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Surfactant in preterm babies

J Johansson, T Curstedt
Treatment of neonatal respiratory distress syndrome (RDS) using animal-derived lung surfactant preparations has reduced the mortality of handling premature infants with RDS to a 50th of that in the 1960s. The supply of animal-derived lung surfactants is limited and only a part of the preterm babies is treated. Thus, there is a need to develop well-defined synthetic replicas based on key components of natural surfactant. A synthetic product that equals natural-derived surfactants would enable cost-efficient production and could also facilitate the development of the treatments of other lung diseases than neonatal RDS...
October 24, 2018: Journal of Internal Medicine
Clara Cipowicz, Manuel Schmid, Helmut Hummler, Ulrich Thome
BACKGROUND: In a project to carefully observe and minimize risk factors of intraventricular hemorrhages (IVH) in preterm infants, the incidence decreased markedly at the perinatal Center in Ulm, Germany. By comparing its data with the perinatal center in Leipzig, Germany, we sought to identify what improvements could still be made. METHODS: A retrospective survey was performed, including 189 infants from Leipzig and 89 from Ulm, all of whom weighed less than 1000 grams...
December 2018: Zeitschrift Für Geburtshilfe und Neonatologie
Ikechukwu Richard Okonkwo, Angela A Okolo
BACKGROUND: Surfactant replacement therapy (SRT) is the standard of care in developed countries. Poor access to surfactant limits its use in low resource settings. The extent of its use and the effect of its regular use on the preterm in such settings is unknown. OBJECTIVE: This study assessed the extent of exogenous surfactant utilization in Nigerian tertiary care facilities and the benefits of its regular use to the preterm population. METHODS: A two-phase cross-sectional study design evaluated the response from a respondent administered structured questionnaire addressed to health care providers from 54 centers and a targeted assessment of the outcome of the regular use of exogenous surfactant in a tertiary care facility from January 2014 to December 2016...
September 25, 2018: Journal of Maternal-fetal & Neonatal Medicine
Valentina Dell'Orto, Nadege Bourgeois-Nicolaos, Caroline Rouard, Olivier Romain, Shivani Shankar-Aguilera, Florence Doucet-Populaire, Daniele De Luca
OBJECTIVES: To establish the reference values, diagnostic accuracy, and effect of various factors on cell count in intubated preterm neonates subjected to nonbronchoscopic bronchoalveolar lavage. STUDY DESIGN: This prospective, cross-sectional, blinded study included preterm neonates ventilated for any reason who underwent nonbronchoscopic bronchoalveolar lavage if they had not previously received postnatal antibiotics or steroids. Lavage was performed before surfactant replacement, if any...
September 2018: Journal of Pediatrics
Anna K Knight, Alicia K Smith, Karen N Conneely, Philippa Dalach, Yuk J Loke, Jeanie L Cheong, Peter G Davis, Jeffrey M Craig, Lex W Doyle, Christiane Theda
OBJECTIVE: To assess associations between epigenetic maturity of extremely preterm babies (born at less than 28 weeks of gestation), neonatal interventions, and respiratory outcomes, including the administration of surfactant and postnatal corticosteroids, duration of assisted ventilation, and development of bronchopulmonary dysplasia (BPD). STUDY DESIGN: DNA was extracted from neonatal blood spots collected after birth from 143 extremely preterm infants born 1991-1992 in Victoria, Australia and used to determined DNA methylation (DNAm)...
July 2018: Journal of Pediatrics
M A Mannan, M A Hossain, J Nasim, Y Sabina, F Navila, D Subir
Since its inception, the neonatal mechanical ventilator has been considered an essential tool for managing preterm neonates with Respiratory Distress Syndrome (RDS) and is still regarded as an integral component in the neonatal respiratory care continuum. Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. This clinical intervention study was done to analyze immediate outcome of preterm neonates with RDS required mechanical ventilation and conducted on preterm neonates with RDS required mechanical ventilation from July 2014 to June 2015...
January 2018: Mymensingh Medical Journal: MMJ
David G Sweet, Mark A Turner, Zbyněk Straňák, Richard Plavka, Paul Clarke, Ben J Stenson, Dominique Singer, Rangmar Goelz, Laura Fabbri, Guido Varoli, Annalisa Piccinno, Debora Santoro, Christian P Speer
OBJECTIVE: CHF5633 (Chiesi Farmaceutici S.p.A., Parma, Italy) is the first fully synthetic surfactant enriched by peptide analogues of two human surfactant proteins. We planned to assess safety and tolerability of CHF5633 and explore preliminary efficacy. DESIGN: Multicentre cohort study. PATIENTS: Forty infants from 27+0 to 33+6 weeks gestation with respiratory distress syndrome requiring fraction of inspired oxygen (FiO2 ) ≥0.35 were treated with a single dose of CHF5633 within 48 hours after birth...
November 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
E V Cope, N Sultana, E A Masson, B J Allen, A Oboh, L Wilkinson, C Wood, S W Lindow
OBJECTIVE: Women with diabetes may need elective preterm delivery due to pregnancy or diabetes related complications. The aim of this study was to describe the neonatal outcomes arising from elective preterm delivery in diabetic women. METHOD: Suitable patients were identified by the obstetric team at Hull Royal Infirmary Women and Children's Hospital and data was extracted from their case notes. 45 diabetic women with planned preterm delivery were identified within a set time frame, resulting in 48 babies...
2017: Journal of Neonatal-perinatal Medicine
Hongmei Huang, Po-Yin Cheung, Megan O'Reilly, Sylvia van Os, Anne Lee Solevåg, Khalid Aziz, Georg M Schmölzer
BACKGROUND: Early studies suggest an association of abnormal carbon dioxide (PCO2) or oxygen (PO2) levels with adverse inpatient outcomes in very preterm babies. Recent resuscitation practice changes, such as targeted oxygen therapy, end-expiratory pressure, and rescue surfactant may influence these associations. OBJECTIVE: The aim of this study is to assess the range of the initial partial pressures of PCO2 and PO2 in preterm neonates <33 weeks gestational age after birth and their correlation to inpatient neonatal outcomes...
2017: Frontiers in Pediatrics
Rikke Wiingreen, Gorm Greisen, Finn Ebbesen, Jesper Padkær Petersen, Gitte Zachariassen, Tine Brink Henriksen, Bo Mølholm Hansen
BACKGROUND: In recent years, early nasal continuous positive airway pressure (nCPAP) as respiratory support for preterm infants is being advocated as an alternative to prophylactic surfactant and treatment with mechanical ventilation. A number of infants treated with early nCPAP do not need treatment with surfactant, but few studies provide data on this. Since the 1990s, the first approach to respiratory support to preterm infants in Denmark has been early nCPAP combined with surfactant administration by the INSURE method by which the infant is intubated and surfactant administration is followed by rapid extubation to nCPAP if possible...
2017: Neonatology
A Elmekkawi, D Abdelgadir, J Van Dyk, J Choudhury, M Dunn
OBJECTIVES: A new guideline for the early respiratory management of preterm infants that included early nCPAP and INSURE was recently introduced in our NICU. This case series describes the clinical courses of a group of preterm infants managed according to this guideline, and reports the rates of successful extubation within 30 minutes of surfactant administration with and without the use of naloxone and adverse events encountered. STUDY DESIGN: Descriptive case series of all preterm babies admitted to our unit who were candidates for INSURE procedure with premedication from August 2012 to August 2013...
2016: Journal of Neonatal-perinatal Medicine
David G Sweet, Virgilio Carnielli, Gorm Greisen, Mikko Hallman, Eren Ozek, Richard Plavka, Ola Didrik Saugstad, Umberto Simeoni, Christian P Speer, Máximo Vento, Gerard H A Visser, Henry L Halliday
Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe...
2017: Neonatology
Kishwar Azad, Jiji Mathews
Preterm births (PTBs), defined as births before 37 weeks of gestation account for the majority of deaths in the newborn period. Prediction and prevention of PTB is challenging. A history of preterm labour or second trimester losses and accurate measurement of cervical length help to identify women who would benefit from progesterone and cerclage. Fibronectin estimation in the cervicovaginal secretions of a symptomatic woman with an undilated cervix can predict PTB within 10 days of testing. Antibiotics should be given to women with preterm prelabour rupture of membranes but tocolysis has a limited role in the management of preterm labour...
October 2016: Best Practice & Research. Clinical Obstetrics & Gynaecology
Daljit Singh, K S Rana, Sheila Mathai
BACKGROUND: Respiratory distress syndrome (RDS) in preterm neonates is caused by a deficiency or dysfunction of pulmonary surfactant. The physiological function of surfactant includes the ability to lower surface tension, as well as the ability to rapidly adsorb and spread. A wide variety of surfactant products have been formulated and studied in clinical trials. The present study was designed to find out whether prophylactic administration of surfactant leads to a significant decrease in the risk of neonatal mortality and neonatal morbidity...
April 2011: Medical Journal, Armed Forces India
Prema Subramaniam, Jacqueline J Ho, Peter G Davis
BACKGROUND: Cohort studies have suggested that nasal continuous positive airways pressure (CPAP) starting in the immediate postnatal period before the onset of respiratory disease (prophylactic CPAP) may be beneficial in reducing the need for intubation and intermittent positive pressure ventilation (IPPV) and in preventing bronchopulmonary dysplasia (BPD) in preterm or low birth weight infants. OBJECTIVES: To determine if prophylactic nasal CPAP started soon after birth regardless of respiratory status in the very preterm or very low birth weight infant reduces the use of IPPV and the incidence of bronchopulmonary dysplasia (BPD) without adverse effects...
June 14, 2016: Cochrane Database of Systematic Reviews
N Yousef
Lung ultrasound (LU) is becoming a bedside point-of-care technique in critical care and emergency medicine as it is performed and immediately interpreted by the clinician. LU is quick, easy, relatively inexpensive, and provides accurate diagnostic information when compared with conventional lung imaging methods, such as CT scans and chest radiographs, with the additional advantage of being non-irradiating, adapted to bedside use, and easily repeatable with no side effects for the patient. LU is easy to learn, does not require sophisticated ultrasound machines or settings, and shows low intra- and interobserver variability when a standardized approach is used...
March 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Fiammetta Piersigilli, Donatella Peca, Francesca Campi, Mirta Corsello, Francesca Landolfo, Renata Boldrini, Olivier Danhaive, Andrea Dotta
Respiratory distress syndrome (RDS) may occur in term and near-term infants because of mutations in surfactant-related genes. ATP-binding cassette A3 (ABCA3), a phospholipid carrier specifically expressed in the alveolar epithelium, is the most frequently involved protein. We report the case of a couple of late-preterm fraternal twin infants of opposite sex carrying the same compound heterozygous ABCA3 mutations, one of which has never been previously reported, with different disease severity, suggesting variable penetrance or sex-related differences...
October 2015: Pediatrics International: Official Journal of the Japan Pediatric Society
Sachiyo Yoshida, José Martines, Joy E Lawn, Stephen Wall, Joăo Paulo Souza, Igor Rudan, Simon Cousens, Peter Aaby, Ishag Adam, Ramesh Kant Adhikari, Namasivayam Ambalavanan, Shams Ei Arifeen, Dhana Raj Aryal, Sk Asiruddin, Abdullah Baqui, Aluisio Jd Barros, Christine S Benn, Vineet Bhandari, Shinjini Bhatnagar, Sohinee Bhattacharya, Zulfiqar A Bhutta, Robert E Black, Hannah Blencowe, Carl Bose, Justin Brown, Christoph Bührer, Wally Carlo, Jose Guilherme Cecatti, Po-Yin Cheung, Robert Clark, Tim Colbourn, Agustin Conde-Agudelo, Erica Corbett, Andrew E Czeizel, Abhik Das, Louise Tina Day, Carolyn Deal, Ashok Deorari, Uğur Dilmen, Mike English, Cyril Engmann, Fabian Esamai, Caroline Fall, Donna M Ferriero, Peter Gisore, Tabish Hazir, Rosemary D Higgins, Caroline Se Homer, D E Hoque, Lorentz Irgens, M T Islam, Joseph de Graft-Johnson, Martias Alice Joshua, William Keenan, Soofia Khatoon, Helle Kieler, Michael S Kramer, Eve M Lackritz, Tina Lavender, Laurensia Lawintono, Richard Luhanga, David Marsh, Douglas McMillan, Patrick J McNamara, Ben Willem J Mol, Elizabeth Molyneux, G K Mukasa, Miriam Mutabazi, Luis Carlos Nacul, Margaret Nakakeeto, Indira Narayanan, Bolajoko Olusanya, David Osrin, Vinod Paul, Christian Poets, Uma M Reddy, Mathuram Santosham, Rubayet Sayed, Natalia E Schlabritz-Loutsevitch, Nalini Singhal, Mary Alice Smith, Peter G Smith, Sajid Soofi, Catherine Y Spong, Shahin Sultana, Antoinette Tshefu, Frank van Bel, Lauren Vestewig Gray, Peter Waiswa, Wei Wang, Sarah LA Williams, Linda Wright, Anita Zaidi, Yanfeng Zhang, Nanbert Zhong, Isabel Zuniga, Rajiv Bahl
BACKGROUND: In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development...
June 2016: Journal of Global Health
Roselyne Brat, Nadya Yousef, Roman Klifa, Stephanie Reynaud, Shivani Shankar Aguilera, Daniele De Luca
IMPORTANCE: Lung ultrasonography (LUS) is a bedside technique useful to diagnose neonatal respiratory problems, but, to our knowledge, no data are available about its use for monitoring lung function or eventually guiding surfactant therapy. OBJECTIVE: To determine the diagnostic accuracy of a neonatal-adapted LUS score to evaluate oxygenation and predict need for surfactant administration. DESIGN, SETTING, AND PARTICIPANTS: Prospective diagnostic accuracy study following STARD (Standards for the Reporting of Diagnostic Accuracy Studies) guidelines at a tertiary level academic neonatal intensive care unit in 2014...
August 2015: JAMA Pediatrics
Jacqueline J Ho, Prema Subramaniam, Peter G Davis
BACKGROUND: Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant is the standard treatment for the condition, but it is invasive, potentially resulting in airway and lung injury. Continuous distending pressure (CDP) has been used for the prevention and treatment of RDS, as well as for the prevention of apnoea, and in weaning from IPPV...
2015: Cochrane Database of Systematic Reviews
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