Artificial Surfactant to Prevent and Treat Neonatal Respiratory Distress Syndrome

Twenty years ago we were first presented with evidence that infants dying from hyaline membrane disease suffer from a pulmonary surfactant deficiency.1 This observation has been substantiated with numerous reports from several countries. It offers a logical explanation to the physiology and pathology characterizing the condition, and has clearly influenced preventive and therapeutic measures. The obstetrician tries to avoid delivery until surfactant synthesis has become adequate through a naturally occurring process of maturation, or through one stimulated with glucocorticoids, and the pediatrician counteracts the tendency for atelectasis to develop by applying an airway pressure which is continuously distending. Delivery quite often occurs so early in gestation that surfactant synthesis is still inadequate and there has not been sufficient time to stimulate it.

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Relationship Between Incidence of Hyaline Membrane Disease and Maternal Hypertension During Pregnancy

Paediatrica Indonesiana ◽

10.14238/pi38.3-4.1998.47-53 ◽

2017 ◽

Vol 38 (3-4) ◽

pp. 47

Author(s):

Lasmida Nazir Nuriman ◽

Dadang Sjarif Hidajat

Keyword(s):

Distress Syndrome ◽

Hyaline Membrane Disease ◽

Cross Sectional Study ◽

Type I ◽

Cross Sectional ◽

Hypertension In Pregnancy ◽

Hyaline Membrane ◽

Neonatal Respiratory Distress ◽

Maternal Hypertension ◽

The Relationship

There have been controversies over the eiTect of hypertension in pregnancy on the incidence of type I neonatal respiratory distress syndrome or hyaline membrane disease (HMD). We investigated the relationship between the incidence of HMD and maternal hypertension during pregnancy in 91 infants at 34 weeks gestation or less. This retrospective cross sectional study included all live born babies between May 1, 1994 and April 30, 1995 at Dr. Hasan Sadikin General Hospital, Bandung. Maternal hypertension during pregnancy was diagnosed in 38 mothers of91 infants studied. The incidence of HMD (5%) in the maternal hypertension during pregnancy group was significantly lower than the 62% in the normotensive group (p<0.01). There was a negative correlation between the occurence of HMD and hypertension during pregnancy. We conclude that the risk of developing HMD in infants born to hypertensive mothers is significantly lower than those born to normotensive mothers.

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Air Leak in Neonatal Respiratory Distress Syndrome

Anaesthesia and Intensive Care ◽

10.1177/0310057x8401200108 ◽

1984 ◽

Vol 12 (1) ◽

pp. 41-45 ◽

Cited By ~ 9

Author(s):

P. D. Sly ◽

J. H. Drew

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Hyaline Membrane Disease ◽

Maternity Hospital ◽

Assisted Ventilation ◽

Air Leak ◽

Mechanical Ventilators ◽

Hyaline Membrane ◽

Neonatal Respiratory Distress

A review of 9401 consecutive live births at the Mercy Maternity Hospital, Melbourne, was performed to determine the incidence of air leak in those with respiratory distress syndrome. Respiratory distress was detected in 552 (5.9%) infants and hyaline membrane disease was the most common cause occurring in 238 (2.5%) infants. Air leak developed in 22% of infants with respiratory distress, 8% had pulmonary interstitial emphysema alone, 14% had pneumomediastinum or pneumothorax and 7% had emphysema with pneumomediastinum or pneumothorax. Mortality increased from 12% in infants without air leak to 31% (p < 0.001) in infants with air leak. Ninety-five per cent of air leak developed in infants with hyaline membrane, and these were smaller, less mature and sicker than those without air leak. Eighty-seven per cent of air leak developed in infants treated with assisted ventilation and was commoner with mechanical ventilators with a more rapid rise in inspiratory pressure.

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▾ Colfosceril palmitate (exosurf) – artificial surfactant for immature lungs

Drug and Therapeutics Bulletin ◽

10.1136/dtb.29.12.46 ◽

1991 ◽

Vol 29 (12) ◽

pp. 46.1-46

Keyword(s):

Surface Tension ◽

Respiratory Function ◽

Distress Syndrome ◽

Hyaline Membrane Disease ◽

Lower Surface ◽

Premature Babies ◽

Hyaline Membrane ◽

Lower Surface Tension ◽

Reducing Substances ◽

Artificial Surfactant

It has been known for about 30 years that lack of surface tension reducing substances (‘surfactant’) in the lungs of premature infants is largely responsible for the development of hyaline membrane disease or respiratory distress syndrome (RDS). About 50% of premature babies develop RDS, characteristically showing tachypnoea, chest retractions and worsening cyanosis. Many babies die of it or suffer complications. Mechanical ventilation is the main treatment, supporting respiratory function until maturing alveolar lining cells synthesise adequate surfactant. Despite its inherent risks it has proved very successful, but drugs which can lower surface tension in the lungs may improve outcome further.

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Role of the Lung Surfactant in the Treatment of Sars-Cov-2 Infection

10.47363/jbbr/2020(2)123 ◽

2020 ◽

pp. 1-6

Author(s):

Bruno Riccardi ◽

◽

Thomas De Paoli ◽

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Pulmonary Surfactant ◽

Distress Syndrome ◽

Lung Surfactant ◽

Hyaline Membrane Disease ◽

Hyaline Membrane ◽

Current Therapies ◽

Preterm Babies ◽

First Time

The spread of SARS-CoV2 has been progressing continuously for over eight months. Numerous treatments have been proposed, and many have shown efficacy and ability to control the Covid-19 syndrome in this study we propose for the first time, the use of replacement therapy with Pulmonary Surfactant (PS), in patients admitted to intensive care. Pulmonary Surfactant is widely used to treat Acute Respiratory Distress Syndrome (ARDS) in preterm babies and has shown remarkable therapeutic efficacy. Since ARDS, also known as hyaline membrane disease, has many pathogenetic and symptomatological similarities with those produced by SARS-CoV2 infection, it may be useful to associate adjuvant therapy with Pulmonary Surfactant to current therapies in use. The Surfactant that we propose in our study can act as a carrier to convey even drugs with reduced absorption and poor bioavailability, directly in the most hidden alveolar areas.

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Neonatal outcome in new-borns admitted in NICU of tertiary care hospital in central India: a 5-year study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182512 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1364 ◽

Cited By ~ 3

Author(s):

Jyotsna Verma ◽

Shweta Anand ◽

Nawal Kapoor ◽

Sharad Gedam ◽

Umesh Patel

Keyword(s):

Intensive Care ◽

Birth Weight ◽

Low Birth Weight ◽

Respiratory Distress ◽

Neonatal Mortality ◽

Distress Syndrome ◽

Perinatal Asphyxia ◽

Hyaline Membrane Disease ◽

Low Birth Weight Babies ◽

Hyaline Membrane

Background: Neonatal mortality rate contributes significantly to under five mortality rates. Data obtained from pattern of admission and outcome may uncover various aspects and may contribute and help in managing resources, infrastructure, skilled hands for better outcome in future.Methods: This retrospective study was done on 1424 neonates who were admitted at LN Medical College and JK Hospital, Bhopal in neonatal intensive care unit (NICU) in the Department of Paediatrics from January 2013-December 2017.Results: 1424 newborns admitted within 24 hours of birth were included in the study. About 767 were male neonates, (Male: female1.16:1). The low birth weight babies were 54% in our study. Among the various causes of NICU admission, Respiratory distress was present in 555 (39%) of neonates, Respiratory distress syndrome (Hyaline membrane disease) being the most common cause of respiratory distress. Neonatal sepsis accounted for morbidity in 24% of neonates, with Klebsiella being the most common organism grown in the blood culture. The incidence of congenital anomalies was 2.5%. The neonatal mortality was found to be 11% in our study. Prematurity with Respiratory distress syndrome (Hyaline membrane disease) and perinatal asphyxia were the two most common causes of neonatal mortality in the study. Extremely low birth weight neonates had the highest case fatality rate in the study, which indicates the need to develop an efficient group of professionals in teaching hospitals who will provide highly specialized and focused care to this cohort of vulnerable neonates.Conclusions: Present study has shown respiratory distress, perinatal asphyxia, and sepsis as the predominant causes of neonatal morbidity. All three are preventable causes, and our health-care programs should be directed toward addressing the risk factors in the community responsible for the development of these three morbidities. The preterm and low birth weight babies had significantly high mortality even with standard intensive care; therefore, a strong and effective antenatal program with extensive coverage of all pregnant females specifically in outreach areas should be developed which will help in decreasing preterm deliveries and also lower the incidence of low birth weight babies.

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STUDIES ON HYALINE MEMBRANE DISEASE

PEDIATRICS ◽

10.1542/peds.32.1.10 ◽

1963 ◽

Vol 32 (1) ◽

pp. 10-24

Author(s):

Clara M. Ambrus ◽

David H. Weintraub ◽

Donal Dunphy ◽

John E. Dowd ◽

John W. Pickren ◽

...

Keyword(s):

Placebo Group ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Plasminogen Activator ◽

Premature Infants ◽

Distress Syndrome ◽

Hyaline Membrane Disease ◽

Blood Coagulation Factors ◽

Plasminogen Activator Activity ◽

Hyaline Membrane

In the serum of normal prematures and premature infants with respiratory distress syndrome, plasminogen was absent. In mature newborns plasminogen levels were low, as compared to adults. In the euglobulin fraction of plasma, plasminogen level was highest in mature newborns, lower in healthy prematures, and lowest in prematures with respiratory distress syndrome. Antiplasmin level was exceptionally high in about a fourth of the premature infants with or without respiratory distress syndrome. Plasminogen activator activity was found more often in the blood of infants with respiratory distress syndrome than in normal infants. This may be due to the liberation of tissue activators as a consequence of hypoxia. Because of the absence of the substrate (plasminogen), this activator level may have no significance. Tissue activator activity was found in the lungs of premature infants whether they died of hyaline membrane disease or from other causes. Forty-five infants with respiratory distress were treated in a therapeutic study. Twelve were treated in a preliminary series and 33 in a randomizd, double-blind investigation. Of the latter, 11 were treated with placebo, and 5 (45%) survived; 8 were treated with streptokinase activated human plasmin and 2 (25%) survived; 14 were treated with urokinase activated human plasmin and 12 (86%) survived. Among the infants who died, no definite hyaline membrane disease was found by histopathologic examination in two of the placebo group, one in the streptokinase-plasmin treated group, and the two who died in the urokinase-plasmin group. No significant side-effects of plasmin therapy were seen. Although considerable fibrinolytic and plasminogen-activator activity was generated in many treated patients, there was no significant fall in blood coagulation factors. Intracerebral hemorrhage, which appears to occur often in patients who die with hyaline membrane disease, was not more frequent in the plasmintreated group than in the placebo group.

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On Replacing the Surfactant

PEDIATRICS ◽

10.1542/peds.65.6.1176 ◽

1980 ◽

Vol 65 (6) ◽

pp. 1176-1177

Author(s):

Mary Ellen Avery

Keyword(s):

Endotracheal Tube ◽

Blood Gases ◽

Hyaline Membrane Disease ◽

Surfactant Deficiency ◽

Hyaline Membrane ◽

Surface Active ◽

Artificial Surfactant ◽

Patent Ductus

Ever since it was realized that hyaline membrane disease was the consequence of surfactant deficiency, replacing the missing surface-active alveolar lining layer has been a tantalizing prospect. The report of Fujiwara et al1 is the first demonstration in the human of consistent and dramatic success after a single instillation of an artificial surfactant by way of an endotracheal tube. The prompt restoration of a stable alveolar lining layer and the impressive improvement in blood gases are well documented. The problem of the widely patent ductus producing difficulties in the subsequent days is expected and of course could be approached by other interventions.

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The Magnitude and Risk Factors of Acute Respiratory Distress Syndrome among Newborn Admitted To Neonatal Intensive Care Unit at Benghazi Medical Center

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2021/v19i1230416 ◽

2021 ◽

pp. 41-61

Author(s):

Munera Awad Radwan ◽

Najia Abdelati El-Mansori ◽

Mufeda Ali Elfergani ◽

Mohanad Abdulhadi Lawgali

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Birth Weight ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Medical Center ◽

Female Gender ◽

Hyaline Membrane Disease ◽

Hyaline Membrane

Background: Hyaline Membrane Disease (HMD)/Respiratory Distress Syndrome (RDS) is the most common lung condition affecting premature babies. The inadequate amount of surfactant causes alveoli to collapse when the baby breathes out. It is hard for your baby to re-inflate the collapsed alveoli when he breathes. The lack of surfactant and resulting inflammation is called. Hyaline Membrane Disease (HMD)/Respiratory Distress Syndrome (RDS). Aim of the Study: To determine the magnitude of Hyaline membrane disease or respiratory distress syndrome and identify the risk factors and complication among newborn babies in neonatal intensive care unit at Benghazi medical center (BMC). Materials and Methods: Case series study. The study was conducted during the period between March 2017 to March 2018 of HMD cases at Benghazi medical center. A convenient sample of 120 cases diagnosed as HMD. Studied variables include the following; gestational age, birth weight, gender, type of pregnancy and type of delivery also the data for mothers such as (diabetes mellitus, preeclampsia hypothyroidism, receiving of Dexamethasone injection and premature rupture of membrane). Also investigation and treatment and finally the outcomes of babies. Statistical Methods: Data were analyzed with SPSS version 17, analysis of associations was made with application Chi - square test for categorical variables comparison, was applied for test of association P <0.25. P was considered statistically significant if ≤ 0.05. Results: Female gender was predominant (52%). Most of cases of HMD were between 1000 -2000 kg. Among the 120 cases we have (15%) sever HMD and the majority of cases have moderate –to sever Hyaline membrane disease 39 (32.5%) whereas very sever HMD were observed in nearly 27% of cases. The risk factors were history of maternal preeclampsia, maternal diabetes mellitus, prematurity and low birth weight babies and neonatal sepsis, all these were found to be very common risk factors of HMD. Pearson chi-square test p value highly significant of female gender with complications of HMD. Our results observed more than half of babies were died. Conclusion: The risk factors were history of maternal preeclampsia, maternal diabetes mellitus, prematurity and low birth weight babies and neonatal sepsis all these were found to be very common risk factors of HMD. Also we concluded that the cases had premature rupture of membrane, which identified as risk factors of hyaline membrane disease. Furthermore, we concluded that highly significant of female gender with complications of HMD, such as Pneumothorax, bronco pulmonary, dysplasia, intra ventricular hemorrhage and congenital heart diseases were common co- morbidities with respiratory distress syndrome, all these could be have an association with the development of hyaline membrane disease, finally we observed more than half of babies were died this is a warning sign for health services.

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