Pulmonary hypoplasia(PH) commonly occurs in association with oligohydramnios and other congenital anomalies, especially congenital diaphragmatic hernia (CDH). Pulmonary hypoplasia is an important factor, as persistent pulmonary hypertension, in the prognosis of CDH. In some reports, there is a decrement of pulmonary surfactant in PH accompanying CDH. Recently, there are some reports that exogenous pulmonary surfactant therapy is effective in experimental animal model and neonatal respiratory distress with PH. We report a case of a 5 day-old male neonate, who had shown dyspnea and diagnosed as left pulmonary hypoplasia accompanying CDH. The CDH was surgically treated and the ipsilateral PH, with intratracheal administration of exogenous pulmonary surfactant postoperatively. After exogenous pulmonary surfactant application, the left lung volume was increased on chest roentgenogram and lung perfusion scan findings, and there was an improvement in oxygenation and clinical manifestations. We suggest that postoperative exogenous pulmonary surfactant replacement therapy is effective in the case of PH and further trials are needed to clarify the optimal dose and timing of supplementation of surfactant for treatment of infants with PH accompanying CDH.
Case Report ; Hernia, Diaphragmatic/*congenital ; Human ; Infant, Newborn ; Lung/*abnormalities ; Male ; Pulmonary Surfactants/*therapeutic use

Humans ; Infant, Newborn ; Meconium Aspiration Syndrome ; drug therapy ; Pulmonary Surfactants ; therapeutic use

Adult ; Bronchoalveolar Lavage ; methods ; Humans ; Male ; Pulmonary Surfactants ; therapeutic use ; Silicosis ; therapy

Bronchopulmonary dysplasia (BPD) is one of the few diseases affecting premature infants that have continued to evolve since its first description about half a century ago. The current form of BPD, a more benign and protracted respiratory failure in extremely preterm infants, is in contrast to the original presentation of severe respiratory failure with high mortality in larger premature infants. This new BPD is end result of complex interplay of various antenatal and postnatal factors causing lung injury and subsequent abnormal repair leading to altered alveolar and vascular development. The change in clinical and pathologic picture of BPD over time has resulted in new challenges in developing strategies for its prevention and management. While some of these strategies like Vitamin A supplementation, caffeine and volume targeted ventilation have stood the test of time, others like postnatal steroids are being reexamined with great interest in last few years. It is quite clear that BPD is unlikely to be eliminated unless some miraculous strategy cures prematurity. The future of BPD prevention will probably be a combination of antenatal and postnatal strategies acting on multiple pathways to minimize lung injury and abnormal repair as well as promote normal alveolar and vascular development.
Adrenal Cortex Hormones ; therapeutic use ; Animals ; Bronchopulmonary Dysplasia ; prevention & control ; Caffeine ; therapeutic use ; Humans ; Oxygen ; therapeutic use ; Pulmonary Surfactants ; therapeutic use ; Respiration, Artificial

OBJECTIVETo investigate the protective and therapeutic effects of pulmonary surfactant in the pathogenesis of chronic obstructive pulmonary disease (COPD) in hamsters.

METHODSCOPD animal model was established by smoke inhalations and intratracheal instillations of pancreatic elastase in hamsters. Ninty hamsters were divided into 9 groups as follows: normal group (N), two groups received smoke inhalations for 1 and 3 months (S1 and S3), one group received intratracheal instillation of surfactant (10 mg/100 g BW) for once after 1 month smoking (SP1), one group was treated with surfactant after 1.5, 2 and 2.5 months of smoking (SP3), and two groups received intratracheal administration of elastase (40 U/100 g BW) and were killed after 1 month and 3 months, respectively (E1 and E3). The surfactant was injected intratracheally after 1 week, 0.5, 1.0, 1.5, 2.0, and 2.5 months, followed by administration with elastase (EP1 and EP3). EP1 group were killed at the first month, and EP3 at the third month. Light microscopy and electromicroscopy observations were performed in each group. Pulmonary mean linear intercept (MLI), mean alveolar numbers (MAN), and pulmonary alveolar area (PAA) was measured by image analysis. The expression of surfactant protein A (SP-A) were observed by immunohistochemistry.

RESULTSSmoking for 3 months and instillations of elastase resulted in chronic bronchitis and emphysema. MLI and PAA increased and MAN decreased in all the experimental groups compared with in the normal group (P < 0.05 or P < 0.01). Administration of surfactant for 3 months resulted in statistically significant inhibition of pulmonary injury. MLI and PAA decreased and MAN increased in SP3 compared with in S3. Only MLI decreased in EP3 compared with E3. The expressions of SP-A in the type II alveolar epithelia decreased in S3 and E3 (compared with the normal group P < 0.01). After pulmonary surfactant intervention, the expression of SP-A increased significantly.

CONCLUSIONPulmonary surfactant may have a long-term protective effect on chronic smoking and elastase-induced COPD.

Animals ; Cricetinae ; Male ; Mesocricetus ; Pancreatic Elastase ; Pulmonary Alveoli ; ultrastructure ; Pulmonary Disease, Chronic Obstructive ; metabolism ; prevention & control ; Pulmonary Surfactant-Associated Protein A ; metabolism ; Pulmonary Surfactants ; therapeutic use ; Smoking

OBJECTIVETo evaluate the efficacy of calf pulmonary surfactant (PS) in the treatment of respiratory distress syndrome (RDS) in late preterm and full-term infants.

METHODSA randomized controlled trial was designed to evaluate the efficacy of calf PS intratracheally given at different times and doses in infants with RDS who had a gestational age of ≥35 weeks and an oxygenation index (OI) of 10-20. The subjects were randomly assigned to treatment group 1 (n=58), treatment group 2 (n=58), and control group (n=59). Treatment group 1 was given PS (50 mg/kg) within 6 hours after admission. Treatment group 2 was given PS (70 mg/kg) within 6 hours after admission. The control group was not given PS within 6 hours after admission and was given PS (50 mg/kg) over 6 hours after admission if having no remission by conventional therapy including mechanical ventilation. For each group, a second dose of PS (50 mg/kg) was given if no remission was observed within 12 hours after the first administration.

RESULTSThere were no significant differences in mortality between the three groups. Treatment group 2 had lower hospitalization expense and shorter duration of mechanical ventilation compared with treatment group 1, and treatment group 1 had lower hospitalization expense and shorter duration of mechanical ventilation compared with the control group. The incidence of ventilator-associated pneumonia and length of hospital stay in treatment group 2 was lower than those in treatment group 1 and control group. Compared with the control group, Treatment groups 1 and 2 showed decreases in 2 or more times of PS use, maximum OI, duration of continuous positive airway pressure treatment, and incidence of air leak syndrome and pulmonary hypertension.

CONCLUSIONSEarly use of sufficient PS in late preterm and full-term infants with RDS can reduce complications, secondary use of PS, duration of mechanical ventilation and length of hospital stay, and hospitalization expense.

Female ; Hospitalization ; economics ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Pulmonary Surfactants ; therapeutic use ; Respiratory Distress Syndrome, Newborn ; drug therapy

OBJECTIVETo explore the clinical efficacy of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal pulmonary hemorrhage (NPH).

METHODSA total of 122 neonates diagnosed with NPH between January 2010 and June 2014 were enrolled. After being stratified by gestational age, the neonates were randomly divided into treatment (HFOV+PS) and control (HFOV alone) groups (n=61 each). Both groups were treated with HFOV after the onset of NPH. After 2-4 hours of HFOV treatment, the treatment group received PS via intratracheal injections, followed by continuous use of HFOV. Dynamic changes in the blood gas, oxygenation index (OI), and PaO2/FiO2 (P/F) values of the neonates were determined before HFOV treatment and after 6, 12, and 24 hours of HFOV treatment. The time to hemostasis, duration of ventilation, incidence of complications, and cure rate were compared between groups.

RESULTSAfter 6, 12, and 24 hours of HFOV treatment, the treatment group had significantly improved PaO2, PaCO2, O/I, and P/F values compared with the control group (P<0.05). The time to hemostasis and the duration of ventilation were significantly shorter in the treatment group than in the control group (P<0.01), and the incidence of complications was lower in the former than in the latter (P<0.05). There was no significant difference in the cure rate between the treatment (87%) and control (82%) groups (P>0.05).

CONCLUSIONSHFOV combined with PS is an effective treatment to improve oxygenation, shorten the time to hemostasis and the duration of ventilation, and reduce the incidence of complications in neonates with NPH. However, the dual therapy is unable to reduce the mortality of neonates compared with HFOV monotherapy.

Combined Modality Therapy ; Female ; Hemorrhage ; therapy ; High-Frequency Ventilation ; Humans ; Infant, Newborn ; Lung Diseases ; therapy ; Male ; Pulmonary Surfactants ; therapeutic use

OBJECTIVEThe efficacy of pulmonary surfactant (PS) replacement therapy for meconium aspiration syndrome (MAS) remains controversial. This study aimed to evaluate the efficacy of PS therapy in neonates with MAS by a meta-analysis.

METHODSRandomized controlled trials (RCTs) on the treatment of MAS with PS were searched electronically in medical debases including PubMed, Science Citation Index, The Cochrane Central Register of Controlled Trials, Ovid, EBSCOhost, BIOSIS previews, Chinese BioMedical Literature Database, Wanfang Database and VIP Chinese Sci-Tech Periodical Database. The Cochrane Handbook 5.0.2 was employed to evaluate methodological quality. RevMan 5.0.25 software was used for the meta-analysis.

RESULTSEight RCTs including 512 MAS neonates (257 cases in the PS treatment group and 255 cases in the control group) were enrolled in this meta-analysis. The meta-analysis showed that PS treatment reduced oxygenation index (MD=-2.59; 95%CI: -4.33, -0.86; P=0.003), increased arterial oxygen/alveolar oxygen ratio (MD=0.05; 95%CI: 0.05, 0.06; P<0.00001), shortened hospitalization days (MD=-4.94; 95%CI: -7.44, -2.44; P=0.0001) and decreased mortality rate (OR=0.47; 95%CI: 0.24, 0.93; P=0.03) significantly. There were no statistical differences in the durations of mechanical ventilation and oxygen therapy, and the incidences of air leak, pulmonary hemorrhage and intracranial hemorrhage between the PS treatment and control groups.

CONCLUSIONSCurrently published evidence from RCTs suggests that PS replacement therapy is effective for MAS, however because of the limited quantity and quality of trials enrolled in the study, further evidence from RCTs is needed to prove the efficacy.

Female ; Humans ; Infant, Newborn ; Male ; Meconium Aspiration Syndrome ; drug therapy ; mortality ; physiopathology ; Pulmonary Surfactants ; therapeutic use ; Randomized Controlled Trials as Topic

OBJECTIVERespiratory distress syndrome (RDS) is a frequently seen acute respiratory disorder in the newborn infants. Since the original description of deficiency of the pulmonary surfactant in premature neonates by Avery in 1959, RDS has most commonly been attributed to developmental immaturity of surfactant production. But in clinical practice it has been found that there was RDS in term and late-term neonates. Many of them were recognized as transient tachypnea at the beginning, they were diagnosed as RDS until respiratory distress and the typical radiological signs were demonstrated. The purpose of this study was to investigate the clinical characteristics of RDS of term and late-term neonates.

METHODSAll neonates admitted to the neonatal intensive care unit of the Children's Hospital, Zhejiang University School of Medicine between May, 2005 and May, 2007 on the basis of RDS were analyzed. RDS was diagnosed when respiratory distress and the typical radiological signs were documented. Patients were grouped into preterm group (Group 1, gestational age < 35 w, n = 103) and term and late-term group (Group 2, gestational age > or = 35 w, n = 74).

RESULTSIn Group 1, 76 preterm infants were male, the mean gestational age was 31.1 w, the mean Apgar score at 1 min was 7.6, the mean birth weight was 1702 g, 56 cases were vaginally delivered and 47 were delivered through Cesarean section. Only one was delivered via elective Cesarean section before onset of labor. A total of 88 patients needed mechanical ventilation (MV), the time for beginning MV was 8.7 h (1 - 72 h), and lasted for 4.3 d (0.5 - 29 d). The oxygenation index (OI) was 11.9 (10.00 - 52.63) and PaO2/PAO2 was 0.29 (0.03 - 0.98). Four patients had an OI > 40. A total of 28 patients were treated with pulmonary surfactant (PS), and 11 of the 28 underwent MV, the OI before and 2 h, 8 - 12 h and 20 - 24 h after using PS were 10.5, 5.4, 3.4, and 4.3, respectively (P < 0.01). A total of 33 patients in Group 1 had intracranial hemorrhage, 4 patients had pneumothorax, 4 patients had persistent pulmonary hypertension of the newborn (PPHN) and 15 patients had ventilator associated pneumonia (VAP). In Group 2, 54 infants were male, the mean gestational age was 37 w, the mean Apgar score at 1 min was 8.5, the mean birth weight was 2789 g, 8 cases were vaginally delivered, 66 were delivered through Cesarean section and 59 were delivered via elective Cesarean section before onset of labor. A total of 63 patients needed MV, the time for beginning MV was 27.8 h (1 - 72 h, compared to Group 1, P < 0.01), and lasted for 3.7 d (0.5 - 13.5 d). The OI was 19.70 (10.00 - 56.67, compared to Group 1, P < 0.01) and PaO2/PAO2 was 0.16 (0.017 - 0.470, compared to Group 1, P < 0.01). Seven patients had an OI > 40. A total of 8 patients were treated with PS and 7 of them had MV, the OI before and 2 h, 8 - 12 h and 20 - 24 h after using PS were 11.2, 7.6, 7.5, and 7.6 (the last two compared to group 1, P < 0.01, respectively). A total of 16 patients had pneumothorax, 10 patients had intracranial hemorrhage, 16 patients had PPHN and 7 patients had VAP.

CONCLUSIONMost of the term and late-term neonates who developed RDS were delivered through cesarean section before onset of labor. They underwent MV later. The oxygenation was worse than RDS in preterm infants. PS did not have the same effect as seen in preterm infants. They had more pneumothorax and PPHN.

Female ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Pulmonary Surfactants ; therapeutic use ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn ; therapy ; Treatment Outcome

OBJECTIVETo investigate the clinical epidemiological characteristics of neonatal respiratory failure in 1,108 neonates, and to provide a reference for improvement in clinical treatment and multicenter clinical studies.

METHODSThe clinical data of 1,108 neonates with respiratory failure were collected with questionnaires, and statistical analysis was performed for the epidemiological indices including primary diseases, clinical therapeutic methods, treatment outcome, and fatality.

RESULTSIn all the neonates with respiratory failure, the median gestational age was 37 weeks+1 day, the median birth weight was 2,600 g, the median age in days on admission to neonatal intensive care unit was 0.71 days (17 hours), and the boy/girl ratio was 3.1:1. The major primary diseases were respiratory distress syndrome (30.51%), pulmonary infection/sepsis (23.55%), and wet lung (13.18%). Of all the neonates, 48.64% received nasal continuous positive airway pressure (nCPAP), 12.81% received high-frequency oscillatory ventilation, 13.45% received pulmonary surfactant, and 8.66% received nitric oxide inhalation therapy. The fatality was 24.19%.

CONCLUSIONSThe major primary disease for neonatal respiratory failure is respiratory distress syndrome. Pulmonary surfactant, nCPAP, high-frequency oscillatory ventilation, and nitric oxide inhalation therapy are major therapeutic methods for neonatal respiratory failure, but neonatal respiratory failure still has a high fatality.

Female ; Humans ; Infant, Newborn ; Male ; Nitric Oxide ; administration & dosage ; Pulmonary Surfactants ; therapeutic use ; Respiration, Artificial ; Respiratory Insufficiency ; therapy