Surfactant therapy in neonates with respiratory failure due to haemorrhagic pulmonary oedema

We studied the clinical and biochemical factors associated with surfactant dysfunction and factors affecting the responsiveness to exogenous surfactant among 27 neonates with haemorrhagic pulmonary oedema (HPE). HPE was defined as the presence of a large amount of blood-stained lung effluent and respiratory failure which was difficult to differentiate from respiratory distress syndrome. Among the neonates, 33% had very low birth weight, 96% were preterm, 70% were delivered by caesarean section, and 44% had delivery room intubation. The onset of HPE was at 1.5±0.1 h (mean ± SEM) after birth. In 26 cases, surfactant was administered at 3.0±1.3 h after the onset of HPE. The concentrations of surfactant protein A (SP-A), disaturated phosphatidylcholine (DSPC), and albumin in the epithelial lining fluid were determined using the first lung effluent from the patients. The level of inhibitory activity against pulmonary surfactant in the effluent was determined in vitro. Surfactant inhibitory activity was associated with lower birth weight, earlier gestational age, delivery room intubation, earlier onset of HPE, and lower SP-A or DSPC concentration. A good response to exogenous surfactant, which was defined as ventilatory index <0.047 at 1 h after surfactant administration, was seen in 82% of cases, and was associated with lower serum albumin, lower birth weight, and earlier gestational age. Cases with higher DSPC concentration prior to surfactant administration and shorter interval between the onset of HPE and surfactant administration showed an immediate response to surfactant, followed by no increase in ventilatory index for 24 h after surfactant administration. Conclusion: exogenous surfactant appeared to be a useful adjunctive therapy for overcoming surfactant inhibition and normalising the respiratory status of infants with haemorraghic pulmonary oedema. Surfactant treatment for this indication awaits further investigations including a randomised controlled study.Abbreviations ALB albumin - AS airway specimen - DSPC disaturated phosphatidylcholine - ELF epithelial lining fluid - HPE haemorrhagic pulmonary oedema - In natural logarithm - RDS respiratory distress syndrome - SP-A surfactant protein A - VI ventilatory index - _min minimum surface tension     

肺表面活性物质治疗新生儿呼吸窘迫综合征的临床对照研究

目的　探讨肺表面活性物质 (PS)治疗新生儿呼吸窘迫综合征 (NRDS)的有效性及临床价值。方法　采用气管内滴注单剂PS治疗NRDS患儿 2 5例 ,并与同期未用PS治疗的 2 5例NRDS患儿进行前瞻性临床对照研究。结果　治疗组在应用PS后 2～ 3h皮肤颜色转红 ,经皮血氧饱和度逐渐升高。 6h后动脉血氧分压 (PaO2 )、动脉 /肺泡血氧分压比值 (a/APO2 )及呼吸机有效指数 (VEI)分别由 ( 48± 14)mmHg( 1mmHg =0 .133kPa)、0 .14± 0 .0 6及 ( 0 .16± 0 .0 9)ml/ (mmHg·kg)上升到 ( 6 5±2 9)mmHg、0 .2 4± 0 .15及 ( 0 .2 9± 0 .16 )ml/ (mmHg·kg) ;而氧合指数 (OI)、吸入氧浓度 (FiO2 )及平均气道压 (MAP)由 11.6± 5 .7、0 .5 9± 0 .13及 ( 15 .6± 3.1)cmH2 O( 1cmH2 O =0 .0 98kPa)逐渐降低至 6 .3±3 .4、0 .47± 0 .10及 ( 13 .5± 2 .4)cmH2 O。经广义线性模型方差分析 ,主效应、分组因素及时间因素对两组PaO2 、a/APO2 、OI、FiO2 、MAP及VEI的值具有明显影响。而分组与时间因素的交互作用无显著影响。治疗组机械通气及氧疗时间较对照组明显缩短 ,二者差异有显著性。结论　PS能有效地改善NRDS患儿肺顺应性及氧合功能 ,缩短需要机械通气及氧疗时间。     

肺表面活性剂治疗新生儿呼吸窘迫综合征疗效的影响因素

目的　 观察肺表面活性剂 (PS)对新生儿呼吸窘迫综合征 (NRDS)疗效的影响因素。 方法 　采用回顾性病例对比分析方法 ,对 42例经气管注入接受PS治疗的NRDS患儿 ,按PS治疗前 5min血气分析结果 ,分为 pH <7 2 5 (A)和 pH≥ 7 2 5 (B)组。观察两组PS治疗前后a/APO2 的变化。再将每一组分别按孕周和体重大小分为孕周 <3 1周和孕周≥ 3 1周组、体重≥1 75kg和体重≥ 1 75kg组。观察不同孕周和不同体重患儿接受PS治疗前后a/APO2 的变化。 结果 　A、B两组患儿PS治疗前a/APO2 均无显著差异 ,PS治疗后 0 5、1、6、12h时 ,B组的a/APO2 均明显高于A组 ,差异有显著意义 (P均 <0 0 5 )。A组内孕周≥ 3 1周的患儿 ,PS治疗前a/APO2 明显低于孕周 <3 1周组 ,差异有显著意义 (P <0 0 5 ) ,PS治疗后各个观察时间 ,两组的a/APO2 均无显著差异。A组内体重≥ 1 75kg的患儿 ,PS治疗前a/APO2 明显低于体重 <1 75kg组 ,差异有显著意义 (P <0 0 5 ) ,PS治疗后各个观察时间 ,两组a/APO2 无显著差异。PS治疗前和治疗后 ,B组内不同孕周和不同体重患儿的a/APO2 均无显著差异。 结论 　严重酸中毒可减弱PS对NRDS患儿的疗效     

Surfactant therapy for respiratory failure due to near-drowning

We report a nearly drowned 3-year-old boy who was treated successfully with exogenous bovine surfactant. Exogenous surfactant should be administered to patients with refractory respiratory failure based on the pulmonary pathophysiology in near-drowning.     

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     

肺表面活性剂治疗对新生儿呼吸窘迫综合征肺功能影响的研究

目的观察肺表面活性剂(PS)对新生儿呼吸窘迫综合征(NRDS)肺功能的影响.方法用PS固尔舒治疗10例NRDS患儿.观察治疗前后血气、肺泡充气程度和胸肺总有效动态顺应性的变化.结果用药后30min,PO2和动脉-肺泡氧分压比值(a/APO2)与用药前比较明显升高,用药后1、6、12、24h和3天,PO2和a/APO2仍高于用药前水平,差异均有显著意义(均为P＜0.05).用药后6h,PCO2显著下降,12、24h和3天,PCO2进一步下降,与用药前比较,差异均有显著意义(均为P＜0.05).用药后6h,胸肺总有效动态顺应性较用药前明显升高(P＜0.05),12和24h仍在较高水平,与用药前比较,均为P＜0.01.同时,X线胸片显示肺野透亮度明显改善.结论PS固尔舒能有效改善NRDS的肺换气和通气功能、肺泡充气程度以胸肺总有效动态顺应性.     

Risk factors for early sepsis in very low birth weight neonates with respiratory distress syndrome

AIM: To identify maternal and neonatal factors that increase suspicion of early sepsis in Very Low Birth Weight neonates with respiratory distress syndrome. METHODS: The cohort included 282 neonates born at Soroka Medical Centre 1996-2000. Definitions of 'high' and 'low'-suspicion groups for early sepsis were based on comparison between neonates with early sepsis and the remaining cohort. Univariate analysis and logistic regression were used to compare between groups. RESULTS: The incidence of early sepsis in the cohort was 1.8%, and 94% received antibiotics following delivery. Comparing with the remaining cohort, the five neonates with early sepsis had increased incidence of positive maternal cultures, use of antenatal antibiotics, lower 1 min Apgar scores and tendency to leucopenia. A 'low-suspicion' group comprised 38% of the cohort and did not include any neonates with early sepsis. This group were more frequently treated with antenatal steroids and delivered by Caesarean section compared to the 'high-suspicion' group, but otherwise there were no clinical and laboratory differences. CONCLUSION: Although the incidence of early sepsis is low almost all neonates received antibiotics. A 'low-suspicion' group was defined and the role of antibiotic treatment in this group needs to be determined.     

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目的归纳新生儿呼吸窘迫综合征(RDS)的临床特点,观察肺表面活性物质(PS)在机械通气治疗新生儿RDS中的作用。方法收集2006年9月至2008年2月在河北省儿童医院新生儿科住院治疗的168例RDS患儿临床资料,平均胎龄为(32.3±3.7)周,平均体重为(1.73±0.75)g。观察比较国产PS(珂立苏,calsurf)应用前后的主要血气指标、呼吸机参数、机械通气模式以及并发症、转归等。结果应用PS在0、1、12和72h不同时点的比较显示:吸氧浓度(FiO2)分别为0.51±0.11、0.32±0.1、0.28±0.08和0.26±0.09。应用PS1h时,RDS患儿所需FiO2明显下降,此后下降幅度逐渐减小(P<0.05)。动脉血氧分压PaO2/吸入氧浓度FiO(2P/F)和动脉血氧分压/肺泡氧分压a/APO2比值则随时间变化呈逐渐增高趋势,但差异无统计学意义(P>0.05)。结论PS能较快地改善新生儿RDS氧合状况;肺保护性通气策略正在为越来越多的临床医生接受。     

Comparative randomized study: Administration of natural and synthetic surfactant to premature newborns with respiratory distress syndrome

BACKGROUND: The respiratory distress syndrome (RDS) in premature newborns has been etiologically correlated to immature lungs and specifically with surfactant deficiency. Exogenous administration of surfactant is nowadays considered to be the treatment of choice. In this paper we attempt a comparison of clinical results from the administration of natural Alveofact and synthetic Exosurf surfactants in premature newborns with respiratory distress syndrome. METHODS: The study subjects were 92 premature newborns who had been hospitalized in the Department of Neonatology, of the University of Crete. A total of 42 subjects received synthetic surfactant and 50 subjects received natural surfactant. The surfactant was administered in one to three doses, depending on respiratory support requirements. RESULTS: The time of administration was a little longer for the natural surfactant group. The duration of mechanical ventilatory support, requiring oxygen, the duration of hospitalization and the percentage of increase of arterial alveolar partial pressure oxygen ratio (a/APO2) were slightly higher for the synthetic surfactant group. The mortality rate during the neonatal period (28th day) was higher for the synthetic surfactant group than for the natural surfactant group (38.1 vs 24%). A similar tendency was noticed also as regards to complications, e.g. pneumothorax (11.2 vs 5.2%; relative risk (RR) 0.27) intraventricular hemorrhage (34.6 vs 21.1%; RR 0.61), septicemia (11.5 vs 5.2%; RR 0.46) and bronchopulmonary dysplasia (12.5 vs 2.8%; RR 0.22). CONCLUSION: The use of natural surfactant seems to offer more advantages in comparison with its synthetic counterpart.     

Lung function in immature baboons with respiratory distress syndrome receiving early caffeine therapy: a pilot study

AIM: The cardiopulmonary effects of early caffeine therapy in surfactant-treated immature baboons were measured. METHODS: Nine 125-d (term = 185 d) baboons receiving caffeine citrate at 1 and 12 h age as part of a pilot study on the use of nasal CPAP at 24 h were compared to six untreated animals destined for prolonged ventilator support. All received surfactant prior to their first breath and again at 6 h age. Serial physiologic and ventilatory parameters were recorded. Lung mechanics were measured by body plethysmography. Data were compared from 1 through 24 h age. RESULTS: There were no between-group differences in any study variables prior to caffeine therapy at 1 h age. Airway resistance (RA) was significantly lower in caffeine-treated compared to non-caffeine-treated animals at 12 and 24 h age [median (range)12 h: 47 (35-107) cm H2O/l/s to 135 (120-259) cm H2O/l/s; and 24 h: 93(60-137) cm H2O/l/s to 211 (86-235) cm H2O/l/s; p < 0.05]. Respiratory system compliance (CRS) was higher in caffeine-treated compared to non-caffeine-treated animals at 18 and 24 h age [median (range) 18 h: 0.60 (0.29-1.58) ml/cm H2O/kg to 0.39 (0.33-0.46) ml/cm H2O/kg; and 24 h: 0.68 (0.36-1.20) ml/cm H2O/kg to 0.36 (0.33-0.55) ml/cm H2O/kg; p < 0.05]. Ventilatory efficiency index and arterial/alveolar ratio significantly improved in caffeine-treated animals over the 24-h study period (p < 0.05, repeated measures ANOVA). CONCLUSIONS: In this pilot study, early caffeine treatment, combined with prophylactic surfactant therapy, was associated with better lung function during the initial 24 h of life. This combined approach may facilitate earlier extubation or prophylactic efforts to support infants on nasal CPAP. Randomized, controlled investigation is warranted.     

Surfactant protein (SP) B associations and interactions with SP-A in white and black subjects with respiratory distress syndrome

BACKGROUND: The etiology of respiratory distress syndrome (RDS) is multifactorial and/or multigenic. Surfactant protein A (SP-A) and/or SP-B genetic variants have been identified as risk or protection factors for RDS. METHODS: We genotyped subjects with and without RDS for the SP-B intron 4 size variants (invariant (inv), deletion (del), insertion (ins) and for four (-18 (A/C), 1013 (A/C), 1580 (C/T), 9306 (A/G)) SP-B single nucleotide polymorphisms (SNP), to study case-control associations in black and white subjects. We also determined whether specific SP-B variants interact with RDS susceptibility or protective SP-A variants to enhance or reduce risk for RDS. RESULTS: Based on odds ratio: (1) the SP-B intron 4 del variant in white subjects is more of an RDS risk factor for males and for subjects of 28 weeks 相似文献   

新生儿呼吸窘迫综合征100例临床分析

目的　 分析新生儿呼吸窘迫综合征的临床特点 ,提高对此病的诊治水平。 方法 　将我院新生儿科 2 0 0 0年 1月—2 0 0 3年 2月收治的 10 0例新生儿呼吸窘迫综合征 (NRDS)分为两组 (孕周 <35周为Ⅰ组 ,孕周≥ 35周为Ⅱ组 ) ,比较他们的临床特点 ,如血气、胸片、合并症、疗效。 结果 　NRDS在同期住院新生儿中占 1 4 %,无效及病死率 40 0 %,明显高于同期我院新生儿病死率 (2 73%) (P <0 0 0 1)。Ⅰ组 73例 ,多在生后 12h内发病 ,1minApgar≤ 6分占 5 0 0 %,剖宫产 5 0 7%,治愈好转率 5 3 4 %;Ⅱ组 2 7例 ,常在 12h后起病 ,1minApgar≤ 6分占 2 1 1%,剖宫产 92 6 %,治愈好转率 77 8%,以上均有显著性差异 (P <0 0 5 ) ;两组患儿泡沫振荡试验及胸片的阳性预测值均在 70 %以上。治愈好转组PaO2 /FiO2 值由 (19 6 0± 13 5 6 )kPa(n =5 6 )上升至(41 34± 2 6 34)kPa(n =5 2 ) ,无效死亡组治疗前后分别为 (2 0 39± 15 39)kPa(n =31)、(2 3 4 9± 2 2 2 0 )kPa(n =15 ) ,治疗后两组的PaO2 /FiO2 值有显著性差异 (P <0 0 5 )。两组合理的产前激素应用率均小于 10 %。 结论 　即使应用CPAP、机械通气、肺表面活性物质 ,NRDS的病死率仍很高 ,应以预防为主 ,产前合理应用肾上腺皮质激素能促胎儿肺成熟     

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.     

肺表面活性物质在儿童急性呼吸窘迫综合征的应用

肺表面活性物质(pulmonary surfactant,PS)是由Ⅱ型肺泡上皮细胞合成分泌的脂质蛋白混合物,主要功能是降低肺泡气-液界面表面张力.急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)时多种原因引起PS的量和质出现变化,导致其功能异常.外源性PS替代治疗可以改善儿童ARDS肺部气体交换,但提高存活率作用不肯定.这可能与ARDS病因、PS成分、给药方法、时机、剂量及次数等不同有关.目前不推荐PS作为儿童ARDS的常规治疗方法.     

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。     

新生儿呼吸窘迫综合征呼吸力学动态监测及临床意义

目的：探讨新生儿呼吸窘迫综合征（ＮＲＤＳ）呼吸力学特征及其与临床的关系。方法：对１７例机械通气下ＮＲＤＳ儿进行了呼吸力学指标、Ｘ线胸片及血气分析检测。结果：呼吸系统顺应性（Ｃｒｓ）与ＮＲＤＳ病情严重程度及预后有关,Ｃｒｓ＜０．３ｍｌ／（ｃｍＨ２Ｏ．ｋｇ）示病情严重,Ｃｒｓ＜０．２ｍｌ／（ｃｍＨ２Ｏ．ｋｇ）病死率高;Ｃｒｓ与氧合指数（ＯＩ）呈负相关关系（ｒ＝－０．９４８）,有直线回归关系：ＯＩ＝６４     

肺表面活性物质对不同胎龄呼吸窘迫综合征新生儿的疗效

目的 探讨肺表面活性物质(PS)对不同胎龄儿呼吸窘迫综合征(RDS)的疗效差异.方法 选择胎龄28～39周,出生体质量760～3 240 g,经PS治疗的RDS患儿67例.早期组:胎龄28～30周的早期早产儿18例;中期组:胎龄31～33周的中期早产儿28例;晚期组:胎龄34周以上的晚期早产儿和足月儿21例.比较3组PS治疗时RDS的重症程度、PS开始使用时间、第1次使用剂量、总剂量、重复使用例数、氧疗时间、最高吸氧体积分数(FiO2)、机械通气时间等指标.结果 PS治疗时早期组和中期组轻度RDS例数明显多于晚期组(Pa＜0.05).中期组和晚期组重度RDS例数明显多于早期组(Pa＜0.05),PS开始使用时间晚期组明显晚于早、中期组(Pa＜0.05).第1次使用剂量早期组明显多于中、晚期组(Pa＜0.05).使用总剂量和重复使用例数各组间均无统计学差异(Pa＞0.05).机械通气时间早、晚期组明显多于中期组(P=0.040);最高FiO2以晚期组最高(P=0.006).结论 早期早产儿RDS病情轻、开始PS治疗时间早、剂量足,但需氧疗和机械通气时间长;晚期早产儿和足月儿RDS病情危重、开始PS治疗时间晚、剂量不足、需氧疗和机械通气时间长.对晚期早产儿和足月儿RDS治疗应尽早、足量使用PS.