Surfactant treatment for respiratory distress syndrome following prolonged rupture of membranes

Surfactant replacement for respiratory distress syndrome (RDS) following very prolonged rupture of the membranes (PROM) is of uncertain value. Seven preterm babies born after PROM (median 48 days, range 22–61 days) were compared with 14 babies without PROM. All had clinical and radiological evidence of severe RDS, requiring mechanical ventilation with inspired oxygen concentrations 60%. Indices of oxygenation and compliance were compared before and serially up to 4h after surfactant treatment. Before treatment the PROM babies had more severe lung disease, based upon higher inspired oxygen concentration and mean airway pressure, and lower arterial/alveolar oxygen tension ratio and ventilator efficiency index. These indices were significantly worse in the PROM group than the comparison group at all times after treatment. The poor response of the PROM group, perhaps because of pulmonary hypoplasia, suggests that surfactant replacement may not be beneficial for RDS in these babies.     

Contemporary neonatal outcome following rupture of membranes prior to 25 weeks with prolonged oligohydramnios

Background

Prolonged oligohydramnios following early preterm prelabour rupture of membranes (PPROM) is traditionally associated with high neonatal mortality and significant risk of pulmonary hypoplasia. However, recent evidence points to an apparent improvement in outcome.

Aims

To document current neonatal outcomes following rupture of membranes prior to 25 weeks with severe persistent oligohydramnios and a latency to delivery of at least 14 days.

Methods

A retrospective case note analysis over a 28-month period at Saint Luc University Hospital, Brussels.

Results

From 23 pregnancies that were complicated by PPROM prior to 25 weeks, 15 infants were born after 24 weeks with a latency of more than 14 days and persistent oligohydramnios. Nine infants (60%) had severe respiratory failure and clinical signs compatible with pulmonary hypoplasia. Seven of these infants (78%) responded to high frequency ventilation and inhaled nitric oxide therapy with good clinical outcome but two died from severe respiratory failure. Five infants showed no clinical signs of pulmonary hypoplasia and responded to conventional neonatal management. One of these infants died at 77 days of age of necrotising enterocolitis. One infant was not resuscitated and died within minutes of birth, following prior discussion with the perinatal team and the parents. Survivors in this high-risk group (73%) had low morbidity at the time of discharge.

Summary

The favourable neonatal survival and morbidity figures are in keeping with recent published evidence. This study confirms improved outcome even amongst the highest risk infants with documented persistent oligohydramnios.     

Effects of prolonged rupture of membranes on the development of respiratory distress syndrome in twin pregnancy

ABSTRACT. One hundred and ten twin infants between 26 to 36 weeks maturity admitted to a neonatal unit over a 3 1/2-year period were studied for the effects of prolonged rupture of membranes (PROM) on the development of respiratory distress syndrome (RDS). Fifty-eight infants were born following PROM, 24 developed RDS; in contrast 34 of the 52 infants who did not have PROM developed RDS. There was a marked difference of incidence of RDS between the presenting infants who had PROM and the non-presenting twins of the same pregnancy with intact gestational sacs (P<0.0005). Among the presenting infants, those with PROM also had significantly lower incidence of RDS compared with those without (P<0.005). This natural and paired controlled study has demonstrated a protective effect of PROM on the development of RDS.     

Perinatal outcome following conservative management of mid-trimester pre-labour rupture of the membranes

To assess perinatal outcome and the effect of antenatal steroid use following conservative management of 86 consecutive singleton pregnancies complicated by pre-labour rupture of membranes (ROM) in the mid-trimester (13–26 weeks; mean 22.8 weeks).

Methodology:

Review of obstetric and neonatal case notes between 1 January 1990 and 31 December 1993.

Results:

The duration of ruptured membranes (latent period) ranged from 1.25 to 105 days (mean 23.8 days; median 14 days) and was inversely related to gestational age at ROM. There was clinical evidence of chorioamnionitis in 39.5% with placental histological changes consistent with chorioamnionitis in 76.6%. All infants were delivered before 33 weeks gestation (mean 26 weeks). Overall, the mortality rate was 43.0% but 62.5% in infants with ROM before 24 completed weeks gestation. Adverse outcome (defined as death, severe intraventricular haemorrhage (IVH) or periventricular leucomalacia (PVL)) occurred in 46.5% and was significantly related to both gestation at delivery and gestation at ROM. In the group ( n = 40) with ROM before 24 weeks gestation, adverse outcome occurred in 65% and was inversely related to gestation at ROM independent of gestation at delivery. Antenatal steroid administration resulted in less adverse outcome independent of gestation at delivery (OR 0.31; 95% CI (0.09–0.98; P = 0.046)).

Conclusion:

From the neonatal perspective conservative management is justified for pregnancies with ROM at or after 24 weeks gestation; in this group the use of antenatal steroids prior to delivery may improve perinatal outcome. A poor outcome is associated with ROM that occurs before 24 weeks gestation.     

Very early prolonged premature rupture of membranes and survival

Fetal survival is possible even with very premature rupture of membranes followed by persisting oligohydramnios, secondary Potter facies and limb deformities. A case history is given with continuous amniotic fluid loss starting at 11⁺⁴ weeks, without development of pulmonary hypoplasia.     

Early functional echocardiogram and inhaled nitric oxide: usefulness in managing neonates born following extreme preterm premature rupture of membranes (PPROM)

Aim: Poor neonatal outcome of preterm premature rupture of membranes (PPROM) <24 weeks' gestational age (GA) is probably a result of abnormalities in both airway and vascular developments, ventilation perfusion mismatch, and possibly persistent pulmonary hypertension of the newborn (PPHN). Perinatal mortality of 50–90% has been reported in the past, with recent literature reporting significant improvement in neonatal survival. We report our 8‐year experience in this group of infants using early diagnostic functional echocardiography (fECHO), high‐frequency ventilation (HFV) and inhaled nitric oxide (iNO). Methods: The obstetric and neonatal databases were searched to identify babies with PPROM (<20 weeks' gestation) or rupture earlier than 25 weeks for more than 14 days. Results: Twenty‐six infants were identified, of whom 20 were admitted to the neonatal intensive care unit (NICU; mean GA 27.8 weeks, mean birth weight (BW) 1207 g). Early echocardiographic data were available in 12/15 infants requiring mechanical ventilation of whom 10 had evidence of PPHN. All infants who received iNO therapy survived to discharge and only two infants died. Survival to discharge was 69% for the whole cohort of infants and 90% for infants admitted to the NICU. In contrast, for the cohort from pre‐iNO and ‐HFV era, the overall survival to discharge was 62% and 66% for the infants admitted to the NICU. Conclusion: Premature infants with PPROM and presumed severe hypoxemic respiratory failure because of hypoplastic lungs often have significant PPHN and may show improvement in oxygenation after treatment with HFV and iNO. Early fECHO results in earlier identification and treatment of infants with PPHN in this high‐risk group.     

胎膜早破对孕母感染及早产儿结局的影响

目的探讨胎膜早破(PROM)对孕母感染及早产儿结局的影响。方法以441例早产儿及其母亲(387例)为研究对象,根据孕母是否胎膜早破分为对照组(无PROM,104例),PROM时间72 h组(90例)及≥72 h组(193例)。比较各组母、婴的临床特点及并发症差异。结果破膜时间≥72 h组孕母的年龄、脐血管炎发生率以及抗生素应用高于对照组和破膜时间72 h组(P0.05);中-重度绒毛膜羊膜炎的发生率高于对照组(P0.05),但与72 h组的差异无统计学意义(P0.05)。破膜时间≥72 h组早产儿肺炎、颅内出血的发生率高于对照组和破膜时间72 h组(P0.01);先天性感染的发生率、住院天数高于对照组(P0.05),但与72 h组的差异无统计学意义(P0.05)。多因素回归分析显示,破膜时间≥72 h是早产儿发生肺炎(P0.05)及颅内出血(P0.05)的独立危险因素。结论破膜时间≥72 h使孕母胎盘炎症发生风险增加,而且与早产儿肺炎、颅内出血发生相关。     

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??Objective To investigate the predictive value of lipopolysaccharide binding protein ??LBP?? in early diagnosis of preterm infection with premature rupture of membrane??PROM??. Methods Totally 93 preterm infants with PROM were enrolled in this study?? and were divided into infection group ??45 cases?? and non-infection group ??48 cases?? according to the discharge diagnosis. Their serum LBP levels were detected within 24 hours after birth. High-sensitivity C-reactive protein ??hs-CRP???? procalcitonin ??PCT?? and interleukin-6 ??IL-6?? levels were compared with LBP. Receiver operator characteristic curve ??ROC?? was drawn and the area under the curve ??AUC?? was calculated. Each parameter was evaluated for the diagnosis of early-onset infection in preterm infants with PROM. In addition?? according to the severity of the disease infection group was further divided into severe infection group??21 cases?? and general infection group??24 cases??. LBP levels were detected in two groups of premature infants to assess the value of LBP in the diagnosis of premature infants with premature rupture of membranes. Results The serum levels of IL-6?? PCT and LBP in the infection group were significantly higher than those in the non-infection group. There was no significant difference on serum levels of hs-CRP between the two groups. The level of LBP in the severe infection group was higher than that in the general infection group?? and the difference between the two groups was statistically significant. The AUC of ROC for LBP ??0.974?? in early-onset bacterial infection of preterm infants with PROM was the highest?? PCT ??0.694?? second?? IL- 6 ??0.588?? third?? and hs-CRP ??0.478?? was the lowest. Conclusion Serum level of LBP is superior to hs-CRP and PCT in the diagnosis of early-onset bacterial infection in preterm infants with PROM. LBP can be used as a useful index for the early diagnosis of bacterial infection in preterm infants with PROM. LBP levels can evaluate the severity of premature premature infection in preterm premature rupture of membranes.     

胎膜早破极早产儿的临床特征和主要不良结局的预测因素分析

目的 探讨胎膜早破(prelabor rupture of membranes,PROM)极早产儿的临床特征及其发生早发型败血症(early-onset sepsis,EOS)和死亡的预测因素.方法 回顾性收集2018年1月至2020年5月入住新生儿重症监护室的PROM极早产儿(胎龄<32周)的临床资料.根据胎膜破裂至...     

Phagocyte activation in preterm infants following premature rupture of the membranes or chorioamnionitis

Phagocyte activation was studied in 48 preterm infants, gestational age 27.3 +/- 0.3 wk, birthweight 968 +/- 40 g, during the first postnatal week. Human neutrophil lipocalin as a marker of neutrophil activation was measured in plasma and tracheal aspirate fractions; and lysozyme, as a marker of monocyte and macrophage activation, in plasma. The concentration of plasma human neutrophil lipocalin was 69 (46-126) microg/l (median and quartiles), tracheal aspirate fraction fluid 213 (71-433) microg/l and plasma lysozyme 1337 (923-1764) microg/l. Infants born to mothers with premature rupture of the membranes or clinical chorioamnionitis (group A, n = 20) had significantly higher plasma [73 (58-151) vs 53 (38-108) microg/l; p=0.027], and tracheal aspirate fraction human neutrophil lipocalin [319 (129-540) vs 190 (57-324) microg/l; p = 0.019], and plasma lysozyme [1739 (1356-2021) vs 1140 (739-1557)microg/l; p=0.0001] than did infants whose mothers had intact membranes and who had no suspicion of infection (Group B, n = 28). In infants born to mothers receiving corticosteroids ante partum, correlations existed between time from treatment to delivery and plasma (r =0.322, p = 0.0256) and tracheal aspirate fraction human neutrophil lipocalin (r = 0.314, p = 0.0096).     

胎膜早破对新生儿健康危害的研究

目的 探讨胎膜早破(PROM)对新生儿健康的影响.方法 对我院3320例住院新生儿资料进行回顾性分析,其中PROM患儿711例.用系统抽样法随机选取各100例足月PROM及未足月PROM患儿,与正常新生儿进行对照分析.结果 25%(178/711)PROM患儿发生各种感染性疾病,其中肺炎与败血症占87.1%(155/178),主要为感染性肺炎(92/711,12.9%)和败血症(63/711,8.9%).血培养阳性率38.7%(63/163),主要致病菌为G+球菌(45.9%)和G-杆菌(54.1%);检出呼吸窘迫综合征69例,占9.7%(69/711);PROM的新生儿血小板计数减少,宽度变窄,血小板平均容积增加,P<0.01;多项红细胞参数值高于正常组(P<0.05);心肌酶谱明显异于正常组(P<0.05);PROM对新生儿的电解质水平无明显影响;PROM的足月儿及早产儿平均住院时间分别延长20.0%、25.1%(P<0.05);平均住院费用足月儿增加30.5%,早产儿则增加60.0%,P<0.05.结论 PROM可对新生儿健康造成多方面危害,应加强对PROM的研究,及时采取合理措施,减少对新生儿健康的危害.     

Management of anorectal malformation in neonates

Anorectal malformations are one of the commonest anomalies in the new born. Major advances have been made in the last decade in operative techniques to reconstruct this abnormality. The final outcome in these babies is dependent on careful planning and operative intervention in the neonatal period. The purpose of this paper is to discuss the varied presentations of this anomaly, initial assessment and operative management with reference to our own experience.     

胎膜早破对超早产儿早期预后的影响

目的 探讨胎膜早破（PROM）对超早产儿早期预后的影响,为超早产儿管理、产前咨询提供依据。方法 收集2017~2019年单胎超早产儿179例为研究对象,按是否存在PROM分为PROM组（69例）和非PROM组（110例）,对孕母情况及患儿早期预后指标进行统计分析。结果 PROM组早发型败血症和坏死性小肠结肠炎发生率高于非PROM组（P < 0.05）,肺表面活性物质使用率及血流动力学显著的动脉导管未闭发生率低于非PROM组（P < 0.05）。多因素logistic回归分析显示绒毛膜羊膜炎是早发型败血症、坏死性小肠结肠炎的独立危险因素（分别OR=11.062、9.437,P < 0.05）,PROM是使用肺表面活性物质的独立保护因素（OR=0.363,P < 0.05）。结论 PROM增加了超早产儿早发型败血症及坏死性小肠结肠炎的发生率,未增加其他不良结局发生率。对有超早产风险的PROM孕妇,建议积极保胎、预防绒毛膜羊膜炎以延长孕周、降低感染发生率,从而改善超早产儿结局。     

Two-year neonatal outcome following PPROM prior to 25weeks with a prolonged period of oligohydramnios

Background

Improved neonatal survival data have been reported following early preterm prelabour rupture of membranes (PPROM) prior to 25 weeks gestation with a prolonged latency to delivery and persistent oligohydramnios. However, data regarding long-term respiratory and neurological morbidity are lacking.

Aims

To evaluate the respiratory and neurological outcome data at two years of age in a cohort of infants born following PPROM prior to 25 weeks with a prolonged latency (14 days) to delivery and compare the data to an aged matched group of infants.

Methods

Retrospective case note analysis over a 43-month period at Saint Luc University Hospital, Brussels.

Results

15 surviving infants born following PPROM were matched to a group of 30 control infants. Although there was no significant difference in the incidence of BPD between the groups (33% vs 27%, p = 0.24), the length of hospitalisation, duration of respiratory support and number of hospital readmissions for respiratory indications were all significantly higher for infants born following a prolonged period of oligohydramnios. There were no major anomalies on cranial ultrasound in the PPROM group and Baileys developmental assessment at 20–24 months corrected gestational age showed no difference between the two groups (Mental development index 93.9 vs 94.4 and Psychomotor development index 95.5 vs 95.8 respectively p = ns).

Conclusion

Neurodevelopmental outcome appears encouraging in this cohort although these infants are at high risk of prolonged initial hospitalisation and significant respiratory morbidity in the first two-years of life.     

胎膜早破新生儿感染的不同抗生素使用策略及高危因素分析

目的 探讨不同抗生素使用策略对胎膜早破新生儿感染的影响及胎膜早破新生儿感染的影响因素分析。方法 回顾性收集胎膜早破新生儿223例为研究对象,依据抗生素使用策略不同将患儿分为研究组（n=95）和对照组（n=128）。研究组入院后以风险评估与感染筛查结果相结合使用抗生素,对照组入院后以风险评估结果使用抗生素,比较两组患儿一般情况及预后。按是否感染将患儿分为感染组（n=32）及非感染组（n=191）,比较两组患儿的一般临床资料,并采用logistic回归分析导致胎膜早破新生儿感染的高危因素。结果 与对照组相比,研究组胎膜早破时间较长,剖宫产率较高,抗生素总使用率及入院时抗生素使用率均较低,感染发生率较高,但败血症发生率较低（P < 0.05）,其他并发症发生率在两组间比较差异无统计学意义（P > 0.05）。与非感染组比较,感染组患儿胎龄较小,胎膜早破时间较长,剖宫产率高,入院时及复查的CRP及PCT水平均较高,发热为常见症状（P < 0.05）。早产儿、剖宫产为胎膜早破新生儿发生感染的高危因素（P < 0.05）。结论 对胎膜早破新生儿严格遵循抗生素使用指征不会增加并发症的发生率;胎膜早破新生儿,特别是早产儿及剖宫产儿,应密切观察其病情的变化,如有发热表现,尽早复查CRP等感染指标,及时使用抗生素,防止严重感染。     

Severe and prolonged sedation in five neonates due to persistence of active diazepam metabolites

Five neonates who suffered from an unexpected long period of respiratory failure, muscular hypotonia, and drowsiness were observed in a retrospective study. Prior to this general depression, unusually high doses of diazepam were administered to all patients via intravenous bolus injection. Serum levels of diazepam and its active metabolites were substantially elevated in the course of the disease. The persistence of the very long-acting N-desmethyldiazepam with considerable extension in neonates and even more exaggerated in premature infants is emphasized due to the reduced capacity of the hepatic biotransformation system. Conclusion The intravenous application of diazepam imposes a risk of marked and prolonged general depression in neonates. Pronounced adverse effects are to be expected for prematures even after a single diazepam intravenous bolus if the dosage is not appropriate. Diazepam should not be used for short sedation and is not the drug of choice for anticonvulsant therapy in neonates. Received: 9 October 2000 / Accepted: 24 January 2001