ABSTRACT
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: With the recent advent of surfactant replacement therapy, there is an increasing need for a rapid and reliable test to predict respiratory distress syndrome (RDS) immediately before or at birth. There are many investigations and methods for the detection of RDS in prenatal or postnatal period. The stable microbubble rating test (SMR-test) developed by pattle et al. is rapid and simple test performed on amniotic fluid and gastric aspirates which reflects the adequacy of pulmonary surfactant with higher diagnostic accuracy. To determine the relation of the SMR and surfactant derivatives [Surfacten : phospholipid (PL), Exosurf : dipalmitoyl-phosphatidyl choline (DPPC) concentration in vitro, author performed SMR test according to 15 groups of surfactant derivatives concentration by using modified Pattle's method. METHODS: Surfacten & Exosurf were diluted each concentration (0, 5, 10, 15, 20, 25, 30, 35, 40, 50, 60, 70, 80, 90, 100microgram/ml) by dilutional fluid. We enveloped test tube by paraffin paper for protection of evaporation. When we performed SMR test, we shaked test tube vigorously by Vlotex shaker. We performed SMR test according to 15 groups of Surfactant concentration by using modified Pattle's method. RESULTS: 1) The number of SMR according to 15 groups of surfactant derivatives concentration were 2, 1/mm2 in 4.2microgram/ml of PL and 3.1microgram/ml of DPPC, 279, 1104/mm2 in 83.3microgram/ml of PL and 61.8microgram/ml DPPC. 2) The regression curve of SMR and surfactant derivatives concentration showed statistically significant relation (p<0.005). CONCLUSION: The SMR test was a good method in estimation of surfactant concentration in vitro and also in diagnosis of RDS recognized as a surfactant deficiency.
Subject(s)
Female , Amniotic Fluid , Choline , Diagnosis , Microbubbles , Paraffin , Parturition , Pulmonary SurfactantsABSTRACT
Respiratory distress syndrome of preterm infants remains a significant cause of morbidyty and mortality. Early, just after birth, prediction and recognition of RDS is so important. The precision and reliability of the stable microbubble test (SMR)and shake test as a predictor of respiratory distress syndrome were studied. A 110-neonate who was born at Chungnam National University Hospital between November 1991 to September 1992was selected randomely and studied. The results were as follows; 1) Among the 110 neonates, 13 cases were noticed as RDS. 2) Among the 13 infants with RDS, SMR results were zero and very weak in 11 cases, weak in 2 cases. Of the 97 infants with Non-RDS, 9 cases were weak, 88cases were medium and strong, positive predictive value and negative predictive value was 100%, 98% respectively. 3) Of the 13 infants with RDS, Shake test result were negative in 8 cases, 1+in 1 case, 2+in 1 case and 4+in 3 case. Of the 97 infants with Non-RDS, 3 cases were negative, 9 cases were 1+, 9cases were 2+ and 63 cases were 4+, positive predictive value and negative predictive value was 72.7%, 9 However, frequent relapses and severe side effects caused by such therapy necessitate development of a more specific and effective therapeutic regimen.Recently, a T cell derived cytokine, interleukin 4 (IL-4)is being recognized as a major cytokine up-regulating IgE production and response, while interferon- (IFN- )counteracts IL-4 actions to down-regulate the IL-4 induced IgE response. Hence, the present study is aimed to investigate the role of IL-4 in MCNS. Using freshly isol 4.9% respectively. We conclude that the rapidity, simplicity and reliability of the stable microbubble test is more useful as a bedside procedure in identifying of predicting the infants who are likely to develop RDS than shake test.