Predictors of mortality in premature babies with respiratory distress syndrome treated by early rescue surfactant therapy

2021 ◽  
pp. 1-6
Author(s):  
V. Gahlawat ◽  
H. Chellani ◽  
I. Saini ◽  
S. Gupta
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Surfactant Therapy ◽  
Mask Ventilation ◽  
Predictors Of Mortality ◽  
Antenatal Steroid ◽  
Bag And Mask Ventilation

OBJECTIVE: To determine the predictors of mortality following early rescue surfactant therapy in preterm babies with respiratory distress syndrome. STUDY DESIGN: Prospective cohort study enrolling babies between 28 weeks to 34 weeks with respiratory distress syndrome requiring early rescue surfactant therapy. For statistical analysis babies were further divided into two subgroups: survivors and non-survivors. Maternal and neonatal variables were compared between the two groups to find out the predictors of mortality. RESULTS: Out of total 110 babies, 72 (65.45%) survived. The mean birth weight and mean gestational age of the study population was 1614.36 (±487.86) g and 31.40 (±2.0)1 weeks, respectively. Birth weight <  1500 g, gestational age <  32 weeks, primiparity, vaginal delivery, prolonged rupture of membranes, lack of antenatal steroid cover, bag and mask ventilation at birth, sepsis, apneic episodes and mechanical ventilation were significantly associated with death on univariate analysis. On multivariate analysis, very low birth weight, vaginal delivery, lack of antenatal steroid cover, bag and mask ventilation at birth and mechanical ventilation were found to be independent predictors of mortality. CONCLUSIONS: Some of the identified predictors of mortality are modifiable and can be used to draw up a screening tool to predict the clinical severity and mortality among these babies.

Surfactant therapy in combination treatment of COVID-19 related acute respiratory distress syndrome

2021 ◽  
pp. 50-56
Author(s):  
Renat R. Gubaidullin ◽  
◽  
Aleksandr P. Kuzin ◽  
Vladimir V. Kulakov ◽  
◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Standard Therapy ◽  
Distress Syndrome ◽  
Severe Pneumonia ◽  
Lung Ventilation ◽  
Surfactant Therapy

ntroduction. The COVID-19 pandemic caused an outbreak of viral lung infections with severe acute respiratory syndrome complicated with acute respiratory failure. Despite the fact that the pandemic has a lengthened run, none of the therapeutic approaches have proved to be sufficiently effective according to the evidence-based criteria. We consider the use of surfactant therapy in patients with severe viral pneumonia and acute respiratory distress syndrome (ARDS) as one of the possible methods for treating COVID-19 related pneumonia. Objective. To prove the clinical efficacy and safety of orally inhaled Surfactant-BL, an authorized drug, in the combination therapy of COVID-19 related ARDS. Materials and methods. A total of 38 patients with COVID-19 related severe pneumonia and ARDS were enrolled in the study. Of these, 20 patients received the standard therapy in accordance with the temporary guidelines for the prevention, diagnosis and treatment of the novel coronavirus infection (COVID-19) of the Ministry of Health of the Russian Federation, version 9. And 18 patients received the surfactant therapy in addition to the standard therapy. Surfactant-BL was used in accordance with the instructions on how to administer the drug for the indication – prevention of the development of acute respiratory distress syndrome. A step-by-step approach to the build-up of the respiratory therapy aggressiveness was used to manage hypoxia. We used oxygen inhalation via a face mask with an oxygen inflow of 5–15 l/min, highflow oxygen therapy via nasal cannulas using Airvo 2 devices, non-invasive lung ventilation, invasive lung ventilation in accordance with the principles of protective mechanical ventilation. Results and discussion. Significant differences in the frequency of transfers to mechanical ventilation, mortality, Intensive Care Unit (ICU) and hospitalization length of stay (p <0.05) were found between the groups. Patients receiving surfactant therapy who required a transfer to mechanical ventilation accounted for 22% of cases, and the mortality rate was 16%. In the group of patients receiving standard therapy without surfactant inhalation 45% were transferred to mechanical ventilation, and 35% died. For patients receiving surfactant therapy, the hospital stay was reduced by 20% on average, and ICU stay by 30%. Conclusion. The inclusion of surfactant therapy in the treatment of COVID-19 related severe pneumonia and ARDS can reduce the progression of respiratory failure, avoid the use of mechanical ventilation, shorten the ICU and hospitalization length of stay, and improve the survival rate of this patient cohort.

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 Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who Are the Best Candidates?

2016 ◽  
Vol 2 (2) ◽  
pp. 73-79 ◽  
Author(s):  
Maria Livia Ognean ◽  
Silvia-Maria Stoicescu ◽  
Oana Boantă ◽  
Leonard Năstase ◽  
Carmen Gliga ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Peripheral Oxygen Saturation ◽  
Apgar Scores ◽  
Group 2 ◽  
Group 1

Abstract Introduction: Respiratory distress syndrome (RDS) continues to be the leading cause of illness and death in preterm infants. Studies indicate that INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is better than mechanical ventilation (MV) with rescue surfactant, for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates, as it has a synergistic effect on alveolar stability. Aim of the study: To identify the factors associated with INSURE strategy failure in preterm infants with gestational age (GA) ≤ 32 weeks. Materials and Methods: This was a retrospective cohort study, based on data collected in the Romanian National Registry for RDS patients by three regional (level III) centers between 01.01.2010 and 31.12.2011. All preterm infants of ≤ 32 weeks GA were included. Prenatal and neonatal information were compared between (Group 1), the preterm infants successfully treated using INtubation-SURfactant-Extubation on nasal CPAP (INSURE) strategy and (Group 2), those who needed mechanical ventilation within seventy two hours after INSURE. Results: A total of 637 preterm infants with GA ≤ 32 weeks were included in the study. INSURE strategy was performed in fifty seven cases (8.9%) [Group 1] and was successful in thirty one patients (54.4%). No differences were found as regards the studied prenatal and intranatal characteristics between (Group 1) and Group 2 who needed mechanical ventilation. Group 2 preterm infants who needed mechanical ventilation within 72 hours after INSURE had significantly lower mean Apgar scores at 1 and 5 minutes and lower peripheral oxygen saturation (SpO2) during resuscitation at birth (p<0.05). Successful INSURE strategy was associated with greater GA, birth weight (BW), fraction of inspired oxygen (FiO2) during resuscitation, and an increased mean dose of surfactant but these associations were not statistically significant (p>0.5). Conclusion: In preterm infants ≤ 32 weeks gestation, increased INSURE failure rates are associated with complicated pregnancies, significantly lower Apgar scores at 1 and 5 minutes, and lower peripheral oxygen saturation during resuscitation.

scholarly journals Results of INSSURE Method in the Treatment of Respiratory Distress Syndrome in Premature Infants at Bac Ninh Obstetric Pediatric Hospital

2017 ◽  
Vol 33 (2) ◽  
Author(s):  
Tran Thi Thuy ◽  
Ngo Thi Xuan ◽  
Pham Trung Kien ◽  
Hoang Ngoc Canh
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Premature Infants ◽  
Distress Syndrome ◽  
Descriptive Study ◽  
Pediatric Hospital ◽  
Lower Temperature

OBJECTIVES: To evaluate the results of the INtubate-SURfactant-Extubate (INSURE) method in the treatment of respiratory distress syndrome in premature infants at Bac Ninh obstetric pediatric hospital from March to September 2017. METHODS: A descriptive study was conducted on 50 preterm infants with respiratory distress syndrome. The infants were treated with INSURE method . RESULTS: Of the 50 infants, 29 (58.0%) were male. All of infants,  49 (98.0%) gestational age under 32 weeks, of which 56.0% was less than 30 weeks. The infants birth weight less than 1500 grams accounted for 78.0%, of which 28.0% under 1000 grams. Only 40.0% of mothers were injected with corticosteroid before giving birth. The most common symptoms are cyanosis , apnea neoatorum  > 10 seconds; lower temperature. X.ray III is 92.0%. All infants were pumped pulsed surfactant before 6 hours, intubated endotracheal tube and was removed within 50 minutes. There were 13 children (26.0%) had to have mechanical ventilation, the highest rate of reintroduction in infants birth weight less than 1000 grams. The rate of SpO2 increased, the FiO2 and Siverman index decreased and remained stable significantly after 6 hours of treatment. The complication rate was 4.0%. Treatment outcomes were only associated with birth weight (p<0.05). CONCLUSIONS: INtubate-SURfactant-Extubate is effective methods in treatment of infants with respiratory distress syndrome (RDS).

scholarly journals Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arash Malakian ◽  
Mohammad Reza Aramesh ◽  
Mina Agahin ◽  
Masoud Dehdashtian
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract Background The most common cause of respiratory failure in premature infants is respiratory distress syndrome. Historically, respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications. Methods 148 neonates (with gestational age of 28 to 34 weeks) with respiratory distress syndrome admitted to Imam Khomeini Hospital in Ahwaz in 2018 were enrolled in this clinical trial study. 74 neonates were assigned to duo positive airway pressure (NDUOPAP) group and 74 neonates to nasal continuous positive airway pressure (NCPAP) group. The primary outcome in this study was failure of N-DUOPAP and NCPAP treatments within the first 72 h after birth and secondary outcomes included treatment complications. Results there was not significant difference between DUOPAP (4.1 %) and NCPAP (8.1 %) in treatment failure at the first 72 h of birth (p = 0.494), but non-invasive ventilation time was less in the DUOPAP group (p = 0.004). There were not significant differences in the frequency of patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD), apnea and mortality between the two groups. Need for repeated doses of surfactant (p = 0.042) in the NDUOPAP group was significantly lower than that of the NCPAP group. The duration of oxygen therapy in the NDUOPAP group was significantly lower than that of the NCPAP group (p = 0.034). Also, the duration of hospitalization in the NDUOPAP group was shorter than that of the NCPAP group (p = 0.002). Conclusions In the present study, DUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 72 h of birth, but the duration of non-invasive ventilation and oxygen demand, the need for multiple doses of surfactant and length of stay in the DUOPAP group were less than those in the CPAP group. Trial registration IRCT20180821040847N1, Approved on 2018-09-10.

Sign in / Sign up

Export Citation Format

Share Document