Respiratory distress syndrome (RDS) in the newborn infants remains a major cause of mortality and morbidity in the newborn period despite much improvements in neonatal intensive care and artificial ventilatory techniques. Gastric fluid was obtained from 151 patients within 6 hours after delivery. The sensitivity, specificity, and predictive value of the simple shake test (133 cases) and stable microbubble rating (SMR) test (151 cases) were assessed in the diagnosis of RDS, as well as the relation between both tests and RDS. We carried out both tests of on gastric aspirates all newborn who admitted to NICU of Presbyterian Medical Center from June 1991 to August 1992. The results were summarized as follows: 1) Among the total 151 cases, RDS were found in 41 cases(27.2%). 2) RDS occurence rate of the simple shake test was 11/11 in 0 group, 17/26 in +1 group, 8/28 in +2 group, 2/41 in +3 group, and 2/27 in +4 group. RDS occurence rate was high the 0 and +1 group. 3) RDS occurence rate of the SMR test was 4/4 in very weak group, 32/36 in weak group, 1/33 in medium group, and 4/78 in strong group. RDS occurence rate was high in the very weak and weak group. 4) Among the positive group of the SMR test 95 cases, positive group of the shake test were found in 87 cases. Among negative group of the SMR test 38 cases, negative of the shake test were found in 29 cases (correlation coefficient=0.763). 5) Sensitivity of the shake test and SMR test were 70%, 87.8% respectively. Specificity of the shake test and SMR test were 93.3%, 96.4% respectively. Positive predictability were 75.7%, 90% respectively and negative predictability were 87.5%, 95.5% respectively. The shake test, as Well as SMR test, has significant value to diagnosis of the RDS. We predict RDS occurence rate of the SMR test was significantly higher than shake test.
Diagnosis ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Microbubbles* ; Mortality ; Protestantism ; Respiratory Distress Syndrome, Newborn* ; Sensitivity and Specificity

Acute Disease ; Fatal Outcome ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Respiratory Distress Syndrome, Newborn ; diagnosis ; therapy

OBJECTIVETo study the association between serum level of high-mobility group box 1(HMGB1) and neonatal respiratory distress syndrome (NRDS).

METHODSA total of 35 infants with NRDS and 35 normal neonates (control group) were enrolled. Peripheral venous blood samples were collected with 12-24 hours after birth. ELISA was used to measure the serum level of HMGB1.

RESULTSThe infants with mild and severe NRDS had a significantly higher serum level of HMGB1 than the control group (P<0.05). The infants with severe NRDS had a significantly higher serum level of HMGB1 than those with mild NRDS (P<0.05). The infants with NRDS who died had a significantly higher serum level of HMGB1 than those who survived (P<0.05). The receiver operating characteristic (ROC) curve showed that the optimal cut-off value for serum level of HMGB1 to predict NRDS was 625.3 pg/mL with an area under the ROC curve (AUC) of 0.846 (95%CI: 0.755-0.936), and the optimal cut-off value for serum level of HMGB1 to predict the death of infants with NRDS was 772.2 pg/mL with an AUC of 0.916 (95%CI: 0.813-1.000).

CONCLUSIONSInfants with NRDS have a significant increase in the serum level of HMGB1, and the serum level of HMGB1 can well predict the development and prognosis of NRDS.

Female ; HMGB1 Protein ; blood ; Humans ; Infant, Newborn ; Male ; Prognosis ; Respiratory Distress Syndrome, Newborn ; blood ; diagnosis

To evaluate the predictive values of oxygenation index (OI), arterial-alveolar oxygen tension ratio (a/APO)2, and alveolar-arterial oxygen gradient ((A-a)DO2) for early recognition of responsiveness to high frequency oscillatory ventilation (HFOV) in very low birth weight infants with respiratory distress syndrome (RDS), 23 infants who received HFOV treatment for severe RDS after failing to be improved with conventional mechanical ventilation from July 1995 to February 1998 were included. Twelve infants survived with HFOV (Responder group), while 11 infants could not maintain oxygenation with HFOV and died (Non-responder group). Clinical record (of each patient) were retrospectively reviewed and compared with the respiratory indices. Mean (A-a)DO2 was significantly lower in the responder group than in the non-responder group at 2 hr after HFOV (p=0.024), and the difference was more remarkable at 6 hr (p=0.005). Death in the patient with (A-a)DO2 over 350 at 2 hr after HFOV therapy was 100% in sensitivity and 80% in specificity. The earliest significant difference of mean a/APO2 between two groups was noted at 6 hr after HFOV treatment (p=0.019). OI showed no significant differences between two groups. In summary, (A-a)DO2 was the most effective and sensitive respiratory index for predicting the responsiveness to HFOV in infants with severe RDS providing due as early as 2 hr.
Comparative Study ; High-Frequency Ventilation* ; Human ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Oxygen/blood ; Predictive Value of Tests ; Prognosis ; Pulmonary Gas Exchange* ; Respiratory Distress Syndrome/therapy* ; Respiratory Distress Syndrome/mortality ; Respiratory Distress Syndrome/diagnosis* ; Retrospective Studies ; Sensitivity and Specificity ; Treatment Outcome

OBJECTIVES: To study the significance of interleukin-6 (IL-6) and interleukin-27 (IL-27) in the differential diagnosis of acute respiratory distress syndrome (ARDS) and neonatal respiratory distress syndrome (NRDS) in preterm infants. METHODS: The preterm infants with the manifestation of respiratory distress who were treated in the Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, from March to November 2021, were enrolled in this prospective study. According to the diagnosis results, they were divided into two groups: ARDS group (n=18) and NRDS group (n=20). ELISA was used to measure the plasma levels of IL-6 and IL-27. The receiver operating characteristic (ROC) curve was used to analyze the value of each index in the diagnosis of ARDS. RESULTS: The ARDS group had significantly higher plasma levels of IL-6 and IL-27 than the NRDS group (P<0.05). The ROC curve analysis showed that IL-6 had an area under the ROC curve (AUC) of 0.867 for the diagnosis of ARDS, with a sensitivity of 61.1% and a specificity of 95.0% at the cut-off value of 56.21 pg/mL. The ROC curve analysis also showed that IL-27 had an AUC of 0.881 for the diagnosis of ARDS, with a sensitivity of 83.3% and a specificity of 80.0% at the cut-off value of 135.8 pg/mL. CONCLUSIONS Plasma IL-6 and IL-27 can be used as biological indicators for early differential diagnosis of ARDS and NRDS in preterm infants.
Diagnosis, Differential ; Humans ; Infant, Newborn ; Infant, Premature ; Interleukin-27/blood* ; Interleukin-6/blood* ; Pilot Projects ; Prognosis ; Prospective Studies ; ROC Curve ; Respiratory Distress Syndrome/diagnosis* ; Respiratory Distress Syndrome, Newborn/diagnosis*

Objective To evaluate the value of serum aminoterminal pro-brain natriuretic peptide (NT-proBNP) and interleukin(IL)-6 levels in diagnosis and severity assessment of the preterm infants with respiratory distress syndrome(RDS).Methods Totally 150 preterm infants with RDS who were hospitalized in our center from August 2016 to March 2018 were enrolled in this study as the RDS group. These infants were further divided into grades 1,2,3,and 4 according to chest radiography. In addition,158 preterm infants without RDS hospitalized in our center during the same period were included as the controls (control group). Serum NT-proBNP and IL-6 levels were measured by ELISA on days 1,3,and 7 after birth,and their pulmonary arterial pressure (PAP) was monitored as well.Results Serum NT-proBNP and IL-6 levels in RDS group were significantly higher than those in control group on day 1 (t=-91.04,P=0.000;t=-11.03,P=0.000),day 3 (t=-89.10,P=0.000;t=-9.909,P=0.000),and day 7 (t=-87.91,P=0.000;t=-8.548,P=0.000). There were significant differences in NT-proBNP levels among grades 1,2,3,and 4 on day 1 (F=50.89,P=0.000),day 3 (F=49.16,P=0.000),and day 7 (F=45.45,P=0.000),showing an increasing trend. Serum IL-6 levels showed no significant difference among grades 1,2,3,and 4 on day 1 (F=0.89,P=0.448),day 3 (F=0.76,P=0.518),and day 7 (F=0.85,P=0.469). The PAP of the RDS group on days 1,3,and 7 was (49.3±3.7),(40.1±5.4),and (39.0±2.6)mmHg (1 mmHg=0.133 kPa),which were significantly higher than those of the control group (35.0±2.7)mmHg (t=-90.01,P=0.000),(30.0±3.1)mmHg (t=-81.90,P=0.000),(26.0±3.0)mmHg (t=-88.89,P=0.000). Thus,there was a positive correlation between NT-proBNP and IL-6 levels (r=0.876,P=0.000) and a positive correlation between NT-proBNP and PAP (r=0.916,P=0.000) in preterm infants with RDS.Conclusion Monitoring serum NT-proBN contributes to early diagnosis and disease severity assessment in preterm infants with RDS.
Biomarkers ; Early Diagnosis ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Interleukin-6 ; Natriuretic Peptide, Brain ; Peptide Fragments ; Respiratory Distress Syndrome, Adult

BACKGROUNDRespiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and neonatal death, however, its clinical characteristics are very different from premature RDS, and these characteristics have not been well documented as yet. This study was to investigate the pathogenesis, clinical characteristics and management strategies of RDS in full-term neonates, with the aim of developing a working protocol for improving the outcome in full-term neonates with RDS.

METHODSA total of 125 full-term infants with RDS were enrolled in this study. Their clinical and laboratory data were collected for analyzing the characteristics of full-term neonatal RDS.

RESULTS(1) The 125 cases included 94 male and 31 female infants, vaginal delivery occurred in 80 cases and cesarean section in 45 cases. (2) The onset time of RDS was (3.11 ± 3.59) hours after birth. (3) The possible reasons included severe perinatal infections in 63 patients, elective cesarean section in 34 cases, severe birth asphyxia in 12 patients, meconium aspiration syndrome in 9 patients, pulmonary hemorrhage in 4 patients and maternal diabetes in 3 patients. (4) Complications included multiple organ system failure (MOSF) in 49 patients, persistent pulmonary hypertension of newborn (PPHN) in 25 patients, acute renal failure in 18 patients, severe hyperkalemia in 25 patients, severe metabolic acidosis in 6 cases, severe myocardial injury in 9 cases, pulmonary hemorrhage in 3 cases, disseminated intravascular coagulation in 14 patients and shock in 12 patients. (5) Four patients died, the mortality was therefore 3.2% with the main cause of septicemia complicating of MOSF, but their prognosis was improved while comprehensive treatment measures including early mechanical ventilation and broad spectrum antibiotics were taken into account.

CONCLUSIONSRDS is not an uncommon disease in full-term infants and is associated with a higher mortality, its clinical characteristics are very different from premature RDS, and its onset is earlier and is more likely to develop into PPHN and/or MOSF. The main cause of death is severe infection complicating of MOSF and most patients require prolonged mechanical ventilation. Comprehensive management strategies will help to improve patient's prognosis.

Anti-Bacterial Agents ; therapeutic use ; Female ; Humans ; Infant, Newborn ; Male ; Multiple Organ Failure ; etiology ; Nitric Oxide ; therapeutic use ; Respiratory Distress Syndrome, Newborn ; complications ; diagnosis ; drug therapy ; mortality

OBJECTIVESevere respiratory distress syndrome (RDS) caused by pulmonary surfactant (PS) deficiency is described not only in preterm infants but also in term babies delivered via caesarean section, especially before the onset of labour (elective caesarean section). Once RDS of term neonates happened, mechanical ventilation is needed, and the infants were at high risk of developing further complications such as persistent pulmonary hypertension of neonates (PPHN), pulmonary air leak and cardiovascular instability, even fatal outcome cannot be avoided. The present study aimed to analyze the association between the elective caesarean section and respiratory distress syndrome (RDS) in term neonates, and to determine the related factors and outcomes of RDS cases in neonatal intensive care unit (NICU) and neonatology ward.

METHODSA retrospective study was conducted at the NICU and the Neonatology Ward of A center (Children's Hospital of Zhejiang University) and the NICU of center B (Obstetrics and Gynecology Hospital of Zhejiang University) on 90 term infants who were diagnosed as RDS between June 2006 and June 2008. The general clinical data, mode of delivery, severity of the radiological sign, pulmonary surfactant (PS) application, the onset time and duration of mechanical ventilation, the ratio of PaO(2) to FIO(2) before mechanical ventilation, oxygenation index (OI), duration of oxygen supplementation, the length of hospital stay and complications including pulmonary air leaks (pneumothorax, pulmonary interstitial emphysema), PPHN, systemic hypotension and ventilator-associated pneumonia (VAP) were collected. The gestational age distribution was studied in RDS cases delivered by elective caesarean section, and the comparative analysis and non-conditional logistic regression analysis wer performed for clinical characteristics and risk factors between the RDS cases with or without complications. P < 0.05 was considered to be significant.

RESULTSThere were 88 episodes of elective caesarean section in 90 RDS patients. The proportion of elective caesarean section was 97.8% (88/90). The number of RDS cases was reduced gradually with the increase of gestational age and the constituent ratio of RDS at 39 w and at 40 w was significantly lower than that of 37 w and 38 w. By logistic regression analysis, the onset time of mechanical ventilation > 12 h independently predicted complications in RDS of term neonates (odds ratio 12.667, 95% confidence interval, i.e., CI 1.455 to 110.300, P = 0.021). Moreover, there was a significant difference in the admission age (t = 11.833, P = 0.001), severity of the radiological findings (t = 4.85, P = 0.028), PS application (t = 11.911, P = 0.002), the onset time of mechanical ventilation (t =10.051, P = 0.018), the ratio of PaO(2) to FIO(2) before mechanical ventilation (chi(2) = 4.184, P = 0.005), OI > 25 (t = 4.737, P = 0.03), duration of oxygen supplementation (chi(2) = 10.475, P = 0.001), systemic hypotension (t = 11.020, P = 0.01) and the length of hospital stay (t = 9.827, P = 0.002) between the two centers.

CONCLUSIONSevere RDS can occur in term babies after elective caesarean section, gestational age at the time of elective caesarean section may also be important for RDS in term neonates. The onset time of mechanical ventilation > 12 h independently predicted complications in RDS of term neonates. The main complications of RDS in term neonates were PPHN, pulmonary air leaks and systemic hypotension. Early diagnosis, early intervention can significantly reduce the complications, alleviate the severity and shorten their time for oxygen therapy and their length of stay in NICU in term RDS infants.

Cesarean Section ; Contraindications ; Elective Surgical Procedures ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Pregnancy ; Respiratory Distress Syndrome, Newborn ; diagnosis ; epidemiology ; Retrospective Studies ; Risk Factors ; Term Birth

PURPOSE: Ultrasonography is non-ionizing, easy to operate, and performed at bedside in neonatal intensive care unit (NICU). We investigated the incidence of respiratory distress syndrome (RDS) with or without using lung ultrasound (LUS) in late preterm infants with postnatal respiratory difficulties. METHODS: We retrospectively reviewed medical records of 494 late preterm infants born at 34–36 weeks' gestation at Keimyung University Dongsan Medical Center. Fifty infants with postnatal respiratory difficulties were admitted to the NICU between May 2015 to October 2015 (period I), and forty-one were between November 2015 to February 2016 (period II). The diagnosis of RDS was based on chest radiography in period I. LUS was additionally performed at bedside in period II. All infants with RDS were received exogenous surfactant therapy. RESULTS: The overall incidence of RDS with surfactant replacement therapy was decreased in period II period II (9.4%, 20/212) compared to period I (14.5%, 41/282) (P=0.088). In terms of infants with postnatal respiratory difficulties, the incidence of RDS in period II (48.8%, 20/41) was significantly lower than that in period I (82.0%, 41/50) (P=0.001). There are no difference in the rate of reintubation, repeated doses of surfactant, oxygen demand at 48 hours after birth, air leak syndrome, pulmonary hemorrhage, persistent pulmonary hypertension of newborn, and mortality (P> 0.05). CONCLUSION: We could decrease the incidence of RDS with surfactant replacement therapy by using LUS in late preterm infants with postnatal respiratory difficulties. Further prospective studies are needed to apply LUS clinically to diagnose RDS.
Diagnosis* ; Female ; Hemorrhage ; Humans ; Incidence* ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Lung* ; Medical Records ; Mortality ; Oxygen ; Parturition ; Persistent Fetal Circulation Syndrome ; Pregnancy ; Prospective Studies ; Radiography ; Respiratory Distress Syndrome, Newborn ; Retrospective Studies ; Thorax ; Ultrasonography*

Bacterial Infections ; diagnosis ; etiology ; therapy ; Brain Injuries ; etiology ; China ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Respiration, Artificial ; adverse effects ; Respiratory Distress Syndrome, Newborn ; diagnosis ; therapy ; Respiratory Insufficiency ; diagnosis ; therapy ; Respiratory Tract Infections ; diagnosis ; etiology ; therapy ; Systemic Inflammatory Response Syndrome ; diagnosis ; therapy ; Ventilators, Mechanical ; adverse effects