Prehospital administration of surfactant to a premature neonate in respiratory distress

Abstract The population of the Kingdom of Bhutan is scattered in small villages throughout the eastern Himalaya. Infants born prematurely in villages have no access to neonatal intensive care until they are transported to the national referral hospital, a process that once took hours, if not days. After the introduction of a helicopter critical-care retrieval team, we were able to send a trained team to a remote location that successfully administered surfactant and initiated critical care to a premature, extreme low birth weight infant in severe respiratory distress in the first hour of life. Although the infant was in shock and in a near-arrest state at the time the team arrived, he made an excellent recovery after resuscitation by the team.

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Double-Blind, Randomized Trial of a Calf Lung Surfactant Extract Administered at Birth to Very Premature Infants for Prevention of Respiratory Distress Syndrome

PEDIATRICS ◽

10.1542/peds.76.4.593 ◽

1985 ◽

Vol 76 (4) ◽

pp. 593-599 ◽

Cited By ~ 4

Author(s):

Donald L. Shapiro ◽

Robert H. Notter ◽

Frederick C. Morin ◽

Karl S. Deluga ◽

Leonard M. Golub ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Premature Infants ◽

Neonatal Intensive Care ◽

Distress Syndrome ◽

Lung Surfactant ◽

Treated Group ◽

Control Group ◽

Double Blind ◽

Severe Respiratory Distress

Organic solvent extraction of surfactant obtained by lavage of calf lungs yields a highly surfaceactive material. A double blind, randomized clinical trial to determine the effect of this material on respiratory distress syndrome in premature infants was initiated in the Neonatal Intensive Care Unit at the University of Rochester in December 1983. Infants 25 to 29 weeks gestational age were eligible for entry into the trial. At the time of this interim analysis 32 patients had been randomly selected and entered into the trial, 16 surfactant-treated patients and 16 in a control group who received only saline. At birth, intrapulmonary instillation of the calf lung surfactant extract dispersed in saline or saline alone occurred in the delivery room immediately after intubation and prior to ventilation; infants were then ventilated and treated as usual. At 6, 12, 24, 48, and 72 hours after birth, the severity of respiratory distress was categorized as either minimal, intermediate, or severe based on oxygen and mean airway pressure requirements. Differences observed at six hours after birth were of marginal significance, but at 12 and 24 hours the surfactant-treated group had significantly (P < .01) less severe respiratory distress compared with the control group. Differences between treated and control infants were not statistically significant at 48 and 72 hours after birth. In four surfactant-treated infants the severity of respiratory distress worsened between 24 and 48 hours after birth, suggesting that one dose of surfactant at birth may not be sufficient for some infants.

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Risk Factors for Death in Bangladeshi Children Under 5 Years of Age Hospitalized for Diarrhea and Severe Respiratory Distress in an Urban Critical Care Ward

Global Pediatric Health ◽

10.1177/2333794x17696685 ◽

2017 ◽

Vol 4 ◽

pp. 2333794X1769668 ◽

Cited By ~ 3

Author(s):

Tahmina Alam ◽

Tahmeed Ahmed ◽

Monira Sarmin ◽

Lubaba Shahrin ◽

Farzana Afroze ◽

...

Keyword(s):

Risk Factors ◽

Critical Care ◽

Respiratory Distress ◽

Severe Respiratory Distress ◽

Care Ward ◽

Children Under 5

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Etiological factors, clinical profile and outcome of meconium aspiration syndrome babies

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192605 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1515

Author(s):

R. Sasivarathan ◽

A. Logesh Anand

Keyword(s):

Respiratory Distress ◽

Tamil Nadu ◽

Neonatal Intensive Care ◽

Birth Asphyxia ◽

Fetal Distress ◽

Fetal Outcome ◽

Meconium Aspiration Syndrome ◽

College Hospital ◽

Severe Respiratory Distress ◽

Etiological Factors

Background: Meconium staining of amniotic fluid has for long been considered to be a bad predictor of the fetal outcome because of its direct correlation of fetal distress, and increased the likelihood of inhalation of meconium, resultant deleterious effects on the neonatal lung. To evaluate etiological factors and severity of MAS in the study group.Methods: This study was done in the Neonatal intensive care unit of the Department of Paediatrics, Government Mohan Kumaramangalam Medical College Hospital Salem, Tamil Nadu, India in the year 2018. Complete maternal and neonatal details were recorded in to the proforma. Delivery details, resuscitation did were also recorded.Results: In present study, fetal distress was found to be the most common (42.5%) factor associated with MAS followed by PIH (21.6%) and PROM (17%). 22 (9.1%) cases were associated with Postdatism, 18 (7.5%) cases were associated with placental insufficiency. 88 babies had fetal distress (36.6%) prior to delivery. 138 babies had no fetal distress (57.5%).Conclusions: MAS is known to cause severe respiratory distress and Downe’s score ranging between 4-8, usually a few hours after the onset of respiratory distress. Nearly 73.3% of the cases with MAS had birth asphyxia, out of which 30% had severe birth asphyxia. This indicates that passage of meconium can occur in utero, often considered a feature of the stressed fetus. Undoubtedly aspiration had occurred before delivery in these babies.

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Neonatal Respiratory Distress and Airway Emergency: Report of Two Cases

Children ◽

10.3390/children8040255 ◽

2021 ◽

Vol 8 (4) ◽

pp. 255

Author(s):

Lorenzo Bresciani ◽

Paola Grazioli ◽

Roberta Bosio ◽

Gaetano Chirico ◽

Cesare Zambelloni ◽

...

Keyword(s):

Respiratory Distress ◽

Neonatal Intensive Care ◽

Renal Dysplasia ◽

Esophageal Intubation ◽

Mask Ventilation ◽

Anal Atresia ◽

Severe Respiratory Distress ◽

First Case ◽

Emergency Tracheostomy ◽

Vertebral Defects

We discuss two cases of congenital airway malformations seen in our neonatal intensive care unit (NICU). The aim is to report extremely rare events characterized by immediate respiratory distress after delivery and the impossibility to ventilate and intubate the airway. The first case is a male twin born at 34 weeks by emergency caesarean section. Immediately after delivery, the newborn was cyanotic and showed severe respiratory distress. Bag-valve-mask ventilation did not relieve the respiratory distress but allowed for temporary oxygenation during subsequent unsuccessful oral-tracheal intubation (OTI) attempts. Flexible laryngoscopy revealed complete subglottic obstruction. Postmortem analysis revealed a poly-malformative syndrome, unilateral multicystic renal dysplasia with a complete subglottic diaphragm, and a tracheo-esophageal fistula (TEF). The second case is a male patient that was vaginally born at 35 weeks. Antenatally, an ultrasound (US) arose suspicion for a VACTERL association (vertebral defects, anal atresia, TEF with esophageal atresia and radial or renal dysplasia, plus cardiovascular and limb defects) and a TEF, and thus, fetal magnetic resonance (MRI) was scheduled. Spontaneous labor started shortly thereafter, before imaging could be performed. Respiratory distress, cyanosis, and absence of an audible cry was observed immediately at delivery. Attempts at OTI were unsuccessful, whereas bag-valve-mask ventilation and esophageal intubation allowed for sufficient oxygenation. An emergency tracheostomy was attempted, although no trachea could be found on cervical exploration. Postmortem analysis revealed tracheal agenesis (TA), renal dysplasia, anal atresia, and a single umbilical artery. Clinicians need to be aware of congenital airway malformations and subsequent difficulties upon endotracheal intubation and must plan for multidisciplinary management of the airway at delivery, including emergency esophageal intubation and tracheostomy.

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Management of an Early Onset Sepsis with COVID19 in a Premature Neonate - A Case Report

10.21203/rs.3.rs-552932/v1 ◽

2021 ◽

Author(s):

Mahbod Kaveh ◽

seyyed Mohsen sadatinejad

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress ◽

Neonatal Intensive Care ◽

Distress Syndrome ◽

Current Knowledge ◽

Premature Neonate ◽

Nasopharyngeal Swab ◽

Medical Specialties ◽

Early Onset Sepsis

Abstract Background: neonates appear to be less affected by COVID-19 than adults. The overall challenge has been for all medical specialties, including neonatal intensive care. Unfortunately, current knowledge about severe acute respiratory distress syndrome of coronavirus 2 (SARS-CoV-2) infection is limited. Case presentation: In this report, we present an ill premature neonate who were born from mother with negative nasopharyngeal swab test for SARS-COV-2. On the 5th day of life, baby developed respiratory distress. Nasopharyngeal swab test for SARS-COV-2 was positive. Intubation and intratracheal surfactant was implemented. Patient was treated with Intravenous immunoglobulin and corticosteroid over a period of 14 days. Conclusion: The basis of treatment in neonatal covid19 is supportive care. Some studies have treated infants with various drugs such as Hydroxychloroquine, Favipiravir, and Remedsivir. In our case, we used corticosteroids and IVIg to treat a 5-day-old baby. We got good results after 2 weeks of treatment with dexamethasone 0.3 mg / kg per day and 2 g / kg IVIg (in three divided doses). It seems that these treatments, along with adjuvant ventilation and the use of endotracheal surfactants, can improve the patient's general condition.

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A premature baby with bilateral pleural effusions, Turner syndrome (monosomy X) and myotonic dystrophy

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2016-0031 ◽

2017 ◽

Vol 6 (2) ◽

Author(s):

Li Jun Thean ◽

Tieh Hee Hai Guan Koh

Keyword(s):

Case Report ◽

Respiratory Distress ◽

Turner Syndrome ◽

Myotonic Dystrophy ◽

Premature Neonate ◽

Premature Baby ◽

Pleural Effusions ◽

Severe Respiratory Distress ◽

Monosomy X ◽

Clinical Presentations

Abstract Respiratory distress in the premature neonate has a variety of causes, some more common than others. Sometimes it may not be apparent that rare underlying conditions may be associated with common clinical presentations. In this case report, we describe an extremely premature neonate presenting with severe respiratory distress who was subsequently diagnosed with both myotonic dystrophy and Turner syndrome (monosomy X; 45, X0). A literature review correlating this neonate’s particular presentation with these diagnoses has been included.

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Association of severe respiratory distress syndrome and thyroid agenesis in a term neonate

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/s-2006-943309 ◽

2006 ◽

Vol 210 (S 5) ◽

Author(s):

S Vanhaesebrouck ◽

K Allegaert ◽

F de Zegher ◽

C Vanhole

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Term Neonate ◽

Severe Respiratory Distress ◽

Severe Respiratory Distress Syndrome

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Hérnia Diafragmática Congênita: Relato de Caso/ Congenital Diaphragmatic Hernia: Case Report

REVISTA CIÊNCIAS EM SAÚDE ◽

10.21876/rcsfmit.v3i1.306 ◽

1970 ◽

Vol 3 (1) ◽

pp. 27-34

Author(s):

Lucas Tavares Dos Santos ◽

Tânia Massini Evangelista

Keyword(s):

Case Report ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Neonatal Intensive Care ◽

Esophageal Hiatus ◽

Bochdalek Hernia ◽

Severe Respiratory Distress ◽

X Ray ◽

Venous Catheterization ◽

Terapia Intensiva

Introdução: A hérnia diafragmática congênita é a falha do fechamento embrionário do músculo diafragmático, resultando em um defeito de continuidade. Esta patologia pode ocorrer pela passagem de estruturas do abdome através de um defeito no diafragma, ou haver herniação parcial do estômago através do hiato esofágico, paralisia frênica com deslocamento do conteúdo abdominal para cima, mas sem herniação, e, eventração do diafragma. Casuística: Foi relatado um caso de hérnia diafragmática congênita, hérnia de Bochdalek, em um recém – nascido do sexo feminino, que nos ultra-sonografias da gestante apresentavam sem alterações. O diagnóstico da patologia foi feito apenas após a realização de raios-X de tórax e abdome para confirmar a posição do cateterismo umbilical venoso. Discussão/Conclusão: A apresentação clínica da hérnia de diafragmática congênita inclui desconforto respiratório moderado a grave com repercussão sistêmica. O diagnóstico, em cerca de 80% dos casos, é feito por ultrassom pré-natal. O tratamento proposto foi intubação endotraqueal com ventilação mecânica e programação para correção cirúrgica da hérnia. Após correção cirúrgica da patologia, a paciente permaneceu na unidade de terapia intensiva neonatal por 21 dias para acompanhamento de pós – operatório e intercorrências na evolução. Palavras-chave: hérnia diafragmática congênita, recém-nascido, hérnia de BochdalekABSTRACTIntroduction: Congenital diaphragmatic hernia is the failure of embryonic closure of the diaphragm, resulting in a lack of continuity. This condition can occur by passing structures of the abdomen through a defect in the diaphragm, or be part herniation of the stomach through the esophageal hiatus, phrenic paralysis with displacement of abdominal contents up but no herniation, and eventration of the diaphragm. Case Report: We report a case congenital diaphragmatic hernia, such as Bochdalek hernia, in a new - born female that in ultrasounds of pregnant women showed without change. The diagnosis of the disease was made only after conducting X-ray of the chest and abdomen to confirm the position of umbilical venous catheterization. Discussion/Conclusion: Clinical presentation of congenital diaphragmatic hernia includes moderate to severe respiratory distress with systemic repercussions. The diagnosis in about 80% of the cases is done by ultrasound prenatally. The proposed treatment was endotracheal intubation with mechanical ventilation and programming for surgical correction of the hernia. After surgical pathology, the patient remained in neonatal intensive care unit for 21 days to monitor post - operative complications and evolution. Keywords: congenital diaphragmatic hernia, newborn, Bochdalek hernia

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Evaluation of Morbidities and Complications of Neonatal İntensive Care Unit Patients with Respiratory Disorders at Different Gestational Ages

American Journal of Perinatology ◽

10.1055/s-0041-1722942 ◽

2021 ◽

Author(s):

Erbu Yarci ◽

Fuat E. Canpolat

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Neonatal Intensive Care Unit ◽

Respiratory Distress ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Respiratory Diseases ◽

Respiratory Disorders ◽

Live Births

Objective Respiratory distress presented within the first few days of life is life-threatening and common problem in the neonatal period. The aim of this study is to estimate (1) the incidence of respiratory diseases in newborns and related mortality; (2) the relationship between acute neonatal respiratory disorders rates and gestational age, birth weight, and gender; and (3) the incidence of complications associated with respiratory disturbances. Study Design Only inborn patients with gestational age between 230/7 and 416/7 weeks having respiratory distress were included in the study. The data were collected from the medical records and gestational age was based on the menstrual dating. Results There were 8,474 live births between January 1, 2013 and June 30, 2013 in our hospital. A total of 1,367 newborns were hospitalized and oxygen therapy was applied in 903 of them because of respiratory distress. An acute respiratory disorder was found to be in 10.6% (903/8,474) among all live births. Mortality was 0.76% (66/8,474). The incidence of respiratory distress syndrome was 2.8% (n = 242). The occurrence of transient tachypnea of newborn was 3.1% (n = 270). Meconium aspiration syndrome, pneumonia, congenital diaphragmatic hernia, and pulmonary maladaptation and primary persistent pulmonary hypertension rates were 0.1, 0.7, 2.2, and 0%, respectively. Overall, 553 (61%) of the 903 newborns having respiratory diseases had complications. The occurrence of necrotizing enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage and air leak was 6.8, 19.8, 4.7, 24.9, and 5%, respectively. Conclusion This study offers an epidemiological perspective for respiratory disorders from a single-center level-III neonatal intensive care unit. Although number of births, premature newborns, extremely low birth weight/very low birth weight infants, and complicated pregnancies increase in years, decreasing rates of mortality and complications are very promising. As perinatal and neonatal cares are getting better in every day, we think that more promising results can be achieved over the coming years. Key Points

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