scholarly journals Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who Are the Best Candidates?

2016 ◽  
Vol 2 (2) ◽  
pp. 73-79 ◽  
Author(s):  
Maria Livia Ognean ◽  
Silvia-Maria Stoicescu ◽  
Oana Boantă ◽  
Leonard Năstase ◽  
Carmen Gliga ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Peripheral Oxygen Saturation ◽  
Apgar Scores ◽  
Group 2 ◽  
Group 1

Abstract Introduction: Respiratory distress syndrome (RDS) continues to be the leading cause of illness and death in preterm infants. Studies indicate that INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is better than mechanical ventilation (MV) with rescue surfactant, for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates, as it has a synergistic effect on alveolar stability. Aim of the study: To identify the factors associated with INSURE strategy failure in preterm infants with gestational age (GA) ≤ 32 weeks. Materials and Methods: This was a retrospective cohort study, based on data collected in the Romanian National Registry for RDS patients by three regional (level III) centers between 01.01.2010 and 31.12.2011. All preterm infants of ≤ 32 weeks GA were included. Prenatal and neonatal information were compared between (Group 1), the preterm infants successfully treated using INtubation-SURfactant-Extubation on nasal CPAP (INSURE) strategy and (Group 2), those who needed mechanical ventilation within seventy two hours after INSURE. Results: A total of 637 preterm infants with GA ≤ 32 weeks were included in the study. INSURE strategy was performed in fifty seven cases (8.9%) [Group 1] and was successful in thirty one patients (54.4%). No differences were found as regards the studied prenatal and intranatal characteristics between (Group 1) and Group 2 who needed mechanical ventilation. Group 2 preterm infants who needed mechanical ventilation within 72 hours after INSURE had significantly lower mean Apgar scores at 1 and 5 minutes and lower peripheral oxygen saturation (SpO2) during resuscitation at birth (p<0.05). Successful INSURE strategy was associated with greater GA, birth weight (BW), fraction of inspired oxygen (FiO2) during resuscitation, and an increased mean dose of surfactant but these associations were not statistically significant (p>0.5). Conclusion: In preterm infants ≤ 32 weeks gestation, increased INSURE failure rates are associated with complicated pregnancies, significantly lower Apgar scores at 1 and 5 minutes, and lower peripheral oxygen saturation during resuscitation.

scholarly journals Results of INSSURE Method in the Treatment of Respiratory Distress Syndrome in Premature Infants at Bac Ninh Obstetric Pediatric Hospital

2017 ◽  
Vol 33 (2) ◽  
Author(s):  
Tran Thi Thuy ◽  
Ngo Thi Xuan ◽  
Pham Trung Kien ◽  
Hoang Ngoc Canh
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Premature Infants ◽  
Distress Syndrome ◽  
Descriptive Study ◽  
Pediatric Hospital ◽  
Lower Temperature

OBJECTIVES: To evaluate the results of the INtubate-SURfactant-Extubate (INSURE) method in the treatment of respiratory distress syndrome in premature infants at Bac Ninh obstetric pediatric hospital from March to September 2017. METHODS: A descriptive study was conducted on 50 preterm infants with respiratory distress syndrome. The infants were treated with INSURE method . RESULTS: Of the 50 infants, 29 (58.0%) were male. All of infants,  49 (98.0%) gestational age under 32 weeks, of which 56.0% was less than 30 weeks. The infants birth weight less than 1500 grams accounted for 78.0%, of which 28.0% under 1000 grams. Only 40.0% of mothers were injected with corticosteroid before giving birth. The most common symptoms are cyanosis , apnea neoatorum  > 10 seconds; lower temperature. X.ray III is 92.0%. All infants were pumped pulsed surfactant before 6 hours, intubated endotracheal tube and was removed within 50 minutes. There were 13 children (26.0%) had to have mechanical ventilation, the highest rate of reintroduction in infants birth weight less than 1000 grams. The rate of SpO2 increased, the FiO2 and Siverman index decreased and remained stable significantly after 6 hours of treatment. The complication rate was 4.0%. Treatment outcomes were only associated with birth weight (p<0.05). CONCLUSIONS: INtubate-SURfactant-Extubate is effective methods in treatment of infants with respiratory distress syndrome (RDS).

The Effect of Antenatal Dexamethasone to Improve Respiratory Neonatal Outcomes in Late Preterm Birth: A Randomized Controlled Trial

2021 ◽  
Vol 104 (4) ◽  
pp. 514-521
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Late Preterm ◽  
Apgar Scores ◽  
Late Preterm Birth ◽  
Neonatal Respiratory Distress ◽  
Group 2 ◽  
Nicu Admission ◽  
Group 1

Objective: To evaluate the effect of dexamethasone on the rate of respiratory distress syndrome in late preterm infants Materials and Methods: One hundred ninety-four singleton pregnant women at risk for late preterm delivery were randomly allocated into two groups. Ninety-seven patients received 6 mg dexamethasone (group 1) and 97 patients received 1.5 mL normal saline (group 2), intramuscularly every 12 hours for four doses or until delivery. The primary outcome was the rate of neonatal respiratory distress syndrome. The secondary outcomes were the need for continuous positive airway pressure (CPAP), the neonatal intensive care unit admission, the Apgar scores at 1 minute and 5 minutes, the rate of transient tachypnea of the newborn (TTN), intraventricular hemorrhage, neonatal hypoglycemia, neonatal sepsis, and adverse effects. Results: The rate of neonatal respiratory distress syndrome was lower in group 1, five cases (5.2%), compared with group 2, six cases (6.2%) (p=0.756, relative risk 0.83, 95% CI 0.26 to 2.64). The need for CPAP, NICU admission, rate of TTN, and intraventricular hemorrhage were not significantly different. Group1 had significantly higher Apgar scores at 1 minute and 5 minutes (p=0.021 and 0.043, respectively). No adverse effects were reported. Conclusion: Administration of dexamethasone in late preterm birth did not decrease the rate of neonatal respiratory distress and the need for CPAP and NICU admission but statistically significantly improved the Apgar scores at 1 minute and 5 minutes. More research in the future is needed to correct the limitation in the present study. Keywords: Late preterm, Dexamethasone, Respiratory distress syndrome, Apgar scores

Predictors of mortality in premature babies with respiratory distress syndrome treated by early rescue surfactant therapy

2021 ◽  
pp. 1-6
Author(s):  
V. Gahlawat ◽  
H. Chellani ◽  
I. Saini ◽  
S. Gupta
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Surfactant Therapy ◽  
Mask Ventilation ◽  
Predictors Of Mortality ◽  
Antenatal Steroid ◽  
Bag And Mask Ventilation

OBJECTIVE: To determine the predictors of mortality following early rescue surfactant therapy in preterm babies with respiratory distress syndrome. STUDY DESIGN: Prospective cohort study enrolling babies between 28 weeks to 34 weeks with respiratory distress syndrome requiring early rescue surfactant therapy. For statistical analysis babies were further divided into two subgroups: survivors and non-survivors. Maternal and neonatal variables were compared between the two groups to find out the predictors of mortality. RESULTS: Out of total 110 babies, 72 (65.45%) survived. The mean birth weight and mean gestational age of the study population was 1614.36 (±487.86) g and 31.40 (±2.0)1 weeks, respectively. Birth weight <  1500 g, gestational age <  32 weeks, primiparity, vaginal delivery, prolonged rupture of membranes, lack of antenatal steroid cover, bag and mask ventilation at birth, sepsis, apneic episodes and mechanical ventilation were significantly associated with death on univariate analysis. On multivariate analysis, very low birth weight, vaginal delivery, lack of antenatal steroid cover, bag and mask ventilation at birth and mechanical ventilation were found to be independent predictors of mortality. CONCLUSIONS: Some of the identified predictors of mortality are modifiable and can be used to draw up a screening tool to predict the clinical severity and mortality among these babies.

INSURE (INtubate, SURfactant and Extubate) method in preterm infants with respiratory distress syndrome: a retrospective study

2020 ◽  
Author(s):  
Mohamed Mubarak Shaik Kidur Mohideen ◽  
Deepika Wagh ◽  
Sam Athikarisamy
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
P Value ◽  
Severe Respiratory Distress ◽  
Surfactant Administration

Abstract Background: Preterm infants with severe respiratory distress syndrome (RDS) are usually managed with endotracheal intubation and surfactant administration followed by mechanical ventilation however this has immediate and long-term complications. Hence, INSURE (Intubate, surfactant administration and extubate) method combined with continuous positive airway pressure (CPAP) support has been accepted as an alternative method in eligible infants. Aim of this study is to look at our experience of administering INSURE and to look at the factors predisposing to the failure of INSURE. Methods: A retrospective chart review was done of all the babies who were born in a tertiary hospital between 1 st January 2014 to 31 st December 2015 (2 years) and received surfactant through INSURE method. Infants requiring reintubation and mechanical ventilation within 3 days post INSURE are considered as INSURE failure for our study purpose. Results: Eighty-five infants were included in the review with gestational age (GA) ranging from 26 +3 to 35 +5 weeks and birth weight ranging from 680 to 3340 grams. Of these, 22 infants (26%) had INSURE failure. INSURE failure rate was higher in infants born <30 weeks gestation (40%). Higher FiO2 requirement prior to INSURE (mean FIO 2 0.5 vs 0.3, P value <0.001) and preeclampsia in mothers of infants < 30 weeks of GA (P value 0.027) were strongly associated with INSURE failure. No mortality was noted in either group. Conclusion: We found that INSURE method may be useful in preventing the need for mechanical ventilation in late preterm infants with RDS. However, this method may be less successful in preterm infants with lower GA (<30 weeks) and higher FiO2 requirement (≥0.5). More prospective studies are needed to assess the effectiveness of INSURE method.

Competing Risk Analysis of the Health Status of Neonates with Respiratory Distress Syndrome

2020 ◽  
Author(s):  
Zenaw Ayele ◽  
Mekonnen Tadesse ◽  
Zelalem Tazu
Keyword(s):  
Prognostic Factors ◽  
Birth Weight ◽  
Health Status ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Preterm Infants ◽  
Gestational Age ◽  
Distress Syndrome ◽  
Competing Risk

Introduction: Respiratory distress syndrome (RDS) is not only the most common respiratory disorder in premature infants but also the main cause of neonatal mortality. Methods: Competing risk framework was used to examine and identify potential prognostic factors of the health status of preterm infants with respiratory distress syndrome. Preterm infants with RDS admitted to the neonatal intensive care units (NICUs) of selected hospitals in Ethiopia were followed for 28 days and only neonates with complete cases were included in the analysis. The Fine-Gray or sub-distribution hazard model was used to identify significant prognostic factors. Three outcome variables (death due to RDS, death due to other causes and discharged alive) were considered. Results: The Fine-Gray model fit results revealed that anemia, multiple pregnancies, birth-weight and gestational age were the prognostic factors significantly associated with the death of neonates due to Respiratory distress syndrome problem while Pneumonia, meningitis, anemia and gestational age of neonates were the significant prognostic factors for death of neonates due to other causes. Moreover, pneumonia, birth weight and gestational age were identified as the prognostic factors associated with neonates being discharged alive. Conclusion: Offering intensive and adequate treatments for neonates with lowest birth-weights and gestational age may be useful to reduce neonatal mortality and increase the incidence of being discharged alive.

scholarly journals A Comparative Pharmacoeconomic Assessment of Two Surfactants for the Prevention of Respiratory Distress Syndrome

2006 ◽  
Vol 11 (1) ◽  
pp. 43-54 ◽  
Author(s):  
Joette M. Gdovin ◽  
Fernando Moya ◽  
Tejal Vishalpura ◽  
Amy Grogg
Keyword(s):  
Mechanical Ventilation ◽  
Cost Effectiveness ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Resource Utilization ◽  
Distress Syndrome ◽  
Healthcare Resource ◽  
Pharmacoeconomic Analysis ◽  
Healthcare Resource Utilization

OBJECTIVE The use of exogenous surfactants among preterm infants for the prevention and treatment of respiratory distress syndrome (RDS) has led to economic and cost-effectiveness evaluations of these products. Lucinactant (Surfaxin), a novel, peptide-based, synthetic surfactant, has been shown to significantly reduce RDS-related mortality, compared with the most commonly prescribed animal-derived surfactant, beractant (Survanta). Infants who survive expend significant healthcare resources; therefore, the impact of improved survival through 1-year corrected age was evaluated in a prospectively defined pharmacoeconomic analysis. The objectives of this study were to estimate the healthcare resource utilization, economic impact, and cost-effectiveness of lucinactant versus beractant for the prevention of RDS among surviving very low birth weight (VLBW) preterm infants weighing 600 to 1250 grams. METHODS A decision-analytic model was developed to compare the healthcare resource utilization, economic impact, and cost-effectiveness of lucinactant versus beractant. RESULTS Infants who received lucinactant had fewer neonatal intensive care unit (NICU) days and fewer NICU days on mechanical ventilation compared with infants who received beractant. Total healthcare costs for the initial stay in the NICU were lower by $8,803 among infants who received lucinactant compared with infants who received beractant. The incremental cost per life saved was $40,309 for lucinactant compared with beractant. CONCLUSIONS Administration of lucinactant to surviving VLBW preterm infants resulted in fewer NICU days and fewer NICU days on mechanical ventilation compared with beractant. Fewer NICU days translates into lower total costs among infants who received lucinactant. This comprehensive pharmacoeconomic analysis indicates that lucinactant is a cost-effective therapy for the prevention of RDS among preterm infants.

scholarly journals Novel Approaches to Surfactant Administration

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Samir Gupta ◽  
Steven M. Donn
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Noninvasive Ventilation ◽  
Clinical Evidence ◽  
Distress Syndrome ◽  
Surfactant Replacement Therapy ◽  
Surfactant Administration ◽  
Novel Approaches

Surfactant replacement therapy has been the mainstay of treatment for preterm infants with respiratory distress syndrome for more than twenty years. For the most part, surfactant is administered intratracheally, followed by mechanical ventilation. In recent years, the growing interest in noninvasive ventilation has led to novel approaches of administration. This paper will review these techniques and the associated clinical evidence.

scholarly journals Persistent Ductus Arteriosus in Critically Ill Preterm Infants

2016 ◽  
Vol 2 (4) ◽  
pp. 175-184 ◽  
Author(s):  
Maria Livia Ognean ◽  
Oana Boantă ◽  
Simona Kovacs ◽  
Corina Zgârcea ◽  
Raluca Dumitra ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Ductus Arteriosus ◽  
Respiratory Support ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Group 1

Abstract Introduction: Persistent ductus arteriosus (PDA) is found with increased incidence in preterm infants, significantly affecting neonatal morbidity and mortality rates. Aim: To evaluate the association between the presence of PDA and the severity of clinical condition at birth in critically ill preterm infants, with gestational ages (GA) ≤ 32 weeks and severe respiratory distress. Methods: All preterm infants with GA ≤ 32 weeks admitted to the neonatal intensive care unit (NICU) of the Clinical County Emergency Hospital, Sibiu between 1 January 2010 and 31 December 2015 were included in the study. These were categorized as Group 1 [Preterm infants with PDA; n=154] and Group 2 [Preterm infants without PDA; n=186]. Epidemiological and clinical data were collected in the National Registry for Respiratory Distress Syndrome for all children, and data related to prenatal period, clinical characteristics at birth i.e GA, weight, gender, Apgar scores, and clinical features such as resuscitation at birth, surfactant administration, need and duration of respiratory support, neonatal sepsis, complications associated with prematurity, and death, were analyzed. Results: Group 1 infants had significantly lower GA and birth weights, were more often out born (p=0.049, HR 1.69), and had significantly lower Apgar scores at 1 and 10 minutes (p=0.022, p=0.000). They presented a significantly higher need for surfactant administration (42.9% vs 24.7%, p<0.0001) and respiratory support (96.8% vs 90.3%, HR 3.19, p=0.019 for need of CPAP and 22.1% vs 10.8%, HR 2.35, p=0.004 for mechanical ventilation). Duration of respiratory support was also significantly higher in the Group 1 (7.6%±7.5 vs. 5.1±3.8 days, p<0.0001 for CPAP and 20.1±22.5 vs. 12.0±15.7 days, p<0.0001 for mechanical ventilation). Conclusion: In very preterm infants, PDA may be associated with a critical clinical condition leading to serious complications. The presence of PDA after the seventh day of life was associated with an increased need for respiratory support, both CPAP and mechanical ventilation, increased severity of the respiratory distress syndrome, requiring a longer duration of respiratory support, and increased the hospitalization length. In very preterm infants, PDA presence was also associated with a higher rate of severe complications and death, indicating the need for a careful and proper management of these critical cases in neonatal intensive care units.

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