scholarly journals Comparison between two natural surfactant poractant alfa and bovine lipid extract in respiratory distress syndrome amongst preterm neonates-a quasi-experimental study

2021 ◽  
Author(s):  
Srikanta Baske ◽  
Sudip Saha ◽  
Partha Pratim Pal
Keyword(s):  
Experimental Study ◽  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Tertiary Care ◽  
Preterm Neonates ◽  
Care Hospital ◽  
Oxygen Requirement ◽  
Quasi Experimental

Background: A comparison study of two natural surfactants in preterm babies admitted in neonatal intensive care unit (NICU) and sick newborn care unit (SNCU) of a tertiary care hospital to find out efficacy and consequences.Methods: A Quasi-experimental study. InSurE technique applied for administering Poractant alfa (CUROSURF) and bovine surfactant (NEOSURF) in two comparison group of preterm neonates with respiratory distress syndrome (RDS) during May 2018 to April 2019. The need of mechanical ventilation, oxygen requirement (FiO2), duration of oxygen requirement and the consequences were assessed.Results: The CUROSURF is 6.67% more efficacious than NEOSURF in respect to less requirement of mechanical ventilation. The differences were found between two groups in terms of FiO2adjusted (33.49% vs 37.17%) and common side effects respectively but the difference of mean duration of oxygenation (69.8 hrs vs 111.9 hrs) was less and statistically significant in CUROSURF group. Mean duration of hospitalization (9.55 day’s vs 14.9 days) also were found to be less and statistically significant.Conclusions: Treatment with CUROSURF was associated with faster improving oxygenation, less additional doses, and decreased need of mechanical ventilation.

scholarly journals Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality

2003 ◽  
Vol 121 (2) ◽  
pp. 45-52 ◽  
Author(s):  
Joice Fabíola Meneguel ◽  
Ruth Guinsburg ◽  
Milton Harumi Miyoshi ◽  
Clovis de Araujo Peres ◽  
Regina Helena Russo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Protective Effect ◽  
Gestational Age ◽  
Distress Syndrome ◽  
Tertiary Care ◽  
Care Hospital ◽  
Antenatal Corticosteroids

CONTEXT: Although the benefits of antenatal corticosteroids have been widely demonstrated in other countries, there are few studies among Brazilian newborn infants. OBJECTIVE: To evaluate the effectiveness of antenatal corticosteroids on the incidence of respiratory distress syndrome and intra-hospital mortality among neonates with a gestational age of less than 34 weeks. TYPE OF STUDY: Cross-sectional. SETTING: A tertiary-care hospital. PARTICIPANTS: Neonates exposed to any dose of antenatal corticosteroids for fetal maturation up to 7 days before delivery, and newborns paired by sex, birth weight, gestational age and time of birth that were not exposed to antenatal corticosteroids. The sample obtained consisted of 205 exposed newborns, 205 non-exposed and 39 newborns exposed to antenatal corticosteroids for whom it was not possible to find an unexposed pair. PROCEDURES: Analysis of maternal and newborn records. MAIN MEASUREMENTS: The primary clinical outcomes for the two groups were compared: the incidence of respiratory distress syndrome and intra-hospital mortality; as well as secondary outcomes related to neonatal morbidity. RESULTS: Antenatal corticosteroids reduced the occurrence of respiratory distress syndrome (OR: 0.33; 95% CI: 0.21-0.51) and the protective effect persisted when adjusted for weight, gestational age and the presence of asphyxia (adjusted OR: 0.27; 95% CI: 0.17-0.43). The protective effect could also be detected through the reduction in the need for and number of doses of exogenous surfactant utilized and the number of days of mechanical ventilation needed for the newborns exposed to antenatal corticosteroids. Their use also reduced the occurrence of intra-hospital deaths (OR: 0.51: 95% CI: 0.38-0.82). However, when adjusted for weight, gestational age, presence of prenatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis and use of mechanical ventilation, the antenatal corticosteroids did not maintain the protective effect in relation to death. With regard to other outcomes, antenatal corticosteroids reduced the incidence of intraventricular hemorrhage grades III and IV (OR: 0.28; 95% CI: 0.10-0.77). CONCLUSIONS: Antenatal corticosteroids were effective in the reduction of morbidity and mortality among premature newborns in the population studied, and therefore their use should be stimulated within our environment.

scholarly journals Indication and short term outcome of Mechanical Ventilation in Neonates in a tertiary care hospital

2017 ◽  
Vol 16 (1) ◽  
pp. 24-28
Author(s):  
Nasim Jahan ◽  
Zabrul SM Haque ◽  
Md Abdul Mannan ◽  
Mahmuda Nasrin ◽  
Farhana Afroz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Survival Rate ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Neonatal Sepsis ◽  
Distress Syndrome ◽  
Perinatal Asphyxia ◽  
Tertiary Care ◽  
Medical Science ◽  
Care Hospital

Background: Mechanical ventilation of newborn has been practiced for several years with advances in many ways. As compared to the western world, neonatal ventilation in our country started in recent years.Subjects, Methods and Results: A retrospective chart review was conducted to analyze the common indications and outcome of neonates requiring mechanical ventilation in neonatal intensive care unit at Ad-Din Medical College Hospital from January 2012 to July 2013. Fifty eight neonates were ventilated over a period of 19 months of whom 39 (67.24%) survived. Respiratory distress syndrome was the commonest indication for ventilation (32.75%), followed by Perinatal asphyxia (18.96%), Pneumonia (13.79%), Neonatal Sepsis (13.79%), Meconium aspiration syndrome 6(10.16%) & Pneumothorax 6 (10.16%). Among the babies who survived, 35(89.74%) were managed solely with conventional ventilator and 4 babies required both conventional and High Frequency Oscillatory (HFOV) ventilation. Survival rate was higher where birth weight >2500gm (76.19%) and gestational age 34-37 weeks (88.88%). Survival rates was (69.23%) in <30 weeks and 60% in <1000 g. Prolong ventilator support was needed for Respiratory Distress Syndrome without surfactant (mean 254 hrs), Perinatal asphyxia (mean 187hrs) and Neonatal sepsis (mean 187hrs). Common complications were Pneumonia (12.06%), Pneumothorax (10.34%), sepsis (8.6%) & Pulmonary hemorrhage (3.4%). Survival rate was higher in babies requiring mechanical ventilation for respiratory distress syndrome (84.21%).Conclusion: Use of surfactant could decrease the duration of ventilation and mortality further in babies with respiratory distress syndrome.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.24-28

scholarly journals Study Of The Outcome Of Early And Late Rescue Surfactant Administration In Preterm Babies

2014 ◽  
Vol 2 (2) ◽  
Author(s):  
Jayachandra Naidu T ◽  
Kireeti AS ◽  
Lokesh B ◽  
Shankar Reddy Dudala
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Surfactant Therapy ◽  
Preterm Neonates ◽  
P Value ◽  
Surfactant Replacement Therapy ◽  
Preterm Babies ◽  
Surfactant Administration

Introduction: Respiratory Distress Syndrome (RDS) is a common cause of mortality and morbidity in preterm. It is the commonest indication for ventilation in neonates in India. Surfactant Replacement Therapy (SRT) for RDS is a major breakthrough that has revolutionized the survival of premature infants worldwide. Randomized controlled trials have also demonstrated that prophylactic or early surfactant therapy compared with delayed surfactant treatment results in improved outcomes for preterm infants at high risk. Objective: To assess the outcome of early and late rescue surfactant administration by InSuRE (Intubation, Surfactant and Rapid Extubation) technic in managing preterm neonates with respiratory distress syndrome (RDS). Methodology: Study design: Prospective analytical study. Sample size: 144 preterm babies between 28-34 weeks of GA. Setting: Level III NICU at SVRR Government General Hospital, Tirupati, AP. Study Period: 1 year (Sep 2013 to Aug 2014). Method: All preterm babies between 28-34 weeks with respiratory distress were given surfactant with InSuRE technic immediately and categorized into early and late rescue group depending on the time of surfactant therapy i.e. within 2 hrs. of life and between 2-24 hrs. of life respectively. Results: In early rescue group there is significant reduction in mortality and lessen the need of mechanical ventilation with p value <0.05. Conclusion: Early routine surfactant administration within 2 hrs. of life as compared to late selective administration significantly reduced the need mechanical ventilation within 7th day of life and mortality among preterm with respiratory distress syndrome.

scholarly journals Respiratory physiology of COVID-19 and Influenza associated Acute Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Niklas Kronibus ◽  
Frederik Seiler ◽  
Guy Danziger ◽  
Ralf M. Muellenbach ◽  
Christian Reyher ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Influenza A ◽  
Distress Syndrome ◽  
Minute Ventilation ◽  
Tertiary Care ◽  
Acute Lung Failure ◽  
Lung Failure

Abstract Background: There is ongoing debate whether lung physiology of COVID-19 associated acute respiratory distress syndrome (ARDS) differs from ARDS of other origin.Objective: The aim of this study was to analyze and compare how critically ill patients with COVID-19 and Influenza A or B were ventilated in our tertiary care center with or without extracorporeal membrane oxygenation (ECMO). We ask if acute lung failure due to COVID-19 requires different intensive care management compared to conventional ARDS. Methods: 25 patients with COVID-19 associated ARDS were matched to a cohort of 25 Influenza patients treated in our center from 2011 to 2021. Subgroup analysis addressed whether patients on ECMO received different mechanical ventilation than patients without extracorporeal support.Results: Compared to Influenza-associated ARDS, COVID-19 patients had higher ventilatory system compliance (40.7 ml/mbar [31.8 – 46.7 ml/mbar] vs. 31.4 ml/mbar [13.7 – 42.8 ml/mbar], p = 0.198), higher ventilatory ratio (1.57 [1.31 – 1.84] vs. 0.91 [0.44 – 1.38], p = 0.006) and higher minute ventilation at the time of intubation (mean minute ventilation 10.7 l/min [7.2 – 12.2 l/min] for COVID-19 vs. 6.0 l/min [2.5 – 10.1 l/min] for Influenza, p = 0.013). There were no measurable differences in P/F ratio, positive end-expiratory pressure (PEEP) and driving pressures (ΔP). Respiratory system compliance deteriorated considerably in COVID-19 patients on ECMO during 2 weeks of mechanical ventilation (Crs, mean decrease over 2 weeks -23.87 ml/mbar ± 32.94 ml/mbar, p = 0.037), but not in ventilated Influenza patients on ECMO and less so in ventilated COVID-19 patients without ECMO. For COVID-19 patients, low driving pressures on ECMO were strongly correlated to a decline in compliance after 2 weeks (Pearson’s R 0.80, p = 0.058). Overall mortality was insignificantly lower for COVID-19 patients compared to Influenza patients (40% vs. 48%, p = 0.31). Outcome was insignificantly worse for patients requiring veno-venous ECMO in both groups (50% mortality for COVID-19 on ECMO vs. 27% without ECMO, p = 0.30 / 56% vs 34% mortality for Influenza A/B with and without ECMO, p = 0.31)Conclusion: The pathophysiology of early COVID-19-associated ARDS differs from Influenza-associated acute lung failure by sustained respiratory mechanics during the early phase of ventilation. We question whether intubated COVID-19 patients on ECMO benefit from extremely low driving pressures, as this appears to accelerate derecruitment and consecutive loss of ventilatory system compliance.

scholarly journals Neonatal Respiratory Distress Syndrome in a Nutshell

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Ease Of Use ◽  
World Health ◽  
Preterm Neonates ◽  
Delayed Cord Clamping ◽  
Safe Place ◽  
Antenatal Steroids

Respiratory distress syndrome (RDS) is an important cause of mortality and morbidity in preterm neonates. With the increasing number of preterm deliveries globally according to the World Health Organization, it is imperative to consider a safe place for delivery and a good obstetric care to start with. Antenatal steroids are helpful not only in reducing the risk of RDS but also reducing necrotizing enterocolitis (NEC) and Intraventricular hemorrhage which further improves the outcome of a preterm delivery. Delayed cord clamping is recommended as it reduces mortality in preterm newborns. Use of optimal oxygen and getting CPAP into the delivery room has improved the outcome and reduced the need of mechanical ventilation thus reducing the risk of Chronic Lung Disease (CLD). Timing the administration of surfactant is important to avoid mechanical ventilation. The increasing use of non-invasive ventilation has reduced ventilator induced lung injury and CLD. Many have embraced Heated Humidified High Flow Nasal Oxygen (HHHFNC) as an alternative to CPAP and its use has increased in view of its ease of use and lesser trauma. Caffeine facilitates early extubation in intubated preemies on ventilators and improves neurodevelopment outcome. Adequate nutrition and proper temperature control starting from the point of delivery cannot be emphasized enough for this group of population.

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