scholarly journals Spectrum of Respiratory Distress in Newborn: A Study From a Tertiary Care Military Hospital

2020 ◽  
Vol 39 (1) ◽  
pp. 4-8
Author(s):  
Biplob Kumar Raha ◽  
Md Julfikkar Alam ◽  
Mohammad Abdul Quddus Bhuiyan

Introduction: Respiratory distress (RD) is a common problem in neonatal period. It is an important cause of neonatal mortality. There are many causes of respiratory distress, among them, transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS) and perinatal asphyxia are commonest causes. Timely and appropriate therapy is essential to prevent ongoing injury and improve outcome. The aim of this study was to determine the prevalence and to identify the causes of respiratory distress in neonatal intensive care unit (NICU) in Combined Military hospital (CMH) Sylhet and to observe the hospital outcome of these babies. Material and Methods: A descriptive type of crosssectional study was conducted in CMH Sylhet over a period of one year from April 2018 to March 2019. All live newborns delivered at CMH Sylhet during the study period were included and observed for development of respiratory distress. Results: All newborns (n=287), delivered at this hospital over the period of 12 months, were observed for respiratory distress. The overall prevalence of respiratory distress was 19.2 %. Prevalence was 10.8 % in full term, 7.3 % in preterm and 1.1% in post term. There was male predominance (54.5%) and two third (71.1%) were born by cesarean section. Transient tachypnea of newborn was found to be the commonest 47.3% cause of respiratory distress followed by respiratory distress syndrome 29.1%, perinatal asphyxia (10.9%), congenital pneumonia 3.6%, congenital heart disease 3.6%, septicaemia 3.6% and meconium aspiration syndrome (MAS) 1.9%. All babies required high flow oxygen initially, subsequently Bubble CPAP and mechanical ventilation was required in 8 (14.5%) and 1(1.8%) cases respectively. Mortality was 1.8% in neonates with respiratory distress syndrome with pneumothorax with septicaemia requiring mechanical ventilation. Conclusion: In this series, RDS in newborn majority of cases were due to TTN followed by respiratory distress syndrome and perinatal asphyxia. Mortality was mainly related to pneumothorax with septicaemia, RDS was more common in births related to caesarian section. J Bangladesh Coll Phys Surg 2021; 39(1): 4-8

2013 ◽  
Vol 3 (1) ◽  
pp. 19-22
Author(s):  
Afroza Haque ◽  
MA Baki ◽  
Tahmina Begum ◽  
Shahida Akhter ◽  
Suraiya Begum ◽  
...  

Objectives: Respiratory distress is one of the most common causes of admission in Neonatal intensive care unit (NICU). There are many causes of respiratory distress, among them, transient tachypnoea of newborn, respiratory distress syndrome and perinatal asphyxia are commonest causes. The aim of this study was to identify the etiology of respiratory distress in special care baby unit (SCABU) in BIRDEM General Hospital and to observe the immediate hospital outcome of these babies. Methods: A retrospective study was conducted in SCABU, BIRDEM. Data were collected from all patients files admitted in to SCABU during the period from January to December 2011. Results: A total of 562 patients were admitted, among them 192 cases were admitted due to respiratory distress (34.1%). There was male predominance (64.6%). Two third (65.6%) babies were inborn and majority (84.4%) were born by caesarian section and preterm babies were more (65.6%). The commonest causes of respiratory distress in our study were transient tachypnea of newborn (43.2%), respiratory distress syndrome (30.2%), perinatal asphyxia (25%), septicaemia (16.1%) congenital pneumonia (11.9%), congenital heart disease (10.4%). All babies required oxygen initially, subsequently mechanical ventilation and Bubble CPAP was required in 48 (25.0%) and 8(04.1%) cases respectively. Mortality was 16.7% and was highest in neonates with respiratory distress syndrome (RDS) (71.8%) followed by septicaemia (40.6%) and perinatal asphyxia (37.3%). Among neonates requiring mechanical ventilation 56.2% died. Conclusion: Transient tachypnoea of newborn (TTN), respiratory distress syndrome (RDS), perinatal asphyxia and septicaemia were the common etiology for respiratory distress. Mortality was very high in RDS and septicaemia. Birdem Med J 2013; 3(1): 19-22 DOI: http://dx.doi.org/10.3329/birdem.v3i1.17122


2017 ◽  
Vol 16 (1) ◽  
pp. 24-28
Author(s):  
Nasim Jahan ◽  
Zabrul SM Haque ◽  
Md Abdul Mannan ◽  
Mahmuda Nasrin ◽  
Farhana Afroz ◽  
...  

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


2016 ◽  
Vol 6 (1) ◽  
pp. 22-25
Author(s):  
Amrita Lal Halder ◽  
Md Abdul Baki ◽  
Nazmun Nahar ◽  
Tahmina Begum

Background: A large number of neonates in intensive care unit require mechanical ventilation due to various disease conditions. There has been a dramatic fall in neonatal mortality in developed countries with the advent of mechanical ventilation and the concept of neonatal intensive care. But still fatality rate is very high in developing countries. So, this study or was done to identify the immediate hospital outcome of the neonates who required mechanical ventilation.Methods: This study was done in Special Care Baby Unit, BIRDEM General Hospital from July 2009 to June 2010. All neonates requiring mechanical ventilation during the study period were prospectively enrolled in this study. During the time of mechanical ventilation neonates were followed up to observe any complication till discharge or death.Results: Total 37 neonates were enrolled in the study. Among them 27 (73%) were preterm and 30 (81%) were low birth weight. Respiratory distress syndrome was the most common reason for ventilation accounting for 17 (45.9%) cases. The other indications were perinatal asphyxia (9, 24.3%), congenital pneumonia (5, 13.5%), septicemia (5, 13.5%) and meconium aspiration syndrome (1, 2.7%). The most common complication during the period of ventilation was septicemia (14, 37.8%). Other complication included pneumothorax (6, 16.2%), acute renal failure (5, 13.3%), pneumonia (5, 13.3%), pulmonary hemorrhage (3, 8.1%), intraventricular hemorrhage (2, 5.4%) and heart failure (2, 5.4%). The fatality rate was 38% and most of the infant died of perinatal asphyxia (5, 35.7%), septicemia (4, 28.5%), respiratory distress syndrome (3, 21.5%) and congenital pneumonia (2, 14.3%).Conclusion: Respiratory distress syndrome was the most common reason for mechanical ventilation followed by perinatal asphyxia and septicemia. Most common complication during mechanical ventilation was septicemia which was also a common cause of death. Another important cause of death was perinatal asphyxiaBirdem Med J 2016; 6(1): 22-25


2003 ◽  
Vol 121 (2) ◽  
pp. 45-52 ◽  
Author(s):  
Joice Fabíola Meneguel ◽  
Ruth Guinsburg ◽  
Milton Harumi Miyoshi ◽  
Clovis de Araujo Peres ◽  
Regina Helena Russo ◽  
...  

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.


2021 ◽  
Author(s):  
Niklas Kronibus ◽  
Frederik Seiler ◽  
Guy Danziger ◽  
Ralf M. Muellenbach ◽  
Christian Reyher ◽  
...  

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.


2021 ◽  
Author(s):  
Daniel Adimasu ◽  
Yilikal Tafere ◽  
Teodros Eshetie ◽  
Bekalu Endalew ◽  
Ermias Abebaw ◽  
...  

Abstract Background: Trophic feeding is a small volume, hypo-caloric feeding, gut priming or minimal enteral feeding acclimate the immature gut of enteral fasting preterm neonates. Delayed starting of trophic feeding had resulted in short and long-term physical and neurological sequels. The current study aimed to assess time to initiate trophic feeding and its predictors among preterm neonates admitted in the neonatal intensive care unit of Debre Markos, Felege Hiwot, and Tibebe Ghion comprehensive specialized hospitals.Methods: An institutional-based prospective follow-up study was conducted among 210 neonates. The data were collected with interview and chart review, entered into Epi data 3.1 and exported to Stata 14.1 for analysis. Multivariable Cox regression models were fitted to identify predictors of time to initiate trophic feeding. Result: A total of 210 neonates were followed for 10136 person-hours of risk time and 191 (90.95%) of neonates were started trophic feeding. The overall incidence of starting trophic feeding was 2 per 100 (95% CI: 2, 2.2) person-hours observations. The median survival time was 42 hours (95% CI: 36, 48). APGAR- score at first minute <7 (AHR: 0.6, 95% CI: 0.44, 0.82), gestational age of <34 weeks (AHR: 0.69, 95% CI: 0.5, 0.94), presence of respiratory distress syndrome (AHR: 0.5, 95% CI: 0.36, 0.68), presence of hemodynamic instability (AHR: 0.37, 95% CI: 0.24, 0.57), presence of perinatal asphyxia (AHR: 0.63, 95% CI: 0.44, 0.89), cesarean section delivery (AHR: 0.63, 95% CI: 0.44, 89) and being delivered within the study hospitals (AHR: 0.54, 95% CI: 0.39, 0.74) were found to be statistically significant predictors of time to initiate trophic feeding.Conclusion: There was a significant delay to initiate trophic feeding in the studied hospitals. Gestational age of below 34 weeks, APGAR-score of less than seven, out-born delivery, cesarean delivery, presence of respiratory distress syndrome; perinatal asphyxia, and hemodynamic instability were predictors of delay in starting of trophic feeding. Standardized feeding guideline has to be implemented to overcome delays in enteral feeding initiation.


Scire Salutis ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. 43-53
Author(s):  
Simone Amancio Teles ◽  
Marineth Ferreira de Carvalho Teixeira ◽  
Daniela Maristane Vieira Lopes Maciel

A Síndrome do Desconforto Respiratório (SDR) é um distúrbio que acomete principalmente os recém-nascidos prematuros pela imaturidade pulmonar, resultante da deficiência ou inativação do surfactante. O surfactante é uma substância lipoprotéica produzida pelas células pneumócitos tipo II e armazenado nos corpos lamelares para, posteriormente, ser liberado no espaço alveolar, sintetizado a partir da 20º semana de gestação, com pico de produção por volta da 35º semana. A função do surfactante é diminuir a tensão superficial dos alvéolos, evitando o colabamento na expiração. Quanto menor a idade gestacional de nascimento, maior o risco de desenvolver a SDR. A prematuridade e a imaturidade do sistema respiratório levam à maior necessidade de suporte ventilatório invasivo, oxigenioterapia, assistência fisioterapêutica e internação na unidade de terapia intensiva neonatal. A fisioterapia respiratória tem papel importante na manutenção da permeabilidade das vias aéreas, prevenção de complicações respiratórias, promoção da higiene brônquica, otimização da reexpansão pulmonar, posicionamento adequado e vigilância nos ajustes dos parâmetros da ventilação mecânica invasiva e não invasiva. Este estudo tem o objetivo de realizar uma revisão bibliográfica para identificar as estratégias terapêuticas respiratórias utilizadas pelo fisioterapeuta na assistência ao recém-nascido prematuro com Síndrome do Desconforto Respiratório. Para este fim, fizemos um levantamento de artigos científicos em bases de dados eletrônicos como SciELO, LILACS, Google Acadêmico e PubMed, através dos cognatos ‘Síndrome do Desconforto Respiratório’, ‘prematuros’, ‘unidade de terapia intensiva neonatal’, ‘fisioterapia’ e ‘ventilação mecânica’, e seus correlatos em inglês ‘Respiratory Distress Syndrome’, ‘premature infants’, ‘neonatal intensive care unit’, e ‘physical therapy and mechanical ventilation’. A assistência fisioterapêutica a neonatos prematuros com SDR na UTIN é imprescindível para o sucesso da terapêutica e melhora progressiva da função pulmonar até a alta. O fisioterapeuta deve exercer um plano de tratamento integral e humanizado indo desde o ajuste ventilatório invasivo e não invasivo a execução de manobras terapêuticas, posicionamento e cuidados com a ocorrência de sequelas como hemorragia intraperiventricular e displasia broncopulmonar que podem comprometer o desenvolvimento neuropsicomotor e qualidade de vida após alta hospitalar.


2021 ◽  
Vol 11 (01) ◽  
pp. e287-e295
Author(s):  
Safwat M. Abdel-Aziz ◽  
Enas A. Hamed ◽  
Amira M. Shalaby

AbstractNeonatal morbidity and mortality rates indicate a country's socioeconomic status and the quality, and effectiveness of its health care system. This research aimed to identify the clinical pattern and causes of neonatal admission for inborn and outborn babies in a tertiary care university hospital and their outcomes. Over a year, this prospective hospital-based research was conducted in the neonatal intensive care unit (NICU) of Assiut Children's Hospital in Upper Egypt (January 1st to December 31st, 2020). Gender, birth weight, gestational age, postnatal age, delivery mode, delivery place, admission cause, hospital stay period, and neonatal outcomes were collected. A total of 1,638 newborns were admitted; 930 (56.8%) were preterm and 708 (43.2%) full-term. Inborn admissions were 1,056 (64.5%) and outborn 582 (35.5%). The majority of inborn admissions were preterm 726 (68.8%), and outborn were full-term 378 (64.9%). The commonest admission causes among inborn and outborn preterm infants were respiratory distress syndrome (84.3%) and congenital intestinal obstruction (22.5%), respectively, while multiple congenital anomalies were the commonest cause for admission among both inborn and outborn full-term babies. The mortality rate was 708 (43.2%), higher among inborn (50%) versus outborn (30.9%). The leading cause of death was respiratory distress syndrome among premature inborn with case fatality rate of (56.9%) and multiple congenital anomalies among premature outborn (60%), as well as inborn (67.4%), and outborn (42.6%) full-term neonates. In conclusion, the neonatal mortality rate was high among studied cases. Morbidity and mortality of respiratory distress syndrome and congenital anomalies were alarmingly high. Therefore, all health care providers must devote a considerable effort to improve health care delivered to these neonates.


Author(s):  
Srikanta Baske ◽  
Sudip Saha ◽  
Partha Pratim Pal

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.


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