Acute respiratory distress syndrome in infants at term and near term about 23 cases

AIM: to precise the incidence of acute respiratory distress syndrome in infants at term and near term and the clinical characteristics of this disease not yet well recognised. METHODS: Retrospective study of the medical records of infants admitted in the paediatric intensive care unit for ARDS along a period of 4 years. Diagnosis of ARDS was based on the following criterias: (1) Gestational age > or =35 weeks of gestation; (2) Severe and immediate respiratory distress requiring mechanical ventilation with PEEP > or =4 cmH2O and FiO2 > or = 0.5 during at least 6 hours; (3) Dependence on oxygen > or =48 hours ; (4) Diffuse alveolar damage in the chest radiograph; (5) PaO2 < or =60 mmHg under FiO2 > or = 0.5. RESULTS: During the period of the study, 23 infants (gestational age = 36 +/- 1.1 weeks of gestation; birth weight = 2756 +/- 453 gr) were included in the study. Their mean age at admission was 16.5 +/- 14.6 hours. The majority of infants (91.3%) were born by caesarean section before the onset of labour in 78.3% cases. All infants had a severe acute hypoxemic respiratory failure (D(A -a)O2 = 468 +/- 165; OI = 19 +/- 8.4). Five infants (21.7 %) improved their oxygenation parameters under conventional mechanical ventilation (CMV) (p < 0.001; p = 0.002 et p = 0.003 respectively for D(A - a)O2, OI and PaO2/FiO2). Eighteen infants (78.2%) required high frequency oscillatory ventilation (HFOV)with a rapid and persistant improvement of oxygenation parameters. Five patients (21.7%) developed pulmonary air leak. One infant died. CONCLUSION: ARDS represents 6.8% of etiology of respiratory distress in infants at term and near term. Caesarean section before the onset of labour seems to be a triggering factor. The outcome seems to be favourable (rate of survival = 95.7%) if the management is suitable.