RESUMO
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 >/= 35 weeks of gestation; 2] Severe and immediate respiratory distress requiring mechanical ventilation with PEEP >/=4 cm H2O and FiO[2] >/= 0.5 during at least 6 hours ; 3] Dependence on oxygen >/= 48 hours; 4] Diffuse alveolar damage in the chest radiograph; 5] PaO[2] /= 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] O[2], OI and PaO2/FiO[2]]. 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