Use of budesonide associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia in premature newborns - A systematic review

Abstract Objective: Among the mechanisms proposed for the development of bronchopulmonary dysplasia is the increase in the pulmonary inflammatory process and oxidative stress. Thus, the control of this process may result in improvements in bronchopulmonary dysplasia-related outcomes. This study aims to analyze the current scientific evidence regarding the use of budesonide, a potent anti-inflammatory drug, associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia. Methods: A systematic review of the literature was performed on the Embase and MEDLINE platforms, and studies that compared budesonide with pulmonary surfactant versus pulmonary surfactant for treating respiratory distress syndrome were included. The primary outcome was a reduction in bronchopulmonary dysplasia or death. Results: Four randomized clinical trials and two observational studies were included in this systematic review. Three of the randomized clinical trials found a reduction in bronchopulmonary dysplasia or death in the use of budesonide with the surfactant, all the other studies (1 clinical trial and 2 observational studies) found no statistical differences between the groups for the primary outcomes. The three main studies showed a reduction in the primary outcome; however, all studies showed great heterogeneity regarding the type of surfactant (poractant or beractant) and the method of administration. Conclusion: Robust clinical studies, in a heterogeneous population, using porcine surfactant associated with budesonide, with administration by a minimally invasive technique are necessary for there to be a recommendation based on scientific evidence for its widespread use.

Short-term clinical outcomes of different courses of antenatal corticosteroids for preterm twins / 中国新生儿科杂志

Objective:To study the short-term clinical outcomes of different courses of antenatal corticosteroids (ACS) for preterm twins.Methods:From January 2017 to December 2021, preterm twins with gestational age (GA) 24-34 weeks admitted to the neonatal ward of our hospital and received ACS were retrospectively studied. The infants were assigned into single-course group, partial-course group and multiple-course group according to ACS courses. The short-term clinical outcomes were compared among the groups. SPSS software version 25.0 was used for statistical analysis.Results:A total of 286 infants were enrolled in this study, including 128 in single-course group, 89 in partial-course group and 69 in multiple-course group. Compared with single-course group, the risks of neonatal respiratory distress syndrome (RDS) in both partial-course group ( OR=2.332, 95% CI 1.028-5.293, P=0.043) and multiple-course group ( OR=3.872, 95% CI 1.104-13.584, P=0.034) were higher. The birth length in multiple-course group ( β=-0.016, 95% CI -0.029 - -0.002, P=0.024) was lower than single-course group. Conclusions:The risks of neonatal RDS in preterm twins are higher in partial-course and multiple-course of ACS. A full course of ACS should be used to prevent neonatal RDS until further evidence of effectiveness is available.

Clinical and follow-up study of premature infants with neonatal respiratory distress syndrome managed by the less invasive surfactant administration / 中华实用儿科临床杂志

Objective:To explore the clinical therapeutic effect and follow-up prognosis of preterm infants with neonatal respiratory distress syndrome (NRDS) managed by less invasive surfactant administration (LISA) and traditional intubation-surfactant-extubation (INSURE) of pulmonary surfactant (PS).Methods:Data during hospitalization and follow-up period of 187 NRDS preterm infants (gestational age 24 weeks to 31 + 6 weeks, and birth weight <1 500 g) admitted to the Department of Neonatology, the Women and Children′s Hospital of Chongqing Medical University from March 2019 to February 2021 were retrospectively analyzed.NRDS preterm infants who were injected with PS by LISA were included in the LISA group (144 cases), and those who were injected with PS by INSURE were included in the INSURE group (43 cases). The propensity score matching method was used to correct the confounding factors between groups, and the covariate equilibrium samples between groups were obtained (39 cases in each group). Clinical treatment effect and prognosis of physical development, hearing and vision development, nervous system development, respiratory system diseases and other conditions of the two groups of children were compared using the t test, Chi- square test and other statistical analysis methods as appropriate. Results:(1)Compared with that of the INSURE group, the incidence of BPD [12 cases (33.3%) vs.23 cases (63.9%), χ2=6.727, P=0.009] and ROP [13 cases (36.1%) vs.26 cases (72.2%), χ2=9.455, P=0.002] in the LISA group were significantly lower.The incidence of mild BPD [8 cases (22.2%) vs.16 cases (44.4%), χ2=4.000, P=0.046] and stage Ⅰ-Ⅱ ROP [11 cases (30.6%) vs.22 cases (61.1%), χ2=6.769, P=0.009] in the LISA group was significantly lower than that of the INSURE group.There was no significant difference in the incidence of moderate and severe BPD and stageⅢ ROP and above between groups (all P>0.05). (2)There were no statistical differences in the repeated use of PS, mechanical ventilation rate within 72 h, pneumothorax/pulmonary hemorrhage, grade Ⅲ-Ⅳ periventricula-rintraventricular hemorrhage, stage Ⅱ-Ⅲ neonatal necrotizing enterocolitis, sepsis, abnormal amplitude integrated electroencephalogram, mortality in 36 weeks of corrected gestational age, total oxygen inhalation duration and hospitalization duration between the two groups (all P>0.05). (3)Follow-up within 1 year of corrected age after discharge.There were no significant differences in extrauterine body mass, body length and head circumference development, visual development, hearing development, Neonatal Behavioral Neurological Assessment score at corrected gestational age of 40 weeks, Bayley Scales of Infants Development score at corrected gestational age of 6 months and age of 1 year, pneumonia and re-hospitalization due to respiratory diseases between groups (all P>0.05). Conclusions:PS administration with LISA technology can reduce the incidence of mild BPD and stage Ⅰ-Ⅱ ROP in premature infants with NRDS who had the gestational age of 24-31 + 6 weeks and birth weight<1 500 g, without increasing the risk of other complications.The long-term prognosis of them treated with PS administration with LISA and INSURE is similar.

Effects of neonatal respiratory distress syndrome on thymus in 130 premature infants / 国际儿科学杂志

Objective:To investigate the effects of neonatal respiratory distress syndrome(NRDS)on thymus of premature infants.Methods:We collected baseline data from premature infants with gestational age of 28~32 weeks in neonatal intensive care unit of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 1, 2019 to December 31, 2019.The largest transverse diameter and the sagittal of thymus were measured by ultrasonography within 24 h of birth, then, the thymic index(TI)and thymic weight index(TWI)were calculated to assess the size of thymus.The preterm neonates were divided into NRDS group and non-NRDS group according to the diagnosic criteria of NRDS, and the two groups were then divided into antenatal corticosteroid administration(ACS)group and non-ACS group according to ACS exposure.We then compared the TI and TWI between these groups.Results:One hundred and sixty-three preterm neonates were enrolled in our study, including 98 NRDS preterm neonates and 65 non NRDS preterm neonates.After matching gestational age and birth weight of the preterm neonates from two groups, 65 preterm neonates with NRDS comprised the NRDS group, and 65 preterm neonates without NRDS served as controls.Preterm neonates in NRDS group had significantly smaller TI[(1.788 ± 0.803)cm 3 vs.(2.420±1.068)cm 3, t=3.818, P<0.01] and TWI[(1.278 ± 0.380)cm 3/kg vs.(1.695 ± 0.491)cm 3/kg, t=5.401, P<0.01] than those in non-NRDS group.Besides, preterm neonates in NRDS group had smaller lymphocytes count[(3.729 ± 1.263)×10 9/L vs.(4.437 ± 1.608)×10 9/L, t=2.789, P<0.01] than that in non-NRDS group.For NRDS preterm neonates, TI[(1.487 ± 0.515)cm 3 vs(2.185 ± 0.942)cm 3, t=3.542, P<0.01] ]and TWI[(1.134± 0.311)cm 3/kg vs(1.469± 0.385)cm 3/kg, t=3.882, P<0.01] in ACS group were significantly smaller than those in non-ACS group.For non-NRDS preterm neonates, TI and TWI in ACS group also were significantly smaller than those in non-ACS group( t=2.676、3.659, P<0.05). Conclusion:NRDS is associated with thymic involution of preterm neonates, and ACS exposure affected the size of thymic in premature infants.

Risk factors of red blood cell infusion in very low/ultra-low birth weight neonates with respiratory distress syndrome / 中国输血杂志

【Objective】 To investigate the risk factors of red blood cell transfusion frequency (fRBCT) toward newborns with very/extremely low birth weight (V/ELBW) who experienced 57 days, >2.75 days and >23.75 days. 【Conclusion】 Increased fRBCT may complicate V/ELBW NRDS newborns who experienced <32 weeks of gestational age with NEC, hematosepsis, BPD and ROP. Duration of hospital stay, invasive ventilation and IVN are relatively effective predictive indicators for whether such cases have undergone ≥3 red blood cell transfusions throughout their hospitalization.

Application of point-of-care cardiopulmonary ultrasound in mechanical ventilation of neonatal respiratory distress syndrome / 中华超声影像学杂志

Objective:To explore the value of point-of-care cardiopulmonary ultrasound (POCUS) in the evaluation of modifying mechanical ventilation and weaning timing of neonates with respiratory distress syndrome (RDS).Methods:A total of 82 infants with RDS received invasive mechanical ventilation in the neonatal intensive care unit of the First Affiliated Hospital of Nanjing Medical University from January 2019 to October 2020 were enrolled.Endotracheal tube was extubated after getting in line with the clinical weaning standard. According to the results of ventilator withdrawal, infants were divided into successful group and failure group. POCUS were performed within half hour of intubation and extubation. Lung ultrasound score (LUS), left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), left ventricular eccentricity index (LVEI) and pulmonary artery systolic pressure (PASP) were recorded also with the arterial blood gas, ventilator parameters, duration of mechanical ventilation and oxygen therapy. The above indexes were compared between two groups to evaluate the predictive value of POCUS for mechanical ventilation evacuation.Results:The gestational age [(28.6±4.2)W vs (32.5±3.7)W], body weight [(1 289±790)g vs (1 969±771)g], initial ventilation PaO 2 [(41.2±8.5)mmHg vs (50.1±12.2)mmHg], LVEF of ventilator withdrawal[(62.7±3.9)% vs (66.9±3.1)%] of the failed weaning group were lower than those of successful group (all P<0.05). LUS at ventilator withdrawal[(13.7±1.0) points vs (11.1±1.6) points], PASP [(40.5±7.2)mmHg vs (32.9±6.2)mmHg] and the duration of mechanical ventilation [(5.4±4.7)d vs (3.6±2.3)d], duration of oxygen therapy [(48.5±25.0)d vs (24.5±18.5)d] were higher than those of successful group (all P<0.05). The initial LUS of mechanical ventilation was positively correlated with the duration of mechanical ventilation ( r=0.188, P<0.01), and TAPSE was negatively correlated with the duration of mechanical ventilation ( r=-0.344, P<0.01). LUS was positively correlated with X-ray grading and mean airway pressure at the initial and withdrawal time ( rs=0.790, P<0.01 and rs=0.686, P<0.01; r=0.383, P<0.01 and r=0.548, P<0.01). To assess LUS prediction of weaning failure, the area under ROC curve (AUC) was 0.922, and the combined ΔLUS (change of pre- and post-LUS ) ≤7 points and ΔPASP (change of pre- and post-PASP) ≤9.5 mmHg predicted AUC was 0.912. Prediction of AUC by using LUS combining PASP and LVEF was 0.937, Youden index was 0.736, the cut-off value was 0.185, with sensitivity 89.5% and the specificity 84.1%. LUS≥13 points, PASP≥43 mmHg and LVEF≤60% were related to weaning failure by using the Logistic regression analysis (all P<0.05). Conclusions:Bedside POCUS can effectively evaluate the application of mechanical ventilation process and predict the weaning of infants with RDS. POCUS is practical, real-time, accurate, and worthy of clinical application.

Efficacy and safety of inhalation of pulmonary surfactant using vibrating mesh nebulizers combined with nasal continuous positive airway pressure in the treatment of neonatal respiratory distress syndrome / 中华危重病急救医学

Objective:To investigate the efficacy and safety of nasal continuous positive airway pressure (NCPAP) combined with inhalation of pulmonary surfactant (PS) using vibrating mesh nebulizers in the treatment of neonatal respiratory distress syndrome (RDS).Methods:A prospective study was performed on premature infants with RDS admitted to the First Affiliated Hospital of Bengbu Medical College between December 2020 and June 2021. They were randomly assigned into vibrating mesh atomization technology group and intubation-surfactant-extubation (INSURE) technology group. The two groups were treated with NCPAP combined with PS. PS in the vibrating mesh atomization technology group was inhaled into the lungs by the new vibrating mesh atomization technology, while PS in the INSURE group was injected into the lungs by endotracheal tube. The pH value, arterial partial pressure of carbon dioxide (PaCO 2), oxygenation index (PaO 2/FiO 2), mechanical ventilation via endotracheal tube (MVET) demand rate, duration of respiratory support, secondary use of PS, complications, and hospital mortality were compared between the two groups. The occurrences of adverse events in the two groups were recorded. Results:A total of 42 preterm infants were finally enrolled, including 20 cases in the vibrating mesh atomization technology group and 22 cases in the INSURE technology group. There were no significant differences in blood gas analysis and PaO 2/FiO 2 before PS administration between the two groups. One hour after PS administration, blood gas analysis and PaO 2/FiO 2 were significantly improved in both groups. Compared with the INSURE technology group, the improvement of PaO 2/FiO 2 was more obvious in the vibrating mesh atomization technology group [mmHg (1 mmHg≈0.133 kPa): 198±34 vs. 173±39, P < 0.05], but no significant difference in pH value or PaCO 2 was found between the two groups. The duration of respiratory support in the vibrating mesh atomization technology group was significantly shorter than that in the INSURE technology group (hours: 96±13 vs. 120±18, P < 0.01), but there was no statistical difference in MVET demand rate [5.0% (1/20) vs. 13.6% (3/22), P > 0.05]. The incidence of periventricular-intraventricular hemorrhage (PVH-IVH) in the vibrating mesh atomization technology group was less than that in the INSURE technology group [0% (0/20) vs. 18.2% (4/22)], but no statistical difference was found ( P > 0.05). No significant differences in the secondary use rate of PS and incidence of bronchopulmonary dysplasia (BPD) or other complications were found between the vibrating mesh atomization technology group and the INSURE technology group [5.0% (1/20) vs. 9.1% (2/22), 5.0% (1/20) vs. 4.5% (1/22), both P > 0.05]. There were no deaths or serious adverse events such as pneumothorax, pulmonary hemorrhage, periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) in both groups. Conclusion:Compared with the INSURE technique, NCPAP combined with vibrating mesh atomization technology was also effective and safe in the treatment of RDS, which could significantly improve PaO 2/FiO 2 and shorten the duration of respiratory support. Thus, it was worthy of clinical popularization and application.

Research progress on caffeine citrate in the treatment of neonatal respiratory distress syndrome / 中国小儿急救医学

Neonatal respiratory distress syndrome is typically characterized by progressive exacerbation of respiratory distress shortly after birth, which is more common in preterm infants and has a high disability and mortality rate.Caffeine citrate has been used in the treatment of premature infants with respiratory distress syndrome to enhance the contraction of the diaphragm and optimize the function of respiratory muscles to accelerate the recovery of spontaneous breathing.This review summarized the use of caffeine citrate in premature infants with respiratory distress syndrome.

Research progress on caffeine citrate in the treatment of neonatal respiratory distress syndrome / 中国小儿急救医学

Neonatal respiratory distress syndrome is typically characterized by progressive exacerbation of respiratory distress shortly after birth, which is more common in preterm infants and has a high disability and mortality rate.Caffeine citrate has been used in the treatment of premature infants with respiratory distress syndrome to enhance the contraction of the diaphragm and optimize the function of respiratory muscles to accelerate the recovery of spontaneous breathing.This review summarized the use of caffeine citrate in premature infants with respiratory distress syndrome.

Clinical effect of red blood cells transfusion on newborns with neonatal respiratory distress syndrome / 中国输血杂志

【Objective】 To analyze the risk factors related to the number of RBCs transfusion in neonates with neonatal respiratory distress syndrome (NRDS), and to explore the complications and the predictive indicators related to the increase of RBCs transfusion frequency. 【Methods】 NRDS newborns admitted to our hospital from January 2017 to January 2019 were selected and divided into three groups according to the number of RBCs transfusion, namely, non-transfusion group, 1~ 2 times group, and ≥3 times group. The clinical data and complications of the three groups were compared, and the risk factors leading to the increase of the number of blood transfusion were analyzed. 【Results】 Such factors as maternal age ≥35 years old, gestational age, birth weight, hemoglobin(Hb) at admission, non-invasive ventilation time, hospitalization time in neonatal intensive care unit(NICU), total enteral feeding time affected the blood transfusion frequency of the three groups(χ2=14.24, F=28.44, 41.70, 60.05, 3.83, 5.97, 4.40, P<0.05). The incidence of necrotizing enterocolitis (NEC), septicemia and feeding intolerance in blood transfusion ≥3 times group was significantly higher than that in 1~2 times group and non-transfusion group (χ2=19.30, 18.68, 6.98, P<0.05). Multivariate logistic regression analysis showed that birth weight, Hb at admission, length of stay in NICU and time of reaching total enteral feeding were independent risk factors for≥ 3 times of blood transfusion (OR=-3.942, -0.186, 0.530, 0.324, P<0.05). The ROC curve showed that birth weight and Hb at admission were effective in predicting blood transfusion ≥3 times, and the area under the ROC curve were 0.846 and 0.802, respectively, and the truncation values were 2.315 kg and 157.5 g/L. 【Conclusion】 Feeding intolerance, NEC and septicemia are the complications of the increased transfusion frequency in children with NRDS, and birth weight and hemoglobin at admission are effective in predicting blood transfusion ≥ 3 times.

Study progress of vitamin D in respiratory diseases in children / 中华实用儿科临床杂志

Vitamin D is an active derivative of fat-soluble steroid, which can promotes the absorption of Ca in the intestine and maintains the concentrations of serum Ca in blood as well as phosphate.Recent researches found that the lack of vitamin D would increase the risk of respiratory diseases, cardiovascular diseases, autoimmune diseases, neuropsychiatric diseases, tumors and other metabolic diseases in addition to affecting the development of bones.More stu-dies have shown that low vitamin D levels is related to respiratory diseases in children.In this review, the physiological characteristics of vitamin D and the relationship with respiratory diseases in children were discussed.

Efficacy of pulmonary surfactant combined with caffeine citrate on neonatal respiratory distress syndrome treated with synchronized nasal intermittent positive pressure ventilation / 中国小儿急救医学

Objective@#To investigate the clinical effects of pulmonary surfactant(PS) combined with caffeine citrate on neonatal respiratory distress syndrome(NRDS) treated with synchronized nasal intermittent positive pressure ventilation(SNIPPV).@*Methods@#We collected and analyzed 99 neonates who were diagnosed with NRDS and required SNIPPV treatment from January 2016 to June 2019 in NICU of Shengjing Hospital of China Medical University.According to the different treatment, they were divided into PS+ citrate caffeine combination group and control group.The control group(53 neonates)was treated by PS alone.The combination group(46 neonates)was treated with PS combined with caffeine citrate.The indexes of ventilator time, the time of using oxygen, length of hospital stay and complications were compared between the two groups.@*Results@#The indexes of ventilator time, the time of using oxygen and length of hospital stay of combination group were significantly shorter than those of the control group.The differences were statistically significant(P<0.05). However, the incidences of ventilator associated pneumonia, gastrointestinal dysfunction, arrhythmia and other complications were not significantly different between the two groups(P>0.05).@*Conclusion@#PS combined with caffeine citrate in the treatment of NRDS with SNIPPV could effectively improve the pulmonary function of infants.It could improve the neonatal survival rate and reduce complications.It is worth to be recommended.

Study progress of vitamin D in respiratory diseases in children / 中华实用儿科临床杂志

Vitamin D is an active derivative of fat-soluble steroid,which can promotes the absorption of Ca in the intestine and maintains the concentrations of serum Ca in blood as well as phosphate.Recent researches found that the lack of vitamin D would increase the risk of respiratory diseases,cardiovascular diseases,autoimmune diseases,neuropsychiatric diseases,tumors and other metabolic diseases in addition to affecting the development of bones.More studies have shown that low vitamin D levels is related to respiratory diseases in children.In this review,the physiological characteristics of vitamin D and the relationship with respiratory diseases in children were discussed.

Efficacy of pulmonary surfactant combined with caffeine citrate on neonatal respiratory distress syndrome treated with synchronized nasal intermittent positive pressure ventilation / 中国小儿急救医学

Objective To investigate the clinical effects of pulmonary surfactant ( PS) combined with caffeine citrate on neonatal respiratory distress syndrome(NRDS) treated with synchronized nasal inter-mittent positive pressure ventilation(SNIPPV). Methods We collected and analyzed 99 neonates who were diagnosed with NRDS and required SNIPPV treatment from January 2016 to June 2019 in NICU of Shengjing Hospital of China Medical University. According to the different treatment,they were divided into PS+ cit-rate caffeine combination group and control group. The control group(53 neonates)was treated by PS alone. The combination group(46 neonates)was treated with PS combined with caffeine citrate. The indexes of vent-ilator time,the time of using oxygen,length of hospital stay and complications were compared between the two groups. Results The indexes of ventilator time,the time of using oxygen and length of hospital stay of combination group were significantly shorter than those of the control group. The differences were statistically significant(P<0. 05). However,the incidences of ventilator associated pneumonia,gastrointestinal dysfunc-tion,arrhythmia and other complications were not significantly different between the two groups(P>0. 05). Conclusion PS combined with caffeine citrate in the treatment of NRDS with SNIPPV could effectively im-prove the pulmonary function of infants. It could improve the neonatal survival rate and reduce complications. It is worth to be recommended.

Progress on phospholipid in pulmonary surfactant / 国际儿科学杂志

Pulmonary surfactant is a kind of phospholipid and protein complexes,synthesized from type Ⅱ alveolar epithelial cells.The primary function of PS is to minimize the surface tension at the alveolar air-liquid interface.The deficiency of phospholipid synthesis or function leads to the occurrence of many lung diseases,such as neonatal respiratory distress syndrome,which seriously affects the morbidity and morality of neonates.Phospholipids are the main form of PS,accounting for about 85％ ～ 90％,and the main active component is dipalmitoylphosphatidylcholine,which is the most important material basis for PS to exert biological activity.In recent years,studies on phospholipids have attracted wide attention,so this article reviews the progress on composition,structure,biological characteristics,physiological function,metabolic regulation and detection methods of phospholipids.

Research progress of relationship between NRDS and free carnitine levels in premature infants / 国际儿科学杂志

Neonatal respiratory distress syndrome (NRDS) is one of the most common crfical illnesses in the neonatal period,characterized by respiratory distress and progressive exacerbation soon after birth.Recent studies have shown that the level of carnitine in preterm infants with NRDS is low,which may be associated with NRDS.This review summarizes the relationship between the occurrence of NRDS and the level of free carnitine in preterm infants,aiming to improve the understanding of carnitine levels with the pathogenesis of NRDS,and provide ideas for further clinical research and delaying the development of NRDS and improving prognosis.

Mortalidad neonatal y factores asociados en recién nacidos internados en una Unidad de Cuidados Neonatales / Neonatal mortality and associated factors in newborn infants admitted to a Neonatal Care Unit

Introducción. La mayor supervivencia de pacientes prematuros ha modificado la epidemiología de las enfermedades del recién nacido, pero la mortalidad neonatal aún es el principal componente de la mortalidad infantil. El objetivo del estudio fue cuantificar la mortalidad neonatal y los factores asociados en recién nacidos internados en una Unidad de Cuidados Neonatales. Material y métodos. Estudio de cohorte prospectivo realizado de enero de 2016 a enero de 2017 en el Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Se cuantificó la incidencia de muertes y las condiciones asociadas mediante un análisis multivariado con regresión logística. Resultados. Se registraron 9366 nacidos vivos; fueron internados en la Unidad de Cuidados Neonatales el 15% (n: 1410). La mortalidad fue de 125,5 por 1000 recién nacidos internados (IC 95%: 109-144); las principales causas fueron malformaciones o enfermedades genéticas (28,2%), infecciones (24,9%) y síndrome de dificultad respiratoria (20,9%). Las condiciones asociadas a muerte fueron edad gestacional < 37 semanas (OR 2,41; IC 95%: 1,49-3,93), peso al nacer < 1500 gramos (OR 6,30; IC 95%: 4,159,55), dificultad respiratoria moderada/grave a los 10 minutos de vida (OR 1,89; IC 95%: 1,242,86), Apgar < 7 a los 5 minutos de vida (OR 9,40; IC 95%: 5,76-15,31), malformaciones congénitas (OR 5,52; IC 95%: 3,12-9,78) y menos de cinco consultas de control prenatal (OR 1,51; IC 95%: 1,09-2,08). Conclusiones. El nacimiento prematuro, bajo peso al nacer, dificultad respiratoria, Apgar < 7, malformaciones congénitas y antecedente de < 5 consultas de control prenatal se asociaron con mayor riesgo de muerte.

Introduction. The increasing survival rate of preterm infants has altered the epidemiology of neonatal diseases; however, neonatal mortality is still the main component of child mortality. The objective of this study was to evaluate neonatal mortality and associated factors in newborn infants admitted to a neonatal care unit. Material and methods. Prospective cohort study conducted between January 2016 and January 2017 at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca." The incidence of deaths and associated conditions was evaluated using a multivariate logistic regression analysis. Results. A total of 9366 live births were registered; 15% (n: 1410) of these were admitted to the neonatal care unit. The mortality rate was 125.5 per 1000 hospitalized newborn infants (95% confidence interval --#91;CI--#93;: 109-144); the main reasons for admission were congenital malformations or genetic disorders (28.2%), infections (24.9%), and respiratory distress (20.9%). The conditions associated with death were gestational age < 37 weeks (OR: 2.41, 95% CI: 1.49-3.93), birth weight < 1500 grams (OR: 6.30, 95% CI: 4.15-9.55), moderate/severe respiratory distress at 10 minutes (OR: 1.89, 95% CI: 1.24-2.86), Apgar score < 7 at 5 minutes (OR: 9.40, 95% CI: 5.76-15.31), congenital malformations (OR: 5.52, 95% CI: 3.12-9.78), and less than 5 antenatal care visits (OR: 1.51, 95% CI: 1.09-2.08). Conclusions. Preterm birth, low birth weight, respiratory distress, Apgar score < 7, congenital malformations, and a history of < 5 antenatal care visits were associated with a higher risk for death.

Risk factors for respiratory distress syndrome in full-term neonates / 영남의대학술지

BACKGROUND: Respiratory distress syndrome (RDS) is a one of the most common cause of respiratory morbidity and mortality in neonates. This study was conducted to investigate the risk factors for RDS in full-term neonates.METHODS: We conducted this retrospective study using medical records. The study group included 80 full-term neonates diagnosed with RDS and hospitalized in the neonatal intensive care unit between January 2012 and December 2016, at Yeungnam University Hospital. We analyzed sex, gestational age, birth weight, delivery method, maternal age, number of pregnancy, history of abortion, and complication of pregnancy. The control group included 116 full-time neonates who were hospitalized with jaundice during the same period.RESULTS: The incidence of full-term RDS was more common in males (odds ratio [OR], 3.288; 95% confidence interval [CI], 1.446–7.479), cesarean section (OR, 15.03; 95% CI, 6.381–35.423), multiparity (OR, 4.216; 95% CI, 1.568–11.335). The other factors rendered no significant results.CONCLUSION: The risk factors for RDS in full-tern neonates were identified as male sex, cesarean section, and multiparity. Further studies involving more institutions are needed to clarify the risk factors for RDS in fullterm infants.

Effect and security of minimally invasive surfactant therapy in neonatal respiratory distress syndrome / 中华实用儿科临床杂志

Objective@#To explore the effect and security of minimally invasive surfactant therapy (MIST) in treatment of preterm infants with neonatal respiratory distress syndrome (NRDS).@*Methods@#A total of 48 pretrm infants with gestational ages between 30-36 weeks diagnosed with NRDS in Guangzhou Women and Children′s Medical Center from January 2017 to January 2018 were randomly divided into MIST group (23 cases) and intubation-surfactant-extubation+ continuous positive airway pressure ventilation (INSURE) group (25 cases) by adopting random number table method.The patients in MIST group were put on nasal continuous positive airway pressure (nCPAP) and a thin vascular catheter was inserted through the vocal cords under direct vision with direct laryngoscope then infused pulmonary surfactant(PS) into the lung; the patients in INSURE group were endotracheally intubated and infused with PS into the lung through endotracheal tube with positive airway pressure, then extubated and put on nCPAP again.The incidences of adverse reactions and various complications related to the 2 groups were observed.@*Results@#There were no significant differences between 2 groups in oxygen saturation decrease(26.1% vs.36.0%), bradycardia (13.0% vs.24.0%) and reuse PS (8.7% vs.4.0%) (all P>0.05). There were no significant differences between 2 groups in noninvasive ventilation time [8 d (5.5-12.5 d) vs.7 d(5.0-14.0 d)], total oxygen intake time [12 d(7.0-26.5 d) vs.10 d(10.0-23.0 d)] and length of hospital stay [(34.22±16.06) d vs.(30.88±14.35) d] (all P>0.05). There was no death or intraventricular hemorrhage in both groups, and there were no significant differences between 2 groups in the incidences of pneumothorax (0 vs.4.0%), bronchopulmonary dysplasia (21.7% vs.16.0%), retinopathy of prematurity (21.7% vs.12.0%) and necrotizing enterocolitis (21.7% vs.12.0%) (all P>0.05).@*Conclusions@#MIST technique is a safe and effective method to administrate surfactant in preterm infants with NRDS.In the NRDS patients who do not need intubation and mechanical ventilation, MIST technique can be used to administrate PS.

Research progress of exogenous pulmonary surfactant in the treatment of neonatal respiratory distress syndrome / 临床儿科杂志

Exogenous pulmonary surfactant (PS) has been widely applied in the treatment of neonatal respiratory distress syndrome (NRDS), and its curative effect was confirmed. However, there is still controversy about the dosage, timing of administration and the routes of administration. This article reviews the progress of the application of PS in NRDS in recent 3 years, and provides a basis for strategies of clinical diagnosis and treatment.