Improved Neonatal Survival Following Multiple Doses of Bovine Surfactant in Very Premature Neonates at Risk for Respiratory Distress Syndrome

PEDIATRICS ◽  
1991 ◽  
Vol 88 (1) ◽  
pp. 10-18
Author(s):  
Ronald E. Hoekstra ◽  
J. Craig Jackson ◽  
Thomas F. Myers ◽  
Ivan D. Frantz ◽  
Mitchell E. Stern ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Neonatal Period ◽  
Clinical Care ◽  
Pulmonary Interstitial Emphysema ◽  
Mortality And Morbidity ◽  
Premature Neonates ◽  
Multiple Doses ◽  
To Receive

To determine whether multiple doses of bovine surfactant would improve neonatal mortality in very premature neonates, we conducted two multicenter controlled trials under identical protocols; the results were combined for analysis. Four hundred and thirty neonates born between 23 and 29 weeks gestation and weighing 600 to 1250 g at birth were assigned randomly at birth to receive either 100 mg of phospholipids/kg of Survanta, a modified bovine surfactant (n = 210), or a sham air placebo (n = 220) within 15 minutes of birth. Neonates who developed respiratory distress syndrome and required mechanical ventilation with at least 30% oxygen could be given up to three more doses in the first 48 hours after birth. Dosing was performed by investigators not involved in the clinical care of the neonates; nursery staff were kept blinded as to the treatment assignment. Cause of death was determined by a panel of three independent, board-certified neonatologists after blindly reviewing case report forms and autopsy reports. Fewer Survanta-treated neonates died of any cause (11.4% vs 18.8%, P = .031), died of respiratory distress syndrome (1.9% vs 15.6%, P < .001), and either died or developed bronchopulmonary dysplasia due to respiratory distress syndrome (39.5% vs 49.1%, P = .044). The incidence of respiratory distress syndrome was also lower in Survanta-treated neonates (28.0% vs 56.9%, P < .001), and the Survanta-treated neonates' oxygenation and ventilatory status were improved significantly at 72 hours. Survanta-treated neonates were also at lowered risk of developing pulmonary interstitial emphysema (23.3% vs 36.9%, P = .002) and other forms of pulmonary air leaks (9.6% vs 20.8%, P .002). We conclude that multiple doses of Survanta reduce mortality and morbidity due to respiratory distress syndrome during the neonatal period.

Reduction of Neonatal Mortality after Multiple Doses of Bovine Surfactant in Low Birth Weight Neonates with Respiratory Distress Syndrome

PEDIATRICS ◽  
1991 ◽  
Vol 88 (1) ◽  
pp. 19-28 ◽  
Author(s):  
Edward A. Liechty ◽  
Edward Donovan ◽  
Dilip Purohit ◽  
Joseph Gilhooly ◽  
Bernard Feldman ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clinical Care ◽  
Pulmonary Interstitial Emphysema ◽  
Mortality And Morbidity ◽  
Multiple Doses ◽  
To Receive

To determine if outcomes of low birth weight neonates with respiratory distress syndrome can be improved by the administration of multiple doses of bovine surfactant, we conducted two identical multicenter, controlled trials, and the results were combined for analysis. Seven hundred and ninety-eight neonates weighing 600 to 1750 g at birth who had developed respiratory distress syndrome within 6 hours of birth were assigned randomly to receive either 100 mg of phospholipid/kg of Survanta, a modified bovine surfactant (n = 402), or a sham dosing procedure (n = 396). Neonates whose respiratory distress persisted could be given up to three more doses, with all doses to be given in the first 48 hours after birth. Dosing was performed by investigators not involved in the clinical care of the neonates; nursery staff were kept blinded as to the treatment assignment. Fewer Survanta-treated neonates died of any cause (18.4% vs 27.3%, P = .002), died of respiratory distress syndrome (9.0% vs 20.3%, P < .001), and either died or developed bronchopulmonary dysplasia due to respiratory distress syndrome (51.2% vs 64.6%, P < .001). Neonates who received Survanta also had greater improvement in their oxygenation and ventilatory status from baseline to 72 hours than did control neonates. Survanta-treated neonates were at lowered risk for developing pulmonary interstitial emphysema (18.6% vs 39.3%, P < .001) and other pulmonary air leaks (11.5% vs 25.9%, P < .001). We conclude that multiple doses of Survanta given after diagnosis of respiratory distress syndrome reduce mortality and morbidity.

Single- Versus Multiple-Dose Surfactant Replacement Therapy in Neonates of 30 to 36 Weeks' Gestation With Respiratory Distress Syndrome

PEDIATRICS ◽  
1990 ◽  
Vol 86 (4) ◽  
pp. 564-571
Author(s):  
Michael S. Dunn ◽  
Andrew T. Shennan ◽  
Fred Possmayer
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Replacement Therapy ◽  
Multiple Dose ◽  
Distress Syndrome ◽  
Optimal Dosage ◽  
Surfactant Replacement ◽  
Multiple Doses ◽  
Surfactant Replacement Therapy ◽  
To Receive

To assess the efficacy of a multiple-dose protocol of surfactant replacement therapy in neonates of 30 to 36 weeks' gestation, 75 neonates were randomly assigned to control, single-dose surfactant, or multiple-dose surfactant groups. Neonates at less than 6 hours of age with a diagnosis of respiratory distress syndrome were eligible. Subjects were randomly assigned to receive either 100 mg/kg of bovine surfactant or air placebo. Neonates in the multiple-dose group were eligible to receive up to three additional doses as indicated. Neonates in both surfactant groups showed a positive response to treatment, with marked improvement in oxygenation by 10 minutes postinstillation (P < .0001). Both surfactant groups had better oxygenation than control subjects at lower ventilatory parameters over the first 24 hours. A deterioration in oxygenation and ventilatory requirements was seen in both treatment groups starting 6 to 12 hours after the first dose. The deterioration in oxygenation could be minimized by the use of multiple doses; however, extra doses had no effect on diminishing ventilatory requirements or time to extubation. It is concluded that surfactant therapy at less than 6 hours of age is effective in acutely reducing oxygen and ventilatory requirements in neonates of 30 to 36 weeks' gestation with respiratory distress syndrome. It appears that multiple doses of surfactant have a greater effect on sustaining improvements in oxygenation than on ventilatory requirements. Further study is required to determine optimal dosage and retreatment strategy.

Respiratory distress syndrome in neonates with extremely low body weight: non-invasive respiratory therapy in the early neonatal period

2020 ◽  
Vol 15 (6) ◽  
pp. 94-102
Author(s):  
O.V. Zavyalov ◽  
◽  
V.V. Marenkov ◽  
A.A. Dementyev ◽  
I.N. Pasechnik ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Body Weight ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Neonatal Period ◽  
Respiratory Therapy ◽  
Non Invasive ◽  
Early Neonatal Period

The aim of this study was to evaluate the efficacy of non-invasive respiratory therapy using the method of dual positive airway pressure (DuoPAP) via nasal prongs performed in the intensive care unit and neonatal intensive care unit in premature newborns with extremely low body weight and respiratory distress syndrome in the early neonatal period. We conducted a retrospective analysis of 55 medical records of premature newborns treated in the intensive care unit of the Perinatal Center at S.S. Yudin City Clinical Hospital during the first 7 days of their life. We included patients treated between January 2018 and December 2019. All newborns had extremely low body weight (850 ± 149 g); mean gestational age was 28 ± 4 weeks; Apgar score at the first minute of life varied between 3 and 6; Silverman Anderson score (severity of respiratory disorders) was between 3 and 5 s. Standard examination was performed in accordance with current protocols developed by Russian and foreign specialists in neonatal medicine. A specially developed clinical protocol of the study was approved by the local ethics committee. Study participants were divided into 3 groups according to their type of spontaneous respiratory efforts, target level of preductal saturation, and Silverman Anderson score. Patients in Group I received synchronized intermittent mandatory ventilation (SIMV); patients in Group II received ventilation using DuoPAP via nasal prongs (if it was ineffective, we considered SIMV via tube); patients in group III received ventilation using DuoPAP only. In this study, we have identified indications and contraindications for initial and prolonged respiratory therapy with DuoPAP and developed main practical recommendations for effective and safe application of DuoPAP. The efficacy and safety of non-invasive respiratory therapy with DuoPAP via nasal prongs in extremely premature infants with respiratory distress syndrome in the early neonatal period is primarily determined by the newborn’s readiness for active spontaneous and productive respiratory movements, but not only by the compensated parameters of the acid-base state and gas composition of the capillary blood. The assessment of feasibility and limitations of non-invasive respiratory therapy with DuoPAP is an important step towards developing a clinical protocol for respiratory therapy in the early neonatal period in a neonatal intensive care unit; it will help to reduce the use of invasive lung ventilation. Key words: premature newborns, non-invasive respiratory therapy, respiratory distress syndrome, extremely low body weight

scholarly journals Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study

2019 ◽  
Vol 54 (4) ◽  
pp. 1900609 ◽  
Author(s):  
Bairbre A. McNicholas ◽  
Fabiana Madotto ◽  
Tài Pham ◽  
Emanuele Rezoagli ◽  
Claire H. Masterson ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Length Of Stay ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Tidal Volume ◽  
Distress Syndrome ◽  
Hospital Length Of Stay ◽  
Lower Tidal Volume ◽  
Volume Ventilation ◽  
To Receive

RationaleWe wished to determine the influence of sex on the management and outcomes in acute respiratory distress syndrome (ARDS) patients in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE).MethodsWe assessed the effect of sex on mortality, intensive care unit and hospital length of stay, and duration of invasive mechanical ventilation (IMV) in patients with ARDS who underwent IMV, adjusting for plausible clinical and geographic confounders.FindingsOf 2377 patients with ARDS, 905 (38%) were female and 1472 (62%) were male. There were no sex differences in clinician recognition of ARDS or critical illness severity profile. Females received higher tidal volumes (8.2±2.1 versus 7.2±1.6 mL·kg−1; p<0.0001) and higher plateau and driving pressures compared with males. Lower tidal volume ventilation was received by 50% of females compared with 74% of males (p<0.0001). In shorter patients (height ≤1.69 m), females were significantly less likely to receive lower tidal volumes. Surviving females had a shorter duration of IMV and reduced length of stay compared with males. Overall hospital mortality was similar in females (40.2%) versus males (40.2%). However, female sex was associated with higher mortality in patients with severe confirmed ARDS (OR for sex (male versus female) 0.35, 95% CI 0.14–0.83).ConclusionsShorter females with ARDS are less likely to receive lower tidal volume ventilation, while females with severe confirmed ARDS have a higher mortality risk. These data highlight the need for better ventilatory management in females to improve their outcomes from ARDS.

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