibly responsible for another 18 per cent. Recommendations for prevention of "iatrogenic" RDS are made.     

The incidence of acute neonatal respiratory disorders in relation to mode of delivery

Over a 3-year period all infants (n = 7401) born at the Department of Obstetrics and Gynecology, Central Hospital, Bor?s Sweden, were studied for signs of respiratory disease. For all infants who developed signs of respiratory disorders the mode of delivery and the type of anesthesia used in cesarean section (CS) were analysed. The incidence of respiratory disorders in the whole material was 3.0% (n = 220) and the mortality rate for these disorders was 0.24%. There was a significantly higher incidence (p less than 0.001) of respiratory disorders in infants weighing greater than or equal to 2500 g born by CS vis-à-vis infants born by the vaginal route. The group born by elective CS under maternal general anesthesia had a higher (p less than 0.05) rate of respiratory disorders than those born by elective CS under maternal epidural anesthesia. It is concluded that the risk of respiratory disorders in infants delivered by CS is related to the mode of delivery per se. Consequently, a reduction in the proportion of such interventions ought to reduce the overall number of infants developing respiratory disease, as indicated in the present study.     

Prevention of respiratory distress syndrome

RDS continues to be a major problem for premature infants despite a better understanding of its pathophysiology and of ways to try to prevent it. To date, prenatal administration of glucocorticoids has been the most widely used method of accelerating fetal lung development. However, several limitations of this therapy have prompted the search for alternative approaches. Most efforts have focused on the potential use of combined hormonal therapy with glucocorticoids and either thyroid hormones or TRH. The easy transplacental passage of the latter tends to favor its use. The use of hormonal therapy prenatally and surfactant administration at birth appears currently to be the best approach to prevent RDS. The greatest benefit would clearly come from the prevention of prematurity (Fig 1), but this has not proved to be an easy task.     

The relationship between the time from rupture of the membranes to delivery and the incidence of respiratory distress syndrome in premature newborns

The records of 520 deliveries of low birth weight infants were reviewed. A significantly lower incidence of respiratory distress syndrome was seen in cases where the time interval between rupture of membranes and delivery exceeded 1 h as compared to neonates delivered within 1 h after rupture of membranes. Premature infants born after complicated pregnancies had higher rates of RDS than those delivered after uncomplicated pregnancies. It is concluded that postponement of delivery of premature infants for at least a few hours after ROM can reduce the probability of the development of a RDS.     

Effect of parenterally l-arginine supplementation on the respiratory distress syndrome in preterm newborns

l-Arginine (l-Arg) is the precursor of nitric oxide which plays an important role on pulmonary circulation and pulmonary vascular tone. Earlier studies suggested that l-Arg levels in preterm newborns with respiratory distress syndrome (RDS) were low due to its consumption and l-Arg supplementation may reduce the severity of RDS. Our aim was detect the effect of the parenterally l-Arg supplementation on RDS severity. The subjects were chosen between preterm newborns (gestational age <34 weeks) (n?=?30). Twenty of the subjects were diagnosed with permaturity and RDS, and 10 of the subjects were healthy preterm newborns. Ten of the subjects was taken l-Arg (1.5?mmol/kg/d) in addition to routine RDS treatment and assumed as “Group 1”. In this group, daily l-Arg supplementation was started end of the first day, and continued at end of fifth day. The others of the subjects diagnosed with RDS was take routine RDS treatment and assumed as “Group 2”. Healthy preterm newbors assumed as “Group 3”. Blood collections for l-Arg levels via tandem mass spectrometry were made in first day and repeated on the seventh days. Oxygenation index was used to determine severity of RDS. l-Arg consentrations in Group 1 were 8.7?±?4.1?μM/L and 11.9?±?5.0?μM/L in first and seventh day, respectively. l-Arg consentrations were 12.6±4.5?μM/Land 10.9?±?5.4?μM/L in Group 2 and 8.6?±?5.1?μM/L and 9.4?±?4.1?μM/L in Group 3. There is no correlation between l-Arg concentrations and OI also duration of the mechanical ventilation of the subjects in patient groups (Group 1 and 2).     

Current perspectives on iatrogenic neonatal respiratory distress syndrome

Iatrogenic respiratory distress syndrome (RDS) continues to result in significant morbidity and mortality. In this series of 176 cases of neonatal RDS, 8 (4.6%) resulted from errors in obstetric management: poor documentation of fetal maturity prior to elective delivery (6 cases), elective cesarean section with premature rupture of the membranes at 33 weeks of gestation (1) and failure to attempt tocolysis at 32 weeks of gestation (1). One neonatal death occurred among the eight cases. The authors encourage others to analyze their experiences in order to identify this important health care problem.     

Collodion baby and respiratory distress syndrome

The congenital ichthyosis appears mainly in the form of collodion baby. This one can be suspected in case of polyhydramnios associated with a snowy aspect of the amniotic liquid in the antenatal echography. The reported four cases of collodion baby were premature children having presented a respiratory distress syndrome of variable gravity. The pulmonary disease was of multifactorial origin. The outcome was favorable for four children.     

Adult respiratory distress syndrome in obstetrics

Despite the advances in medical technologies, ARDS is highly lethal. In the management of patients with ARDS, certain clinical conditions are common predisposing factors to the development of the syndrome. Infection, sepsis syndrome, and conditions requiring massive transfusion are the most common causes in patients initially managed by obstetricians and gynecologist. Early recognition of ARDS with timely consultation is of paramount importance in these patients. Early in the course of the illness, the patient should be placed in an intensive care unit. Physicians with experience in the altered pulmonary physiology should be included in the team, as well as infectious disease and renal consultants, as the situation demands. Due to the overall relative youth of our obstetric and gynecologic patients and their lack of other underlying diseases, they should do better than most patients with ARDS. However, at least 50% of all patients succumb to the disease itself or to complications inherent in the care needed. Families and treating physicians should be apprised of this early in the course.     

Adult respiratory distress syndrome complicating ovarian hyperstimulation syndrome

A rare case of OHSS complicated by an ARDS from which the patient recovered after appropriate treatment is presented. Pulmonary capillary leakage induced by prostaglandin release, hypoalbuminemia, and shift of dextran 40 macromolecules to the intraalveolar space is considered the most probable reason for this complication.     

Relationship of time interval between steroid therapy and labor to the incidence of respiratory distress syndrome

The authors used Dexamethasone before delivery in 577 cases of pregnancy. There were 460 prematurities. Occurrence of RDS was significantly lower in cases, where delivery took place more than 48 hours after the steroid treatment. Where the steroid effect was not optimum (48 hours), the RDS was similar to that of the control group, although mild in form. In their studies they found no connection between the tocolysis (Partusisten) and the occurence of RDS. They emphasize that in the cases where respiratory insufficiencies are predisponated (elective caesarean section, diabetes mellitus etc.) the steroids significantly reduce the frequency of the disease. Neither the number of apoplexy nor that of death due to infections increase in dexamethasone treatment.     

Effect of repeated doses of dexamethasone on the incidence and severity of respiratory distress syndrome in multifetal gestation between 24 and 34 weeks

The objective of the study was to evaluate the effects of antenatal corticosteroid therapy in multiple pregnancy on the incidence and severity of respiratory distress syndrome (RDS). Twenty-two women with twin, 12 with triplet and 2 with quadruplet pregnancies and an emergency group of 20 mothers with twin pregnancies, who only had one course of dexamethasone, were compared with controls. Corticosteroid therapy was associated with a reduction in moderate to severe RDS in all groups (twins p < 0.01, triplets and quadruplets p < 0.008) and the emergency group with dexamethasone therapy (p < 0.036) when compared to their individual controls. Dexamethasone reduced the duration of stay in the neonatal intensive care unit of the emergency twin group (p < 0.01). Neonatal birth weights were significantly less in all groups treated with repeated doses in comparison to the controls.     

Natural surfactant substitution in respiratory distress syndrome

Natural surfactants consist of unique proteins and lipids. Their effectiveness in improving subnormal lung function in surfactant deficiency should be established prior to any clinical trials. Rigorous tests are required to document batch to batch variability in surface activity and to exclude toxic contaminants. Up to this date randomized clinical trials in small preterm infants have demonstrated a striking improvement in lung function, and a decrease in incidence of acute complications (pneumothorax, interstitial emphysema). Administration of human surfactant at birth or in severe RDS decreased deaths and incidence of bronchopulmonary dysplasia. Although homologous surfactant may not be more advantageous than the heterologous one in terms of its acute beneficial effects on lung function, the safety and efficacy of animal surfactant in improving the outcome remains to be established. Human surfactant may serve as a model for unlimited natural surfactant produced by gene technology. The pharmacodynamics aspects of surfactant substitution, the indications of exogenous surfactant, and the management of the patients undergoing surfactant substitution remain to be studied. Exogenous surfactant offers a potential to treat or prevent severe respiratory failure in infants, children and adults.