A CONTROLLED TRIAL OF ANTEPARTUM GLUCOCORTICOID TREATMENT FOR PREVENTION OF THE RESPIRATORY DISTRESS SYNDROME IN PREMATURE INFANTS

PEDIATRICS ◽  
1972 ◽  
Vol 50 (4) ◽  
pp. 515-525 ◽  
Author(s):  
G. C. Liggins ◽  
R. N. Howie
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Controlled Trial ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
Treated Group ◽  
Premature Delivery ◽  
Glucocorticoid Treatment ◽  
Increased Risk

A controlled trial of betamethasone therapy was carried out in 282 mothers in whom premature delivery threatened or was planned before 37 weeks' gestation, in the hope of reducing the incidence of neonatal respiratory distress syndrome by accelerating functional maturation of the fetal lung. Two hundred and thirteen mothers were in spontaneous premature labor. When necessary, ethanol or salbutamol infusions were used to delay delivery while steroid or placebo therapy was given. Delay for at least 24 hours was achieved in 77% of the mothers. In these unplanned deliveries, early neonatal mortality was 3.2% in the treated group and 15.0% in the controls (p 0.01). There were no deaths with hyaline membrane disease or intraventricular cerebral hemorrhage in infants of mothers who had received betamethasone for at least 24 hours before delivery. The respiratory distress syndrome occurred less often in treated babies (9.0%) than in controls (25.8%, p 0.003), but the difference was confined to babies of under 32 weeks' gestation who had been treated for at least 24 hours before delivery (11.8% of the treated babies compared with 69.6% of the control babies p. 0.02). There may be an increased risk of fetal death in pregnancies complicated by severe hypertensionedema-proteinuria syndromes and treated with betamethasone, but no other hazard of steroid therapy was noted. We conclude that this preliminary evidence justifies further trials, but that further work is needed before any new routine procedure is established.

A Controlled Trial of Antepartum Glucocorticoid Treatment for Prevention of the Respiratory Distress Syndrome in Premature Infants, by G. C. Liggins, MB, PhD, FRCOG, and R. N. Howie, MB, MRACP, Pediatrics, 1972;50:515–525

PEDIATRICS ◽  
1998 ◽  
Vol 102 (Supplement_1) ◽  
pp. 250-252
Author(s):  
Mary Ellen Avery
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Controlled Trial ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
Treated Group ◽  
Premature Delivery ◽  
Glucocorticoid Treatment ◽  
Increased Risk

A controlled trial of betamethasone therapy was carried out in 282 mothers in whom premature delivery threatened or was planned before 37 weeks' gestation, in the hope of reducing the incidence of neonatal respiratory distress syndrome by accelerating functional maturation of the fetal lung. A total of 213 mothers were in spontaneous premature labor. When necessary, ethanol or salbutamol infusions were used to delay delivery while steroid or placebo therapy was given. Delay for at least 24 hours was achieved in 77% of the mothers. In these unplanned deliveries, early neonatal mortality was 3.2% in the treated group and 15.0% in the control subjects. There were no deaths with hyaline membrane disease or intraventricular cerebral hemorrhage in infants of mothers who had received betamethasone for at least 24 hours before delivery. The respiratory distress syndrome occurred less often in treated babies (9.0%) than in controls (25.8%), but the difference was confined to babies of <32 weeks' gestation who had been treated for at least 24 hours before delivery (11.8% of the treated babies compared with 69.6% of the control babies). There may be an increased risk of fetal death in pregnancies complicated by severe hypertension–edema–proteinuria syndromes and treated with betamethasone, but no other hazard of steroid therapy was noted. We conclude that this preliminary evidence justifies additional trials, but that additional work is needed before any new routine procedure is established.

Antepartum Glucocorticoid Treatment for Prevention of the Respiratory Distress Syndrome in Premature Infants

2021 ◽  
pp. 81-85
Author(s):  
Melissa H. Spiel ◽  
John Zupancic
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Premature Infants ◽  
Distress Syndrome ◽  
Controlled Trial ◽  
Hyaline Membrane Disease ◽  
Premature Delivery ◽  
Glucocorticoid Treatment ◽  
Patients At Risk ◽  
Contemporary Context

Two hundred eighty-two patients at risk for premature delivery were included in this controlled trial of betamethasone therapy versus placebo. Of those included, 213 were in spontaneous premature labor. Ethanol or salbutamol infusions were used to delay delivery while steroid or placebo was given. Among those infants born to mothers who received betamethasone, there were no deaths with hyaline membrane disease or intraventricular hemorrhage. Respiratory distress syndrome occurred less often in those who received betamethasone than in controls (9% vs. 25.8%, p = 0.003), but this difference was primarily for those neonates born less than 32 weeks gestation who had been treated for at least 24 hours before delivery. This article reviews this hallmark study and provides contemporary context for its findings.

STUDIES ON HYALINE MEMBRANE DISEASE

PEDIATRICS ◽  
1966 ◽  
Vol 38 (2) ◽  
pp. 231-243
Author(s):  
Clara M. Ambrus ◽  
David H. Weintraub ◽  
Julian L. Ambrus
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Hyaline Membrane Disease ◽  
Treated Group ◽  
Control Group ◽  
Hyaline Membrane ◽  
The Difference ◽  
The Uk ◽  
Experimental Group

Fibrinolytic enzyme therapy of respiratory distress syndrome was explored in a controlled, randomized, double-blind clinical study. Of 100 infants entered in the study, 60 corresponded to all of the predetermined criteria and were included in the final evaluation. Infants with respiratory distress syndrome were admitted to the study if they were (1) premature, (2) from diabetic mothers, or (3) from mothers with hemorrhagic complications of pregnancy. In regard to sex, delivery route, maternal status, pretreatment respiratory rate, Silverman score, venous pressure, electrolytes, protein levels, and circulating levels of members of the fibrinolysin system, the placebo-treated control group and the experimental group were found to be comparable. The groups were comparable in regard to pretreatment blood pH and pCO2 as well, except that the subgroup that was treated with the enzyme preparation and expired showed a greater degree of acidosis than the other groups. Patients in the experimental group received 5 RPMI units/kg of human plasmin activated with human urokinase (UK-plasmin) intravenously in 4 hours, plus 60 RPMI units/kg/day of enzyme by aerosol. In the placebo-treated control group, 11 of 28 infants recovered (39%) and in the UK-plasmin treated group, 23 of 32 recovered (72%). The difference is statistically significant at less than 5% level. Of the infants with a birth weight of 2 kg or less, 3 of 16 recovered in the placebo-treated control group (19%), and 10 of 16 recovered in the UK-plasmin treated group (63%); the difference is statistically significant at less than 5% level. No clinical side effects were seen in any of the patients. Autopsy findings indicated a high degree accuracy of diagnosis. The incidence of hemorrhage diagnosed at autopsy was the same in the control and experimental groups. In all but one of the patients that expired in the UK-plasmin treated group, sufficient pathologic findings were obtained to account for death regardless of the presence of hyaline membrane disease. Similar findings were obtained in 9 of 17 patients who expired in the control group. UK-plasmin therapy of respiratory distress syndrome of infants due to hyaline membrane disease appears to be worthy of further exploration. A diagram correlates certain features of the pathophysiology of this disease and the mechanism of action of therapy.

Neonatal Morbidity in Growth-Discordant Monochorionic Twins: Comparison Between the Larger and the Smaller Twin

2012 ◽  
Vol 15 (4) ◽  
pp. 541-546 ◽  
Author(s):  
Enrico Lopriore ◽  
Carolien Sluimers ◽  
Suzanne A. Pasman ◽  
Johanna M. Middeldorp ◽  
Dick Oepkes ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Neonatal Morbidity ◽  
Fetal Lung ◽  
Cerebral Lesions ◽  
Lung Maturation ◽  
Monochorionic Twins ◽  
Increased Risk ◽  
Fetal Lung Maturation

Fetal growth restriction in singletons has been shown to enhance fetal lung maturation and reduce the risk of respiratory distress syndrome due to increased endogenous steroid production. However, data on lung maturation in growth-discordant monochorionic (thus, identical) twins are lacking. Our objective was to compare the risk of severe neonatal morbidity between the larger and the smaller twin in monochorionic twins with birth weight discordance (BWD). We included in the study all consecutive monochorionic diamniotic pregnancies with severe BWD (≥25%) and two live-born twins delivered at our center (n = 47 twin pairs). We compared the incidence of neonatal morbidity, particularly respiratory distress syndrome (RDS), and cerebral lesions between the larger and the smaller co-twin. The incidence of severe neonatal morbidity in the larger and smaller twin was 38% (18/47) and 19% (9/47), respectively (odds ratio (OR) 2.66, 95% confidence interval (CI) 0.94–7.44) and was due primarily to the higher incidence of RDS, 32% (15/47) and 6% (3/47), respectively (OR 6.88, 95% CI 1.66–32.83). In conclusion, this study shows that the larger twin in monochorionic twin pairs with BWD is at increased risk of severe neonatal morbidity, particularly RDS, compared to the smaller twin.

A CONTROLLED TRIAL OF MANAGEMENT OF RESPIRATORY DISTRESS SYNDROME IN A BODY-ENCLOSING RESPIRATOR I. EVALUATION OF SAFETY

PEDIATRICS ◽  
1967 ◽  
Vol 39 (5) ◽  
pp. 740-748
Author(s):  
William A. Silverman ◽  
John C. Sinclair ◽  
Gillian M. Gandy ◽  
Mieczyslaw Finster ◽  
William A. Bauman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Central Nervous System ◽  
Nervous System ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Controlled Trial ◽  
Treated Group ◽  
Trained Personnel

A sequential, controlled trial was conducted to compare the results of standard supportive care of RDS with those of management in a body-enclosing respirator. No important lowering of survival nor increased incidence of pulmonary or central nervous system complications occurred in the respirator-treated group. Evaluation of the efficacy of respirator care for the respiratory distress syndrome should be carried out in a well organized neonatal intensive care unit staffed by specially trained personnel.

Pre-Existing Psychiatric Illness Is Associated With an Increased Risk of Delirium in Patients With Acute Respiratory Distress Syndrome

2021 ◽  
pp. 088506662110190
Author(s):  
Saminder Singh Kalra ◽  
Johnny Jaber ◽  
Bashar N. Alzghoul ◽  
Ryan Hyde ◽  
Sarina Parikh ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Psychiatric Illness ◽  
Distress Syndrome ◽  
Multivariable Logistic Regression Analysis ◽  
Psychiatric Illnesses ◽  
Increased Risk ◽  
Icu Delirium ◽  
The Impact

Background: Patients with acute respiratory distress syndrome (ARDS) are highly susceptible to developing delirium for a multitude of reasons. Previous studies have linked pre-existing depression with an increased risk of postoperative delirium in patients undergoing cardiac and non-cardiac surgery. However, the evidence regarding the association between pre-existing psychiatric illnesses and delirium in ARDS patients is unknown. In this study, we aim to determine the relationship between pre-existing psychiatric illness and the risk of development of delirium amongst ARDS patients. Study Design and Methods: We performed a retrospective study of a mixed group of patients admitted to the intensive care unit (ICU) between January 2016 and December 2019 with a diagnosis of ARDS per the Berlin definition. The study group was divided into 2 cohorts: subjects with delirium and subjects without delirium. Comparison between the 2 groups was conducted to examine the impact of pre-existing psychiatric illnesses including major depressive disorder (MDD), generalized anxiety disorder (GAD), bipolar disorder, schizophrenia, or post-traumatic stress disorder. Multivariable logistic regression analysis was performed adjusting for benzodiazepine use, sedatives, analgesics, sequential organ failure assessment score, and corticosteroid use to determine the association between pre-existing psychiatric disorders and delirium. Results: 286 patients with ARDS were identified; 124 (43%) of whom were diagnosed with ICU delirium. In patients diagnosed with ICU delirium, 49.2% were found to have preexisting psychiatric illnesses, compared to 34.0% without any preexisting psychiatric illness (OR = 1.94, P = 0.01). In a subgroup analysis of individual psychiatric illnesses, GAD and MDD were associated with the development of delirium (OR = 1.88, P = 0.04 and OR = 1.76, P = 0.05 respectively). Interpretation: ARDS patients with preexisting psychiatric illnesses, particularly GAD and MDD are associated with an increased risk of developing ICU delirium. Clinicians should be aware of the effect of psychiatric co-morbidities on developing delirium in critically ill patients.

Pneumothorax and Pneumomediastinum in Infants With ldiopathic Respiratory Distress Syndrome Receiving Continuous Positive Airway Pressure

PEDIATRICS ◽  
1975 ◽  
Vol 55 (4) ◽  
pp. 493-496
Author(s):  
Robert T. Hall ◽  
Philip G. Rhodes
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Oxygen Concentration ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Underlying Mechanism ◽  
Treated Group ◽  
Controlled Study ◽  
Idiopathic Respiratory Distress Syndrome ◽  
Inspired Oxygen

A review of infants with idiopathic respiratory distress syndrome developing pneumomediastinum and pneumothorax reveals (1) an incidence of 20% in patients receiving CPAP with an 11% incidence in comparable infants not receiving this mode of therapy; (2) in the CAPA-treated group the occurrence was at a stage in the illness when the inspired oxygen concentration was being lowered and when ventilation was stable; (3) the inspired oxygen concentration in the CPAP group at the time of the PM and/or PT was 52% (± S.D. 15%) at a mean age of 33 hours (± S.D. 23 hr). These observations suggest that distending airway pressure creates excessive alveolar distention as an underlying mechanism of the air leak. It is recommended that distending airway pressure be lowered prior to achieving an inspired oxygen concentration of 60%. A controlled study is in progress to delineate the optimum distending airway pressures at specific inspired oxygen concentrations in order to reduce the incidence of alveolar rupture to a minimum.

A Controlled Trial of Hydrocortisone Therapy in Infants With Respiratory Distress Syndrome: II. Pathology

PEDIATRICS ◽  
1973 ◽  
Vol 52 (6) ◽  
pp. 850-854 ◽  
Author(s):  
H. William Taeusch ◽  
Nai San Wang ◽  
Melvin Baden ◽  
Charles R. Bauer ◽  
Leo Stern
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Beneficial Effect ◽  
Intraventricular Hemorrhage ◽  
Distress Syndrome ◽  
Controlled Trial ◽  
Clinical Results ◽  
Steroid Treatment ◽  
Pathological Findings

The pathological findings from seven infants who died with respiratory distress syndrome and had been treated with placebo are compared with seven infants with comparable disease treated with hydrocortisone. Differences in lung, liver, adrenal, thymus, heart and spleen pathology attributable to steroid treatment did not occur between the two groups. A statistically significant association was found between intraventricular hemorrhage and steroid treatment. The pathological findings are consistent with the clinical results in that no beneficial effect occurs when steroids are used after an infant manifests respiratory distress. The possibility that elevated steroid levels increase the likelihood of intraventricular hemorrhage in association with respiratory distress syndrome is raised by these observations, although further information is needed to establish such a relationship.

Physical Development and Medical History of Children Who Were Treated Antenatally With Corticosteroids to Prevent Respiratory Distress Syndrome: A 10- to 12-Year Follow-up

PEDIATRICS ◽  
1990 ◽  
Vol 86 (1) ◽  
pp. 65-70 ◽  
Author(s):  
H. Smolders-de Haas ◽  
J. Neuvel ◽  
B. Schmand ◽  
p. E. Treffers ◽  
J. G. Koppe ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Medical History ◽  
Distress Syndrome ◽  
Hospital Admissions ◽  
Controlled Trial ◽  
Ophthalmological Examination ◽  
Double Blind ◽  
History Of

Potential side effects of antenatal administration of corticosteroids to prevent neonatal respiratory distress syndrome were studied in 10- to 12-year-old children whose mothers had participated in a randomized, double-blind, placebo-controlled trial of betamethasone. The children had a general physical examination; parents were interviewed about the medical history of their child with special attention to infectious diseases; growth data were collected; and a developmental neurological examination, an ophthalmological examination, and a lung function test were conducted. In the corticosteroid group significantly more hospital admissions because of infectious diseases during the first years of life were reported. On the other variables no differences between the corticoid and the placebo groups were found.

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