ABSTRACT
Background: Preterm babies' survival has improved with advances in neonatology care in this era. Even with advances in treatments, there is still morbidity and mortality among preterm. The objective of this study was to know the incidence of prematurity and complications seen in them.Methods: A cross sectional study was conducted on all preterm babies born in Sapthagiri Institute of Medical Sciences, Bangalore, over period of one year from 1st August 2017 to July 2018.Results: Out of 500 babies born, 110 babies had RDS, among 110 babies 85 cases were preterm RDS babies included in study. Majority were males 55 (64.5%) and females 30 (35.2%). The gestational age group was maximum in the 28-32weeks,the most common morbidity noted was sepsis (77.7%) and RDS (22%). Death was 9(10.5%) only 4(4.7%) needed intervention in the form of CPAP.Conclusions: The study concluded that males were commonly affected by respiratory distress syndrome, sepsis was a common cause for morbidity and mortality. Inspite of advances in neonatology sepsis continues to be a leading cause of death. Proper hand cleansing has to be emphasized and reinforced to prevent sepsis in NICU. The best possible attempts to delay preterm delivery have to be followed. One should have a high index of suspicion and low threshold to treat sepsis in preterm.
ABSTRACT
Background: Respiratory distress syndrome occurs primarily in premature infants. The increased risk of RDS is associated with lower gestational age. The length of gestation is the primary factor that influences the risk of RDS the risk for development of RDS increases with maternal diabetes, multiple births, cesarean delivery, precipitous delivery, asphyxia, cold stress, and a maternal history of previously affected infants. Antenatal corticosteroids (ACS) significantly reduced neonatal morbidity and mortality when administered to women with imminent preterm delivery Antenatal steroids accelerate development of type 1 and type 2 pneumocytes, leading to structural and biochemical changes that improve both lung mechanics (maximal lung volume, compliance) and gas exchange. Induction of type 2 pneumocytes increases surfactant production by inducing production of surfactant proteins and enzymes necessary for phospholipid synthesis. Alveolisation occurs rapidly as a result of the antenatal corticosteroids Antenatal corticosteroid is usually administered for fetal lung maturity and can be expected to induce negative maternal and fetal side-effects hence this study was conducted to know the beneficial effect of single dose antenatal corticosteroids verses double doses antenatal corticosteroids. The Objective of the present study was to observe the effect of single dose and double dose antenatal corticosteroids on respiratory distress syndrome in preterm babies born to less than 37 weeks of gestation admitted under department of pediatrics at Raja Rajeswari medical college Hospital, Kambipura, Bangalore.Methods: There were 55 babies born to mothers who received single dose of antenatal corticosteroids and delivered at 12hrs before receiving 2nd dose antenatal corticosteroids and 55 babies born to mothers who received double dose of antenatal corticosteroids. Once baby is born, they compared for the requirement of surfactant.Results: Multiple course of steroids significantly reduced Respiratory distress syndrome.Conclusions: It was concluded that there was significant reduction in RDS in babies whose mother received complete course of antenatal corticosteroids.
ABSTRACT
Para estimar la eficacia y eficiencia de los surfactantes pulmonares utilizados en los recién nacidos con síndrome de dificultad respiratoria en la Fundación Cardiovascular de Colombia sediseñó un estudio observacional, descriptivo. Se analizaron las historias clínicas de los recién nacidos hospitalizados allí entre enero de 2009 y abril de 2011 y se calcularon los indicadores de eficacia y eficiencia para cada surfactante. El medicamento más eficaz y eficiente para estos pacientes, cuando se analizaron datos globales, fue el survanta; su tratamiento requiere menos dosis, es más económico, genera menos días de estancia en unidad de cuidados intensivos y menos días de ventilación mecánica. Para algunos casos resultó ser más eficaz el infasurf que el survanta; causo menos extubaciones fallidas en recién nacidos con bajo peso y menos complicacionesdurante el tratamiento...
To estimate the effectiveness and efficiency of pulmonary surfactants used in infants with respiratory distress syndrome at the Colombian Cardiovascular Foundation, we designed an observational, descriptive study. We analyzed the medical records of newborns hospitalized in this institution between January 2009 and April 2011 and calculated the effectiveness and efficiency indicators for each surfactant. After analyzing aggregate data, we found that the most efficient and effective medication for these patients was Survanta. It requires fewer doses per treatment, is more economical, and generates fewer days in the intensive care unit and fewer days of mechanical ventilation. In some cases, however, Infasurf was more effective than Survanta, caused less extubation failure in infants with low birth weight and fewer complications during treatment...
Para estimar a eficácia e a eficiência dos surfactantes pulmonares utilizados nos recém- nascidos com síndrome de desconforto respiratório na Fundação Cardiovascular da Colômbia desenhouseum estudo observacional descritivo. Analisaram-se os protuários dos recém-nascidos internados entre janeiro de 2009 e abril de 2011 e foram calculados os indicadores de eficáciae eficiência de cada surfactante. O medicamento mais eficaz e eficiente para esses pacientes, quando analisados dados agregados, foi o survanta; seu tratamento requer doses menores, émais econômico, gera menos dias de estância na unidade de tratamento intensivo e menos dias de ventilação mecânica. Para alguns casos resultou mais eficaz o infasurf do que o survanta;causou menos extubações falhadas em recém-nascidos com baixo peso e menos complicações durante o tratamento...
Subject(s)
Infant, Newborn , Infant, Newborn , Pulmonary Surfactants/administration & dosage , Pulmonary Surfactants , Respiratory Distress Syndrome, NewbornABSTRACT
PURPOSE: Early detection of RDS is imperative in treatment of neonatal respiratory distress syndrome (RDS). Shake test and stable microbubble rating (SMR) test have been commonly used for early detection of RDS. In this study, we analyzed the cut-off point of SMR test to identify whether current dianostic criteria (SMR 10/mm2) correlates with actual development of RDS. METHODS: Retrospective analysis of SMR test performed on neonates with birth weight less than 2, 500 gm or gestational age less than 37 weeks or had the symptoms of respiratory distress from 1990 to 2001. We evaluate the correlations of SMR counts and actual development of RDS and calculated the sensitivity, specificity and diagnostic accuracy at each SMR count. RESULTS: The diagnostic accuracy was considerably high when microbubble count was between 7 and 11. SMR count 9, the mean of these numbers, was determined as the cut-off point with 81.4% diagnostic accuracy. Sensitivity and specificity was 59.1% and 95.8% respectively. CONCLUSION: Current diagnostic criteria of SMR test would be effective in expecting development of RDS.
Subject(s)
Humans , Infant, Newborn , Birth Weight , Gestational Age , Microbubbles , Respiratory Distress Syndrome, Newborn , Retrospective Studies , Sensitivity and SpecificityABSTRACT
PURPOSE: Antenatal dexamethasone administration is associated with a significant lowering respiratory distress syndrome (RDS) incidence, but can increase neonatal infection. Ambroxol has been accepted as an alternative treatment to dexamethasone and is of at least equal efficacy but without adverse reaction. The aim of this study was to evaluate the effectiveness of ambroxol versus dexamethasone in RDS incidence and neonatal infection. METHODS: In this study, 30 infants, who received prenatal dexamethasone therapy, were compared retrospectively to 19 infants who received prenatal ambroxol therapy and 45 infants who received placebo during 28 to 34 weeks' of gestation. RESULTS: RDS incidence was comparable in both the dexamethasone (10.0%) and ambroxol (10.5%) groups but higer in the control group (26.6%). The puerperal infection rate in the mothers of these infants was 33.3% in the dexamethasone group, 10.5% in the ambroxol group and 20.0% in the control group. Neonatal infection in the 28 days following delivery was 56.6% in the dexamethasone group, 26.3% in the ambroxol group and 26.6% in the control group. Neonatal infection rate of the dexamethasone group was higher than ambroxol and control groups (P<0.05). When premature rupture of membrane was controlled, the sepsis rate (<28 days) was significantly lower in the ambroxol group than in the dexamethasone group (P<0.05), but puerperal infection and sepsis (<7 days) were not significantly different. CONCLUSOIN: Ambroxol was as effective as the dexamethasone in reducing the RDS incidence. Neonatal and puerperal infection were significantly higher in the dexamethasone group than in the ambroxol group.
Subject(s)
Humans , Infant , Pregnancy , Ambroxol , Dexamethasone , Incidence , Membranes , Mothers , Puerperal Infection , Retrospective Studies , Rupture , SepsisABSTRACT
PURPOSE: To produce a new generation of artificial pulmonary surfactant(PS), surfactant protein (SP)-B from human PSwas isolated, and the amino acid sequences of these proteins were studied. Artificial peptides of human SP-B were synthesized. New artificial PS preparations which were cornposed of phospholopids and two artificial synthetic SP-B peptides were made, and the surface physical properties of these new PS preparations were tested. METHODS: The purities of SP-B were assessed by SDS-polyacrylamide gel and the amino acid sequences of these proteins were determined. We synthetized two peptides SP-1 and SP-2 and the amino acid sequences were as follows,' SP-1: RMLPQLVCRLVLRCSMD, SP-2: RMLP- QLVCRLVLRCSM. Surface physical properties of newly artificial PSs, which were composed of a mixture of phospholipid(PL) and SP-1 or SP-2(sample A; PL+SP-1, sample B; PL+SP-2), were measured by surface spreading, adsorption rate, and surface tension-area diagram. RESULTS: The amino acid sequence of human SP-B was obtained. We produced the artificial peptides of SP-B and prepared the new generation PS(sample A and sample B). The order of the superiority of spreading and adsorption rate was SurfactenSubject(s)
Humans
, Absorption
, Adsorption
, Amino Acid Sequence
, Peptides
, Pulmonary Surfactants
ABSTRACT
PURPOSE: For the synthesis of surfactant protein(SP) peptides and production of next generation artificial pulmonary surfactant(PS), we have isolated SP-B, C from bovine PS, and studied the biochemical properties and amino acid sequences of these protein-peptides. METHODS: Crude surfactant and purified surfactant were isolated from materials extracted from the bovine lung lavage. The hydrophobic SP-B, C were purified by Sephadex LH 60 column chromatography from PS. The purities of SP-B, C were assessed by tricine buffer SDS-polyacrylamide gel electrophoresis and the amino acid sequences of these proteins were determined using Beckman PI-2090. RESULTS: The molecular weights of SP-B, C shown in SDS-polyacrylamide gel electrophoresis were as follows; 15,000-18,000(oligomer) Da for SP-B, 3,500-5,000 Da for SP-C. The amino acid sequences were; FPIPLPYCWL LRTLIKKIQA VIPKGVLAMT VAQCHVVPL LVGGIQQLV IEYSVILLTD TLLGRLPNLV CGLRLRCSG in SP-B, LIPCCPVNIK RLLIVVVVVV LLVVVIVGAL LMGL in SP-C, respectively. These results indicated that the amino acid sequences of bovine SPs were different. CONCLUSION: The SP-B, C were purified from bovine PS, and amino acid sequences of SP-B, C were determined. Further studies are needed for the development and use of next generations of exogenous PS preparation based on synthetic SP-peptides for the treatment of neonatal RDS in the future.
Subject(s)
Humans , Infant, Newborn , Amino Acid Sequence , Bronchoalveolar Lavage , Chromatography , Electrophoresis , Family Characteristics , Molecular Weight , Peptides , Pulmonary SurfactantsABSTRACT
OBJECTIVES: This study was performed to evaluate obstetric aspects and epidemiologic data of respiratory distress syndrome(RDS) in premature baby(under 37 gestational weeks). We compared the mortality and incidence of RDS in premature baby according to gestational age, birth weight, infant sex, mode of delivery. In addition, this study was searched for demonstrating the influence of hypertensive mother, and effectiveness of surfactant and corticosteoid administration. METHODS: A study was conducted for 2,360 premature baby under 37gestatinal weeks, who were born at four main hospitals in Kwangju and Chonnam from January 1, 1995 to December 31, 1997. Data were collected from hospital records and was analyzed by SPSS computer program. RESULTS: 1. The total incidence of RDS among all the preterm infants under 37gestational weeks, who were admitted in NICU of four hospitals was 22.7%. 2. Neonatal mortality was decreased as the gestational age and or birth weight advanced. (p0.005) 4. The mortality of RDS infants in this study was 28.1%. 5. There was no statistical correlation between neonatal mortality and use of surfactant. 6. Corticosteroids administration to preterm mother did not decrease the incidence of RDS, but, there was no statistical significance due to insufficient study group. 7. The incidence of RDS among the babies of hypertensive mother was 21.0%. CONCLUSION: Still the RDS in premature baby is the most common cause of perinatal death in this country. In our study, the incidence and mortality of RDS in prematue baby was mainly depends on gestational age of infants. Therefore, we suggested that prevention of preterm labor is the important to decrease the incidence and mortality of RDS.
Subject(s)
Female , Humans , Infant , Infant, Newborn , Pregnancy , Adrenal Cortex Hormones , Birth Weight , Gestational Age , Hospital Records , Incidence , Infant Mortality , Infant, Premature , Mortality , Mothers , Obstetric Labor, PrematureABSTRACT
PURPOSE: Several kinds of exogenous pulmonary surfactants (SF), either synthetic or animal- derived, are being used for the replacement therapy in respiratory distress syndrome (RDS) of newborn, especially in premature infants, and improved the neonatal mortality and morbidity. Because synthetic preparations are lack of surfactant protein (SP) and animal-derived preparations cause immunogenecity of heterogenous SP, there have been great necessity for the development of next generation of exogenous SF which made by new technology to produce new type of human SF (contained human synthetic SP). There are two methods to make next generation of SF (mixtures of phospholipids and human synthetic SP) which are using of recombinant SP or synthetic peptides of SP. For the synthesis of SP peptides and production of next generation of SF, at first step, we have isolated SP-A, B, and C from bovine lung SF, and studied the biochemical properties of these proteins. METHODS: Crude natural surfactant (CNS) and purified natural surfactant (PNS) were isolated from materials which extracted from the bovine lung lavage. The hydrophilic SP-A was purified from PNS by method of modified Hawgood, and hydrophobic SP-B, C were purified by Sephadex LH 60 column chromatography. The purities of the purified SP-A and SP-B, C were assessed by 12% SDS-polyacrylamide gel and tricine buffer SDS-polyacrylamide gel, respectively and the N-terminal amino acid sequences of these proteins were determined using Beckman PI-2090. The polyclonal anti-serum against SP-A was prepared by immunization of the purified SP-A into the mouse and the immunization of the purified SP-A into the mouse and the immunogenecity of SP-A was confirmed by indirect ELISA. RESULTS: Total 22 gm of CNS, 11 gm of PNS, and 2.5 mg of SP-B and 3.2 mg of SP-C/ 1 gm of CNS, were purified from one bovine both lungs. The molecular weights of SP-A, B, C shown in SDS-polyacrylamide gel were as follows; 28,000-35,000 Da (molecular weight) of SP-A, 15,000-18,000 Da of SP-B, 3,500-5,000 Da of SP-C. The partial N-terminal amino acid sequences of each SPs were; Leu-Glu-His-Asp-Val-Lys- Glu-Val-.... in SP-A, Phe-Pro-Ile-Pro-Ile-Pro-Tyr-.... in SP-B, Leu-Ile-Pro-.... in SP-C, respectively. These results indicated that the amino acid sequences of bovine SPs were different from those of other species, i.e., human, dog and rat, which were reported previously by another investigators and species-specific patterns were shown. The immunogenecity of the purified SP-A was confirmed by the production of polyclonal antibody against mouse. The polyclonal antibody of SP-A could be used for measuring the amount of pulmonary SF in lung lavages. Carbohydrate portion of SP-A was cleaved with N-glycocisidase F. This result suggested that carbohydrate group could be N-glycosylated in some arginine residue of SP-A. CONCLUSIONS: The SP-A, B, C were purified from bovine lung SF, and N-terminal amino acid sequences of each SP-A, B, C were determined. Further studies were needed for the development and use of next generations of exogenous SF preparation, which based on synthetic SP-peptides, for the treatment of neonatal RDS in the future.