scholarly journals Antenatal Corticosteroids: Extending the Practice for Late-Preterm and Scheduled Early-Term Deliveries?

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 272
Author(s):  
Zeyar T. Htun ◽  
Jacqueline C. Hairston ◽  
Cynthia Gyamfi-Bannerman ◽  
Jaime Marasch ◽  
Ana Paula Duarte Ribeiro
Keyword(s):  
Respiratory Distress ◽  
Distress Syndrome ◽  
Late Preterm ◽  
Short Term ◽  
Antenatal Corticosteroids ◽  
Term Infants ◽  
Early Term ◽  
Lung Fluid ◽  
Surfactant Production

Respiratory distress in late-preterm and early term infants generally may warrant admission to a special care nursery or an intensive care unit. In particular, respiratory distress syndrome and transient tachypnea of the newborn are the two most common respiratory morbidities. Antenatal corticosteroids (ACS) facilitate surfactant production and lung fluid resorption. The use of ACS has been proven to be beneficial for preterm infants delivered at less than 34 weeks’ gestation. Literature suggests that the benefits of giving antenatal corticosteroids may extend to late-preterm and early term infants as well. This review discusses the short-term benefits of ACS administration in reducing respiratory morbidities, in addition to potential long term adverse effects. An update on the current practices of ACS use in pregnancies greater than 34 weeks’ gestation and considerations of possibly extending versus restricting this practice to certain settings will also be provided.

scholarly journals Clinical Outcomes According to Cannula Configurations in Patients with Acute Respiratory Distress Syndrome under Veno-Venous Extracorporeal Membrane Oxygenation: a Korean multicenter study

2020 ◽  
Author(s):  
Sung Yoon Lim ◽  
Soyeon Ahn ◽  
Sang-Bum Hong ◽  
Chi Ryang Chung ◽  
Kyeongman Jeon ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Short Term ◽  
Vv Ecmo ◽  
Long Term Mortality

Abstract Background Recirculation during veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a known drawback that limits sufficient oxygenation. This study aimed to compare the short-term oxygenation and long-term mortality based on cannula configuration in patients with acute respiratory distress syndrome (ARDS) who receive VV-ECMO, especially in the absence of newly developed double-lumen, single cannula.Methods Data of patients with severe ARDS who received VV-ECMO from 2012–2015 at six hospitals were retrospectively analyzed. Primary outcomes were the partial pressure of oxygen (PaO 2 ) at 1, 4, and 12 hours after ECMO initiation and 180-day mortality.Results Patients ( n = 354) were divided into two groups based on the return cannula site: femoral vein ( n = 193) or internal jugular vein ( n = 161). Baseline characteristics at admission, including PaO 2 , were similar between the groups. PaO 2 at 1 hour after ECMO initiation was higher in the femoral than in the jugular group (190.3 vs. 160, P = 0.108). No significant increase in PaO 2 occurred at 4 and 12 hours between the groups. PaCO 2 decrement at 4 hours was lower in the jugular than in the femoral group (36.4 vs. 33.7 mmHg, P = 0.009). The two groups did not differ in terms of mortality at 180 days after ECMO, however more cannula related complications occurred in the jugular group.Conclusion Regardless of the cannula configuration, patients with ARDS managed with VV-ECMO showed comparable clinical outcomes in terms of short-term oxygenation and long-term mortality. Nevertheless, further well-designed randomized control trials are warranted.

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.

Clinical Utility of Surgical Lung Biopsy for Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Respiration ◽  
2021 ◽  
pp. 1-11
Author(s):  
Hiroyuki Hashimoto ◽  
Shota Yamamoto ◽  
Hiroaki Nakagawa ◽  
Yoshihiro Suido ◽  
Shintaro Sato ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Likelihood Ratio ◽  
Lung Biopsy ◽  
Clinical Utility ◽  
Distress Syndrome ◽  
Short Term ◽  
Surgical Lung Biopsy ◽  
Short Term Mortality

<b><i>Background:</i></b> Surgical lung biopsy (SLB) is performed in patients with acute respiratory distress syndrome (ARDS); however, its clinical utility remains unclear. <b><i>Objectives:</i></b> We categorized the pathological diagnoses and investigated the predictive value for short-term mortality. <b><i>Method:</i></b> Three electronic databases (MEDLINE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) were searched for the included studies. The QUADAS-2 was used to evaluate the risk of bias and its applicability. The types and populations of pathological diagnoses were investigated. The pooled sensitivity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR) were estimated at a fixed specificity. Hierarchical summary receiver operating characteristic curves were drawn. <b><i>Results:</i></b> A total of 16 studies that enrolled 758 patients were included. The pathological diagnoses were as follows: diffuse alveolar damage (DAD) 29.9%; infection 24.7%; interstitial lung disease 17.2%; malignancy 3.6%; cardiovascular disease 3.6%; drug toxicity 2.3%; connective tissue disease 2.2%; allergic disease 1.1%; and nonspecific diagnosis 15.4%. To predict short-term mortality, 13 studies that enrolled 613 patients used DAD as an index test and recorded a mortality rate of 56.9% (349 of 613 patients). A total of 3 studies that used index tests other than DAD were excluded. The pooled sensitivity, fixed specificity, LR+, LR−, and DOR were 0.46 (95% confidence interval [CI]: 0.29–0.56), 0.69, 1.48 (95% CI: 0.92–1.81), 0.78 (95% CI: 0.63–1.03), and 1.90 (95% CI: 0.89–2.86), respectively. <b><i>Conclusions:</i></b> SLB is unlikely to provide a specific diagnosis and should not be recommended for confirming DAD or predicting ARDS prognosis.

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