The objective of this study was to determine how the neonatal mortality rate has changed since surfactant (S) therapy was introduced in our Neonatal Intensive Care Unit (NICU), and to evaluate the efficacy of surfactant therapy in respiratory distress syndrome (RDS) patients. Incidences of risk babies such as outborns, prematurity, low birth weight infants and RDS, and neonatal mortality rates were compared between 'pre' (control, 1988 to 1991, n=4,861) and 'post' S period (study, 1993 to 1996, n=5,430). In RDS patients of 'post' S period, neonatal mortality rate was compared between S-treated and non-treated patients, and chest X-ray and ventilatory parameters were compared between pre- and post-72 hr of surfactant treatment. Surfactant therapy showed short term effects, judging by the decrease of early neonatal deaths and improvement of chest X-ray and ventilatory parameters in RDS patients. The overall neonatal mortality rate had a tendency to decrease in spite of increased incidences of risk babies in 'post' S period but it was less than expected. The reasons were thought to be that we had a high proportion of risk babies, and there was some bias in patient selection for surfactant therapy and its use. In conclusion, with the active prevention of risk baby delivery and appropriate use of surfactant, better results could be expected.
Female ; Human ; Incidence ; Infant Mortality ; Infant, Newborn ; Male ; Pulmonary Surfactants/therapeutic use* ; Respiratory Distress Syndrome/mortality* ; Respiratory Distress Syndrome/epidemiology ; Respiratory Distress Syndrome/drug therapy* ; Risk Factors

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

China ; Consensus ; Humans ; Infant, Newborn ; Infant, Premature ; Pulmonary Surfactants/therapeutic use* ; Respiratory Distress Syndrome, Newborn/drug therapy*

OBJECTIVE: To evaluate the efficacy and safety of less invasive surfactant administration (LISA) in the treatment of neonatal respiratory distress syndrome (NRDS). METHODS: PubMed, Cochrane Library, Embase, China Biology Medicine disc, China Scientific Journal Database, CNKI Database, and Wanfang Database were searched for randomized controlled trials (RCTs) on the use of LISA strategy in the treatment of NRDS. Literature screening and quality assessment were performed according to inclusion and exclusion criteria. Review Manager 5.3 software was used to perform the Meta analysis. RESULTS: A total of 9 RCTs were included, with a total of 1 212 children with NRDS. There were 611 children in the experimental group (treated with LISA strategy) and 601 children in the control group [treated with intubation-surfactant-extubation (INSURE) strategy]. The Meta analysis showed that the use of LISA strategy reduced the rate of mechanical ventilation within 72 hours after birth (OR=0.39, 95%CI: 0.29-0.51, P<0.001) and the incidence rates of bronchopulmonary dysplasia (OR=0.53, 95%CI: 0.38-0.72, P<0.001) and pneumothorax (OR=0.56, 95%CI: 0.33-0.93, P=0.02). There were no significant differences in the mortality rate and incidence rates of other neonatal diseases between the two groups (P>0.05). There was no significant difference in the rate of repeated use of pulmonary surfactant (PS) between the two groups (P>0.05), but there was a higher incidence rate of PS reflux observed by LISA strategy (OR=2.60, 95%CI: 1.64-4.12, P<0.001). CONCLUSIONS Compared with INSURE strategy, LISA strategy has advantages in reducing the need for mechanical ventilation and the incidence rates of bronchopulmonary dysplasia and pneumothorax in children with NRDS.
China ; Humans ; Infant, Newborn ; Infant, Premature ; Pulmonary Surfactants ; therapeutic use ; Respiratory Distress Syndrome, Newborn ; drug therapy ; Surface-Active Agents

OBJECTIVETo study the efficacy of different preparations of budesonide combined with pulmonary surfactant (PS) in improving blood gas levels and preventing bronchopulmonary dysplasia (BPD) in preterm infants with neonatal respiratory distress syndrome (NRDS).

METHODSA total of 184 preterm infants who developed NRDS within 4 hours after birth were randomly administered with PS + continuous inhalation of budesonide aerosol (continuous aerosol group), PS+budesonide solution (solution group), PS + single inhalation of budesonide aerosol (single aerosol group), and PS alone, with 46 neonates in each group. The changes in arterial blood gas levels, rate of invasive mechanical ventilation after treatment, time of assisted ventilation, rate of repeated use of PS, and the incidence of BPD were compared between the four groups.

RESULTSOn the 2nd to 4th day after treatment, pH, PCO2, and oxygenation index (FiO2/PaO2) showed significant differences among the four groups, and the continuous aerosol group showed the most improvements of all indicators, followed by the solution group, single aerosol group, and PS alone group. The continuous aerosol group had a significantly shorter time of assisted ventilation than the other three groups (P<0.05). The solution group had a significantly shorter time of assisted ventilation than the single aerosol and PS alone groups (P<0.05). The rate of invasive mechanical ventilation after treatment, rate of repeated use of PS, and incidence of BPD showed significant differences among the four groups (P<0.05), and the continuous aerosol group had the lowest rates, followed by the solution group.

CONCLUSIONSA combination of PS and continuous inhalation of budesonide aerosol has a better efficacy in the treatment of NRDS than a combination of PS and budesonide solution. The difference in reducing the incidence of BDP between the two administration methods awaits further investigation with a larger sample size.

Bronchopulmonary Dysplasia ; prevention & control ; Budesonide ; administration & dosage ; Drug Therapy, Combination ; Female ; Humans ; Infant, Newborn ; Male ; Pulmonary Surfactants ; administration & dosage ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn ; drug therapy

This study was performed to elucidate the mechanism of improved oxygenation after surfactant replacement therapy in respiratory distress syndrome (RDS) of the newborn infants. In 26 newborns with RDS, end tidal-CO2 tension (PetCO2), arterial blood gas analysis and pulmonary function tests were measured at baseline, 30 min, 2 hr and 6 hr after surfactant administration. The changes in dead space/tidal volume ratio (VD/VT ratio=(PaCO2-PetCO2)/PaCO2), oxygenation index and arterial-alveolar partial pressure difference for oxygen ((A-a)DO2) were elucidated and correlated with pulmonary mechanics. Oxygenation index and (A-a)DO2 improved, and VD/VT ratio decreased progressively after surfactant administration, becoming significantly different from the baseline at 30 min and thereafter with administration of surfactant. Pulmonary mechanics did not change significantly during the observation period. VD/VT ratio showed close correlation with OI and (A-a)DO2, but not with pulmonary mechanics. These results suggest that decreased physiologic dead space resulting from the recruitment of atelectatic alveoli rather than improvement in pulmonary mechanics is primarily responsible for the improved oxygenation after surfactant therapy in the RDS of newborn.
Airway Resistance ; Human ; Infant, Newborn ; Lung/physiopathology* ; Lung Compliance ; Pulmonary Gas Exchange ; Pulmonary Surfactants/therapeutic use* ; Respiratory Dead Space* ; Respiratory Distress Syndrome/physiopathology ; Respiratory Distress Syndrome/drug therapy* ; Tidal Volume*

OBJECTIVETo compare the clinical efficacy of imported pulmonary surfactant (PS) pig lung phospholipids injection (pig PS) and domestic cattle lung surface-active agent (cattle PS) for the treatment of neonatal respiratory distress syndrome (NRDS).

METHODSA total of 180 cases of grade IV NRDS receiving pig PS (n=90) or cattle PS treatment (n=90) were enrolled. The blood gas analysis and chest X-ray results and the incidence of complications after treatment, and hospitalization time and cost were compared between the two treatment groups.

RESULTSThe efficiency rate in the pig PS group (97%) was higher than in the catle PS group (83%) (P<0.01). The cure rate in the pig PS group was also higher than in the cattle PS group (84% vs 66%; P<0.01). The incidence of pneumothorax in the pig PS group was lower than in the cattle PS group (3% vs 7%; P<0.05). The hospitalization time in the pig PS group was shorter than in the cattle PS group (21 ± 4 days vs 23 ± 4 days; P<0.05). There were no significant differences in the total hospitalization cost between the two groups.

CONCLUSIONSPig PS seems to be superior to cattle PS in the treatment of grade IV NRDS.

Animals ; Blood Gas Analysis ; Cattle ; Female ; Hospitalization ; economics ; Humans ; Infant, Newborn ; Length of Stay ; Male ; Pulmonary Surfactants ; therapeutic use ; Respiratory Distress Syndrome, Newborn ; complications ; drug therapy ; Swine

OBJECTIVETo study the efficacy of pulmonary surfactants (PS) combined with continuous distending pressure (CDP) for treatment of respiratory distress syndrome (RDS) in very low birth weight (VLBW) infants.

METHODSNinety VLBW infants with RDS (weight <1500 g, gestational age <34 weeks) were randomly treated with a combination of PS and the Infant Flow Advance system which can provide CDP, PS alone or the Infant Flow Advance system alone (n=30 in each group). Clinical symptoms, signs, and blood gas changes were assessed 1, 6, 12 and 24 hrs after treatment. The treatment outcomes were compared between the three groups.

RESULTSClinical symptoms and signs, as well as the values of PaO2, PaCO2 and pH, in the three groups were improved 1, 6, 12 and 24 hrs after treatment. The combined use of PS with CDP produced a higher PaO2 and a lower PaCO2 compared with the PS or CDP use alone (P<0.01). The combination treatment group had shorter duration of oxygen therapy and shorter length of hospital stay than the PS or CDP use alone group.

CONCLUSIONSThe combined use of PS with CDP can effectively improve pulmonary oxygenation and ventilation and shorten the duration of oxygen therapy and the length of hospital stay in VLBW infants with RDS.

Continuous Positive Airway Pressure ; Female ; Humans ; Infant, Newborn ; Infant, Very Low Birth Weight ; Male ; Pulmonary Surfactants ; therapeutic use ; Respiratory Distress Syndrome, Newborn ; drug therapy

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

OBJECTIVERespiratory distress syndrome (RDS) is a major cause of morbidity and mortality in preterm neonates. Pulmonary surfactant deficiency is the primary cause of RDS. The purpose of this study was to determine the effect of surfactant therapy in reduction of the mortality rate in premature neonates with RDS and to assess the relationship between the efficacy of surfactant therapy and some risk factors associated with RDS.

METHODSThis study comprised 89 premature neonates with signs of RDS. The neonates were selected by simple sampling from those admitted to the Neonatal Intensive Care Unit (NICU) of Shaheed Beheshti Hospital. The eligible neonates received surfactant replacement-therapy (100 mg/kg) during 48 hours after birth.

RESULTSOverall, 34 (38.2%) out of 89 neonates who received surfactant survived. The higher efficacy of surfactant replacement therapy was observed in neonates with gestational age of more than 32 weeks (47.5%), in those who received the first dose of surfactant during the first 24 hours of life (43.3%), in those with an Apgar score of more than 7/10 at 1 and 5 min (48.1%), and in those with a birth weight of more than 1 500 g (52.5%). The neonates whose mother received steroid therapy before labor had higher reduction in mortality after surfactant therapy (41.7% with steroid vs 34.2% without steroid; p<0.05).

CONCLUSIONSSurfactant replacement therapy in neonatal RDS should be started as soon as possible after birth. It could reduce the mortality rate from RDS by 38.2%. The efficacy of surfactant therapy for neonatal RDS may be associated with gestational age, Apgar score, birth weight, starting time of surfactant therapy and maternal steroid therapy.

Apgar Score ; Birth Weight ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Pulmonary Surfactants ; therapeutic use ; Respiratory Distress Syndrome, Newborn ; drug therapy ; mortality