Shunts in Patients With Respiratory Distress Syndrome

PEDIATRICS ◽  
1993 ◽  
Vol 92 (5) ◽  
pp. 738-738
Author(s):  
FRANS J. WALTHER ◽  
JOHN O. LEIGHTON
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Full Term ◽  
Persistent Pulmonary Hypertension ◽  
Term Neonates ◽  
Premature Neonates ◽  
Group 4 ◽  
Study Population

In Reply.— We agree with Dr Evans that bidirectional ductal shunting is more common than net right-to-left ductal shunting in premature neonates with severe RDS and persistent pulmonary hypertension. Our conclusion that large right-to-left shunts via the ductus are common findings in these cases was not intended to exclude the presence of concomitant left-to-right shunting. In our study population the incidence of right-to-left ductal shunting at 12 and 24 hours of age was 86% and 94% in premature neonates with fatal RDS, 39% and 34% in the severe RDS group, 4% and 0% in the no/mild RDS group, and 6% and 0% in the full-term neonates without RDS.

Adult Respiratory Distress Syndrome in Full-Term Newborns

PEDIATRICS ◽  
1990 ◽  
Vol 85 (6) ◽  
pp. 1132-1132
Author(s):  
ROGER G. FAIX ◽  
MICHAEL A. DIPIETRO
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Adult Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
Full Term ◽  
Persistent Pulmonary Hypertension ◽  
Term Newborns ◽  
The Difference

In Reply.— We appreciate the interest and continuing contributions of Drs Pfenninger and Tschaeppeler. We agree with their assessment that the difference in mortality rates is probably attributable to selection differences. All five of their infants would have been excluded from our series, since proven sepsis and documented persistent pulmonary hypertension were both among the criteria for exclusion. As we noted in our article, the low mortality in our series was not surprising because of such exclusions.

scholarly journals Postnatal causes and severity of persistent pulmonary Hypertension of Newborn

2021 ◽  
Vol 37 (5) ◽  
Author(s):  
Muhammad Sohail Arshad ◽  
Mudasser Adnan ◽  
Hafiz Muhammad Anwar-ul-Haq ◽  
Arif Zulqarnain
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Gestational Age ◽  
Distress Syndrome ◽  
Birth Asphyxia ◽  
Meconium Aspiration Syndrome ◽  
Persistent Pulmonary Hypertension ◽  
High Morbidity ◽  
Meconium Aspiration

Background & Objective: Persistent pulmonary hypertension of the newborn (PPHN) is described as severe respiratory failure along with hypoxaemia. PPHN is known to be linked with high morbidity and mortality around the world. This study was planned to determine the postnatal causes and assess the severity of persistent pulmonary hypertension of newborn in babies presenting to the Children’s Hospital, Multan. Methods: This observational study was conducted at the Department of Paediatric Cardiology, The Children Hospital &Institute of Child Health, Multan, Pakistan from July to December 2019. A total of 122 confirmed cases of PPHN admitted having gestational age above 34 weeks were enrolled. Demographic data of the newborns was recorded along with maternal medical history, pregnancy status and postnatal causes of PPHN. Severity of PPHN was also recorded. Results: Out of a total of 122 cases of PPHN, 81 (66.3%) were male. Majority, 78 (64.0%) had gestational age above 37 weeks. Mode of delivery as cesarean section was noted in 70 (57.4%). Meconium aspiration syndrome 52 (42.6%), birth asphyxia 48 (39.3%), respiratory distress syndrome 23 (18.8%) and sepsis 33 (27.0%) were found to be the commonest causes of PPHN. Severe PPHN was found to be the most frequent, noted among 63 (51.6%) while Moderate PPHN was observed in 40 (32.8%) and Mild PPHN in 19 (15.6%). Morality was noted among 26 (21.3%) of cases. Conclusion: Meconium aspiration syndrome, birth asphyxia and respiratory distress syndrome were the commonest postnatal causes of PPHN. Severe PPHN was found to be the most frequent form of PPHN. doi: https://doi.org/10.12669/pjms.37.5.2218 How to cite this:Arshad MS, Adnan M, Anwar-ul-Haq HM, Zulqarnain A. Postnatal causes and severity of persistent pulmonary Hypertension of Newborn. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.2218 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Persistent Pulmonary Hypertension in Premature Neonates With Severe Respiratory Distress Syndrome

PEDIATRICS ◽  
1992 ◽  
Vol 90 (6) ◽  
pp. 899-904 ◽  
Author(s):  
Frans J. Walther ◽  
Manon J. Benders ◽  
John O. Leighton
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pressure Difference ◽  
Pulmonary Blood Flow ◽  
Distress Syndrome ◽  
Left Pulmonary Artery ◽  
Persistent Pulmonary Hypertension ◽  
Term Neonates ◽  
Premature Neonates ◽  
The Mean

Cardiac catheterization studies have demonstrated that Doppler-derived flow velocities in the ductal flow jet and the left pulmonary artery accurately predict the aortopulmonary pressure difference and left-to-right shunt size in newborns. To assess the presence of persistent pulmonary hypertension in premature newborns with various degrees of respiratory distress syndrome (RDS) severity, we estimated pulmonary artery pressure from the aortopulmonary pressure difference and pulmonary blood flow from the left pulmonary artery flow velocity with color-flow-directed, pulsed Doppler echocardiography. Seventy-nine premature neonates were divided into three groups—no or mild RDS (n = 27), severe RDS (n = 38), and fatal RDS (n = 14)—and compared with a group of healthy term neonates (n = 34). In premature and term neonates with no/mild RDS the mean ± SEM aortopulmonary pressure difference increased from 7.3 ± 0.4 and 6.6 ± 0.5 mm Hg to 22.8 ± 1.4 and 21.4 ± 1.1 mm Hg over the first 24 hours (P < .001). The mean aortopulmonary pressure difference was 0.9 ± 0.3 mm Hg during the first 72 hours in neonates with fatal RDS, but increased from 1.5 ± 0.3 mm Hg at 4 hours to 7.4 ± 0.6 at 24 hours and 21.5 ± 0.7 mm Hg at 72 hours of age in neonates with severe RDS. Left pulmonary artery velocity time integrals were 18.3 ± 0.5 cm in premature and 18.8 ± 0.5 cm in term neonates with no/mild RDS at 12 hours vs 11.2 ± 0.4 cm in neonates with severe and 9.9 ± 0.5 cm in neonates with fatal RDS (P < .001). At 36 hours of age pulmonary blood flow velocity in neonates with severe RDS had caught up with that of those with no/mild RDS, but was only 11.6 ± 0.6 cm in neonates with fatal RDS (P < .001). These data indicate that persistent pulmonary hypertension and large right-to-left shunts via the ductus are common findings in small premature neonates with severe RDS and are predictive of early demise.

Surfactant Therapy in Full-term Neonates With Severe Respiratory Failure

PEDIATRICS ◽  
1993 ◽  
Vol 92 (1) ◽  
pp. 135-139
Author(s):  
Hatem Khammash ◽  
Max Perlman ◽  
Julian Wojtulewicz ◽  
Michael Dunn
Keyword(s):  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Oxygenation Index ◽  
Meconium Aspiration Syndrome ◽  
Full Term ◽  
Surfactant Therapy ◽  
Term Infants ◽  
Meconium Aspiration

Objective. In light of the paucity of published data on the use of surfactant in full-term infants with respiratory failure due to meconium aspiration syndrome and respiratory distress syndrome, we report our experience with this therapy. Our goal was to explore possible justification for randomized controlled trials of surfactant treatment in similar patients at an earlier, less severe stage of the disease. Methods. Retrospective consecutive case series of 20 infants with severe meconium aspiration syndrome and 29 infants with severe respiratory distress syndrome who received bovine surfactant between March 1990 and December 1992 in three neonatal intensive care units in a regionalized setting. Outcome of treatment was assessed by comparing changes in several respiratory indices including the oxygenation index, between 4 and 6 hours and 1 and 3 hours before and after the first dose of surfactant. Differences were analyzed using analysis of variance for repeated measures, with treatment and time as co-variates. Results. In the meconium aspiration group the mean oxygenation index decreased from 36 ± 12 at 1 to 3 hours presurfactant to 24 ± 14 at 1 to 3 hours postsurfactant (P < .001). In the patients with respiratory distress syndrome the mean oxygenation index fell from 30 ± 17 at 1 to 3 hours presurfactant to 12 ± 6 at 1 to 3 hours postsurfactant (P = .0001). Three of 20 patients with meconium aspiration syndrome and 3 of 29 patients with respiratory distress syndrome received extracorporeal membrane oxygenation. Conclusions. Surfactant therapy in full-term infants with respiratory failure due to the meconium aspiration and respiratory distress syndromes is often effective in improving gas exchange. A randomized controlled trial of surfactant therapy at an earlier stage in the course of the illness should be performed.

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