ABSTRACT
OBJECTIVES: Natural surfactant preparations have been shown to reduce the severity and mortality of respiratory distress syndrome (RDS) in preterm infants. The objective of this study was to compare the efficacy of two natural surfactants, namely SF-RI 1 (Alveofact) and barectant (Survanta), on the incidence of chronic lung disease (CLD) and other associated complications of RDS in preterm infants. METHODS: Preterm infants with RDS requiring artificial ventilation were randomly selected to receive an initial dose of either Alveofact or Survanta. The two treatment groups were tested for variation in gas exchange, ventilatory settings and neonatal complications such as CLD and mortality. RESULTS: After 5 days the Survanta-treated infants had a lower fraction of inspired oxygen (FiO2) compared with the Alveofact-treated infants. There were no differences in the ventilatory settings. More infants in the Survanta group were extubated at 3 days and fewer required the use of postnatal steroids. Less CLD and duration of oxygenation were experienced by the Survanta-treated group. CONCLUSIONS: Improved oxygenation and reduced ventilatory requirements were greater with Survanta compared to Alveofact, which in turn was associated with a trend towards a lower incidence of serious pulmonary complications.
Subject(s)
Biological Products/therapeutic use , Lipids/therapeutic use , Phospholipids/therapeutic use , Respiratory Distress Syndrome, Newborn/drug therapy , Biological Products/administration & dosage , Critical Care , Dose-Response Relationship, Drug , Female , Humans , Infant, Newborn , Infant, Premature , Lipids/administration & dosage , Male , Phospholipids/administration & dosage , Prospective Studies , Respiration, Artificial , Surface-Active Agents/administration & dosage , Surface-Active Agents/therapeutic use , Treatment OutcomeSubject(s)
Brain Diseases, Metabolic, Inborn , Glutaryl-CoA Dehydrogenase/deficiency , Brain Diseases, Metabolic, Inborn/diagnosis , Brain Diseases, Metabolic, Inborn/epidemiology , Brain Diseases, Metabolic, Inborn/genetics , Brain Diseases, Metabolic, Inborn/prevention & control , Carnitine/therapeutic use , Child, Preschool , Cough/etiology , Diet, Protein-Restricted , Dietary Carbohydrates/administration & dosage , Fever/etiology , Genes, Recessive/genetics , Glutarates/urine , Homozygote , Humans , Incidence , Kuwait/epidemiology , Magnetic Resonance Imaging , Male , Mutation/genetics , Seizures/etiology , Tomography, X-Ray Computed , Vomiting/etiologyABSTRACT
Coeliac disease (CD) is more prevalent in individuals with type 1 diabetes mellitus (DM), and when untreated is associated with a number of medical complications, including poor glycaemic control. Identification of patients with CD has been facilitated in recent years by serological screening, including the use of antigliadin antibodies (AGAs) and endomysial antibodies (EMAs). The aim of this study was to assess the prevalence of CD in a clinic-based paediatric population with type 1 DM, and to study longitudinal changes in AGA status. Two-hundred-and-eighty-one children and adolescents with type 1 DM aged 9.9 +/- 3.8 yr were screened using AGAs of immunoglobulin A (IgA) and immunoglobulin G (IgG) classes (AGA-IgA and AGA-IgG). Thirty-five patients had both antibodies positive and underwent gastro-duodenoscopy and multiple biopsies. Fifteen of the 35 patients had histological evidence of CD, and the overall clinic prevalence of CD was 5.7%. A number of patients did not exhibit florid symptoms, and recurrent unexplained hypoglycaemia was a significant finding. Patients who perceived themselves to be asymptomatic had more problems with compliance with a gluten-free diet (GFD). Ninety-seven patients had follow-up AGAs performed after 2.5 +/- 1.5 yr. One patient with initially normal AGAs developed positive antibodies and histological findings of CD. Antibody status has fluctuated in other patients. CD is common in patients with DM, and diagnosis is important to detect to minimize long-term morbidity related to both disorders. Initial normal screening does not exclude CD and repeat screening is indicated.
