The Magnitude and Risk Factors of Acute Respiratory Distress Syndrome among Newborn Admitted To Neonatal Intensive Care Unit at Benghazi Medical Center

Background: Hyaline Membrane Disease (HMD)/Respiratory Distress Syndrome (RDS) is the most common lung condition affecting premature babies. The inadequate amount of surfactant causes alveoli to collapse when the baby breathes out. It is hard for your baby to re-inflate the collapsed alveoli when he breathes. The lack of surfactant and resulting inflammation is called. Hyaline Membrane Disease (HMD)/Respiratory Distress Syndrome (RDS). Aim of the Study: To determine the magnitude of Hyaline membrane disease or respiratory distress syndrome and identify the risk factors and complication among newborn babies in neonatal intensive care unit at Benghazi medical center (BMC). Materials and Methods: Case series study. The study was conducted during the period between March 2017 to March 2018 of HMD cases at Benghazi medical center. A convenient sample of 120 cases diagnosed as HMD. Studied variables include the following; gestational age, birth weight, gender, type of pregnancy and type of delivery also the data for mothers such as (diabetes mellitus, preeclampsia hypothyroidism, receiving of Dexamethasone injection and premature rupture of membrane). Also investigation and treatment and finally the outcomes of babies. Statistical Methods: Data were analyzed with SPSS version 17, analysis of associations was made with application Chi - square test for categorical variables comparison, was applied for test of association P <0.25. P was considered statistically significant if ≤ 0.05. Results: Female gender was predominant (52%). Most of cases of HMD were between 1000 -2000 kg. Among the 120 cases we have (15%) sever HMD and the majority of cases have moderate –to sever Hyaline membrane disease 39 (32.5%) whereas very sever HMD were observed in nearly 27% of cases. The risk factors were history of maternal preeclampsia, maternal diabetes mellitus, prematurity and low birth weight babies and neonatal sepsis, all these were found to be very common risk factors of HMD. Pearson chi-square test p value highly significant of female gender with complications of HMD. Our results observed more than half of babies were died. Conclusion: The risk factors were history of maternal preeclampsia, maternal diabetes mellitus, prematurity and low birth weight babies and neonatal sepsis all these were found to be very common risk factors of HMD. Also we concluded that the cases had premature rupture of membrane, which identified as risk factors of hyaline membrane disease. Furthermore, we concluded that highly significant of female gender with complications of HMD, such as Pneumothorax, bronco pulmonary, dysplasia, intra ventricular hemorrhage and congenital heart diseases were common co- morbidities with respiratory distress syndrome, all these could be have an association with the development of hyaline membrane disease, finally we observed more than half of babies were died this is a warning sign for health services.

Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report

Background The Cushing reflex does not appear to have been described in preterm neonates. This case report shows the presence of an active Cushing reflex in a 32-week preterm neonate with hyaline membrane disease. Case presentation The 1.94 kg Caucasian infant was delivered by caesarean section following concerns about possible maternal infection and fetal compromise. Chest X-ray showed mild-to-moderate hyaline membrane disease and treatment was initiated with supplemental oxygen and nasal continuous positive airway pressure. It is probable that a pneumothorax occurred at 5–6 hours of age, with progression during the day. Interstitial air, pneumomediastinum, and tension pneumothorax were diagnosed on subsequent X-ray, and ultrasound of the brain showed a grade IV intraventricular hemorrhage. A review of the nurses’ recordings of heart rate, blood pressure, and respiratory rate showed a progressive increase in blood pressure accompanied by slowing of the heart rate and irregular respiration. These are features of the Cushing reflex that is elicited in response to raised intracranial pressure. Conclusion While well-described in older children and adults, in neonates the Cushing reflex has mainly been described in animal experiments and infants who have developed hydrocephalus. It is likely that in this case, the reflex was elicited as a result of a progressive increase in intracranial pressure due to the combination of elevated intrathoracic pressure, obstructed venous return from the brain, and concurrent intraventricular hemorrhage.

The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study

Background Hyaline membrane disease (HMD) is a leading cause of morbidity and mortality in preterm newborn babies. Though, there are studies related to Hyaline membrane disease inclusive of all neonates, studies related to the burden among preterm neonates were limited. In addition, increasing neonatal mortality in Ethiopia could be related to increase in the burden of hyaline membrane disease among preterm neonates. Therefore, this study was aimed to assess the burden of hyaline membrane disease, mortality and its associated factors among preterm neonate admitted at neonatal intensive care unit, North Central Ethiopia. Methodology An institution-based retrospective follow-up study was conducted among 535 preterm neonates admitted at neonatal intensive care unit from January 1, 2014-December 30, 2017. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for statistical analysis. Binary logistic regression was used for the analysis. All variables with P-value < 0.25 during bi-variable analysis were considered for multivariable logistic regression. Level of statistical significance was declared at P value ≤0.05. Results In the current study, proportion of hyaline membrane disease was 40% (95% CI; 35.8, 44.3) of which 49.5% died. Preterm neonate born with Gestational age of less than 34 weeks of age (Adjusted odd ratio (AOR = 2.64; 95 CI: 1.49, 4.66)), 5th minute Apgar score less than 7 (AOR = 2.2; 95% CI: 1.20, 4.07), and newborn with birth weight of less than 1500 gram (AOR = 2.4, 95% CI: 1.3, 4.3) were predictors of hyaline membrane disease. Conclusions The mean gestational age (±) was 33.46 (±2.55) weeks. The incidence of hyaline membrane disease among preterm admissions was high. Preterm neonate born with gestational age of less than 34 weeks of age, asphyxiated newborns and newborn with birth weight of less than 1500 gram were predictors of hyaline membrane disease. So, emphasis should be given on early screening, follow up and timely interventions for preterm neonate.

Pneumolysis: a fundamental concept in COVID-19 lung disease

BackgroundCOVID-19 severe lung compromise often evolves to life-threatening hypoxia. The experience led to the implementation of standardized protocols assuming similarity to SARS-CoV. Impulsive use of ventilators ended in up to 88% fatality.MethodsCOVID-19 pathophysiology and histopathological lung biopsy photomicrographs are analyzed. ResultsPneumolysis is defined as progressive alveolar-capillary destruction resulting from the CoV-2 attack on pneumocytes. The histopathological results show the presence of Masson bodies, alveolar coating cells with nuclear atypia, reactive pneumocytes, reparative fibrosis, intra-alveolar hemorrhage, moderate inflammatory infiltrates, microabscesses, microthrombus, hyaline membrane remnants, and emphysema. The three theoretical pathophysiological stages of progressive hypoxemia (silent hypoxemia, gasping, and death zone) are depicted.Conclusion Silent hypoxemia suddenly evolves to critical hypoxemia. This, as a consequence of progressive pneumolysis + inflammation + overexpressed immunity + autoimmunity + HAPE-type edema resulting in acute pulmonary insufficiency. The proposed treatment (based on Tolerance to Hypoxia and the Hemoglobin factor) includes: prompt oxygen administration, inflammation and immunity reaction control, antibiotics, rehydration &amp; anticoagulation.

Karakteristik Gambaran Histologis Paru-Paru Pasien COVID-19

Severe acute respiratory syndrome coronavirus (SARS-COV-2) is an infectious disease caused by coronavirus. Coronavirus (COVID-19) first attacks the upper respiratory system such as the nose, mouth, throat even the lungs and can trigger symptoms of fever and cough (pneumonia) resulting in changes in lung organ tissue during histological examination. This study aimed to determine the characteristics of the histological picture of the lungs of COVID-19 patients. This research uses a literature review research method. Based on 12 research reports analyzed in this research, the most common characteristic of histological features found in 12 research report journals is the finding of a diffuse alveolar damage pattern. Diffuse alveolar damage is a condition of acute lung injury which is accompanied by an acute phase with edema, a hyaline membrane, and inflammation followed by an organizing phase, where there is hyperplasia of type II pneumocytes, there is also fibrin or intra-alveolar protein. In conclusion, the characteristics of the histological features of the lungs most commonly found in COVID-19 patients are the findings of a diffuse alveolar damage pattern, which is a condition of acute lung injury and an acute phase with edema, hyaline membrane, and inflammation followed by an organizing phase, namely there is hyperplasia of type II pneumocytes, there is also fibrin or intra-alveolar proteinKeywords: lung histology, COVID-19. Abstrak: Severe acute respiratory syndrome coronavirus (SARS-COV-2) adalah sebuah penyakit menular yang disebabkan oleh coronavirus. Coronavirus (COVID-19) pertama kali menyerang sistem pernapasan bagian atas seperti hidung, mulut, tenggorokan bahkan sampai ke paru – paru dan dapat memicu gejala demam dan batuk (pneumonia) sehingga terjadi perubahan jaringan organ paru – paru pada saat dilakukan pemeriksaan histologi. Penelitian bertujuan untuk mengetahui karakteristik gambaran histologis paru – paru pasien COVID-19. Penelitian ini menggunakan metode penelitian literature review. Berdasarkan 12 laporan penelitian yang di analisis pada penelitian ini, karakteristik gambaran histologis yang paling umum ditemukan pada 12 jurnal laporan penelitian yaitu terdapat temuan pola diffuse alveolar damage. Diffuse alveolar damage merupakan kondisi cedera paru akut atau acute lung injury yang disertai dengan fase akut dengan adanya edema, terdapat membran hialin, dan inflamasi di ikuti dengan fase pengorganisasian yaitu terdapat hiperplasia pneumosit tipe II, juga terdapat fibrin atau protein intra-alveolar. Sebagai simpulan, karakteristik gambaran histologis paru – paru yang paling umum ditemukan pada pasien COVID-19 adalah temuan pola diffuse alveolar damage yang merupakan kondisi cedera paru akut atau acute lung injury serta fase akut dengan adanya edema, terdapat membran hialin, dan inflamasi di ikuti dengan fase pengorganisasian yaitu terdapat hiperplasia pneumosit tipe II, juga terdapat fibrin atau protein intra-alveolarKata Kunci: histologi paru, COVID-19

USE OF EARLY NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE IN PRETERM NEONATES WITH HYALINE MEMBRANE DISEASE

Background & Objective: Mechanical ventilation is the standard treatment for hyaline membrane disease (HMD) and has increased neonatal survival. However this increased survival has come at the expense of increased morbidity in the form of chronic lung disease, longer duration of hospitals stay and at the cost of expensive technology. Alternate form of respiratory support is early nasal CPAP. Hence present study aims at managing increasing number of preterm babies with HMD with a non-invasive approach in the form of early nasal CPAP. Methods: 50 babies of 28-34 weeks gestational age admitted in neonatal ICU of pediatrics Department at Patna Medical collage & hospital, Patna with clinical diagnosis of HMD, requiring respiratory support were treated with early nasal CPAP and studied prospectively from 01.12.2019 to 30.11.2020. Chi-square and other appropriate tests. We found a succ Statistical analysis: Results: ess rate of 80% in babies with HMD, who were managed with early nasal CPAP alone. Remaining 20% needed intubation and higher mode of ventilation. Mild and moderate grade HMD were effectively managed with early nasal CPAP (P<0.05). It was also found to be effective in babies of mothers who have received antenatal steroids (P<0.05). Prematurity is the commonest predi Conclusion: sposing cause for HMD. Early nasal CPAP is safe, inexpensive and effective means of respiratory support in HMD. it is useful in mild and moderate grade disease. It may not be a replacement for assisted ventilation in severe disease. It is also found to be effective in babies of mothers who have received antenatal steroids

Analysis of Pathology in Premature Infants in Obstetrics and Gynecology Clinic at St George University Hospital, Plovdiv between 2013 and 2015

Introduction: Premature birth is now one of the most profound prenatal problems worldwide because of the high morbidity and mor-tality it is associated with at the beginning of life. Advances in prenatal medicine over the past decades have led to a significant improve-ment of neonatal survival in risk groups of newborns. Infants of gestational age of 22-25 weeks represent the greatest medical, social, and ethical dilemma in neonatology. Most of these newborns need intensive care to survive, and most infants born between 28 and 32 weeks of gestation require special care. Those born 34 to 36 weeks&rsquo; gestation also have higher rates of short-term morbid premature birth-related conditions such as respiratory distress syndrome (RDS) and intraventricular hemorrhage (IVH) than their peers born at term. Aim: To carry out an analysis of morbidity during the neonatal period in premature babies. Materials and methods: A retrospective triennial study was conducted on 598 premature newborns. Results: The results of the study show that morbidity rate in premature born infants is high. The most frequent reasons for admission to the neonatal intensive care unit are the other forms of respiratory distress syndrome (45%). Respiratory distress syndrome (RDS) was observed in 23.41% of the prematurity, 10.7% of them were suspected of having other pathology, and 20.9% of premature neonates &nbsp;manifested no complications in the neonatal period. There was a significant difference in the diagnosis of newborns after birth (p=0.0001, r=0.58), with the newborns with RDS demonstrating the most complications in the neonatal period. Conclusions: The conclusions to be drawn from the analysis of the data are as follows: there is wide comorbidity in the prematurity of RDS. Lower gestational age strongly correlates with the development of RDS. If no corticosteroid therapy is administered the risk of developing hyaline membrane disease increases. There is extremely high probability of neonatal mortality in children with hyaline membrane disease. There is significant difference between the primary diagnosis and the condition of the child at discharge from the medical establishment. Adequate and specialized prenatal care is essential when trying to reduce the incidence of preterm birth.

Use of early nasal continuous positive airway pressure in preterm neonates with hyaline membrane disease (neonatal respiratory distress syndrome)

Background: In developing countries like ours, there is high burden of prematurity and sub-optimal use of antenatal steroid administration resulting infrequent hyaline membrane disease (HMD).Methods: A total 50 cases of clinically diagnosed HMD with gestational age between 28-34 weeks admitted to neonatal intensive care unit (ICU). 50 babies were treated with early nasal continuous positive airway pressure (CPAP) (within 6 hours of onset of respiratory distress).Results: Incidence of prematurity was 12.42%. Incidence of HMD observed between gestational ages of 28-34 weeks is 3.2%. Out of total 50 babies who were managed with early nasal CPAP, it proved effective in 40 babies (80%), remaining 10 babies (20%) had to be intubated and required ventilation. Out of 10 babies who required ventilation 90% of the babies were less than 32 weeks gestation age; remaining 10% were between 33-34 weeks. Analysis of these results showed that outcome is better with increased gestational age (p<0.005). Out of 10 babies who failed 80% were <1500 g and remaining 20% above 1500 g. We found significant improvement (p<0.005) in SA score after application of nasal CPAP. Babies on CPAP had significant improvement in oxygenation (p<0.05). A success rate of 93.1% observed in moderate grade HMD (p<0.005). Out of 10 babies who failed on nasal CPAP, 80% of them had severe grade HMD and 20% showed moderate HMD. A success rate of 92.86% was found in babies of mothers who had received antenatal steroids and 63.63% of babies whose mothers had not received antenatal steroids improved with early nasal CPAP (p<0.05).Conclusions: Nasal CPAP is found to be effective in babies of mothers who had received antenatal steroids. Nasal CPAP is safe, inexpensive and effective means of respiratory support in HMD. Use of early nasal CPAP which is simple, non-invasive, has low capital outlay and does not require expertise, is the option for us where most places cannot provide invasive ventilation.