A prospective multicentre 12-month survey of neonatal respiratory disorders in 63 537 Italian infants was performed to evaluate the incidence of acute neonatal respiratory disorders and of the main related complications. A total of 1427 developed respiratory disorders (2.2%), 208 of whom died (14.6%). The incidence of respiratory distress syndrome was 1.16%, with a case fatality rate (CFR) of 24%; that of transient tachypnoea was 0.93%, with a CFR of 1.3%. The rates of meconium aspiration syndrome, persistent pulmonary hypertension and pneumonia were 0.06%, 0.02% and 0.07%, with CFRs of 10.3%, 38.5% and 21.7%, respectively. The occurrences of the main complications in affected newborns were: bronchopulmonary dysplasia 5.6%, necrotizing enterocolitis 1.7%, patent ductus arteriosus 9.8%, 3o and 4o grade intraventricular haemorrhage 6.8% and air leak 4.9%. It was concluded that the incidence of acute neonatal respiratory disorders and the main related complications was lower than that reported two decades ago and that the CFR of acute neonatal respiratory disorders had increased. These results may be the consequences of (i) progress in the management of high-risk pregnancies, (ii) an increased number of viable infants with extremely low birth weight and (iii) diffusion of antenatal treatment with corticosteroids which, in this series, seemed to reduce the morbidity but not the mortality in the high-risk infants.

Acute neonatal respiratory distress in Italy: a one‐year prospective study

The safety and efficacy of nitric oxide therapy in premature infants

Objective. To assess incidence and clinical risk factors of chronic oxygen dependency (COD) among survivors who were born at or before 31 weeks9 gestation. Methods. This prospective, multicenter study enrolled 802 infants who were born at or before 31 weeks9 gestation and admitted to 8 level III neonatal intensive care units in northern and eastern France from January 1 through December 31, 1997. Need for oxygen to maintain oxygen saturation between 92% and 96% was assessed at 28 days of life and at 36 and 42 weeks9 postconceptional age (PCA). Stepwise logistic regression analysis was used to identify the incidence of COD and the risk factors related to its occurrence. Results. The mortality rate was 14%. Antenatal corticotherapy was administered to 51% of patients, surfactant therapy to 76% of the ventilated patients, and high-frequency oscillatory ventilation at day 1 to 32%. At 28 days and 36 and 42 weeks9 PCA, respectively, 25%, 15%, and 6% of survivors had COD. After adjustment for intercenter variations, we identified the significant risk factors for COD at these dates: a low gestational age, a high score on the Clinical Risk Index for Infants, intrauterine growth restriction, and surfactant treatment. Conclusion. COD incidence was high at 28 days of life but decreased dramatically by 42 weeks9 PCA. This study confirmed previously reported risk factors and underlined the importance of intrauterine growth restriction and the Clinical Risk Index for Infants as significant risk factors.

https://pediatrics.aappublications.org/content/pediatrics/108/2/e26.full.pdf

Chronic Oxygen Dependency in Infants Born at Less Than 32 Weeks' Gestation: Incidence and Risk Factors

Respiratory distress is one of the most common causes of admission in NICU. The aim of this work was to study the commonest causes of respiratory distress in NICU, analysis of each cause, and to deter-mine the strategic plan needed to improve the outcome of these cases.Patients and Methods: A prospective study was conducted through the period from January 2003 to October 2004. Data were collected from all patients admitted in the unit during this period.Results: Total number of, 855(17.27%) newborn were admitted to NICU, 140 of them developed respiratory distress comprising 16.37% of all NICU admissions and with an incidence of 2.83%. The commonest causes of respiratory distress in our study were transient tachypnea of newborn (TTN) 57 (40.7%) respiratory distress syndrome (RDS) 24 cases (17.2%), birth asphyxia 16 cases (11.4%) and Meconium aspiration syndrome (MAS) 13 cases (9.3%). Cesarean section was the most common predisposing factor associated with the development of TTN and RDS (the most 2 common causes of respiratory distress in our study). The overall mortality rate of cases of respiratory distress in our study was 22.86%.Conclusion -the study confirmed the importance of NRD with a frequency rate of 2.83%, morbidity of 5% and mortality of 22.86% of cases. The causes, risk factors and immediate outcome were determined and discussed. Some recommendations were suggested in order to reduce its frequency, morbidity and mortality

Neonatal respiratory distress in early neonatal period and its outcome

Resume La pression positive continue (PPC) neonatale ⪡ prophylactique ⪢, en prevention du syndrome de detresse respiratoire, est utilisee depuis plusieurs annees. Ce travail represente le bilan de son emploi depuis fevrier 1994 a Marseille. Population et methodes. — Une PPC est appliquee dans les premieres minutes de vic chez les prematures a risque de syndrome de detresse respiratoire nes dans les maternites publiques de Marseille. Les indications d'intubation sont, en salle de travail: l'aggravation des signes cliniques avec augmentation des besoins en oxygene (FIO 2 >a 60 %), la survenue d'apnees et/ou d'une hypercapnie superieure a 60 mmHg. Resultats. — Cent cinquante et un prematures nes vivants entre 25 et 32 semaines otte ete pris en charge a transferes dans le service de neonatologie. L'âge gestationnel moyen etait de 29.6 ± 1,9 SA, le poids de 1 326 ± 378 g. Soixante-trois pour cent ont beneficie d'une pression positive continue a la naissance, 13 % ont duetre intubes en salle de naissance et 42 % ont necessite une ventilation artificielle. Dix-sept pour cent ont recu du surfactant a titre curatif: deux enfants ont beneficie d'une instillation suivie d'extubation immediate. La mortalite a ete de 10 %, la pathologie respiratoire etant directement responsable de trois deces. Conclusions . — L'emploi d'une PPC neonatale diminue les indications de ventilation artificielle chez le premature de 32 semaines d'âge gestationnel et moins. Pour les enfants necessitant secondairement une ventilation, le delai liea la PPC n'a pas d'effets defavorables immediats, ou a plus long terme, comme en temoignent les durees de ventilation artificielle courtes et le faible ponrcentage de dysplasies bronchopulmonaires.

Pression positive continue précoce en salle de travail

BACKGROUND Data concerning neonates with acute respiratory distress syndrome (RDS) are still scarce. The characteristics and follow-up of a French cohort which has participated in an international trial concerning the efficacy of artificial surfactant have been studied. POPULATION AND METHODS One thousand one hundred and fifty-seven neonates admitted from October 1990 to December 1991 in 27 French intensive care units because of RDS due to hyaline membrane disease were included in the study, whatever their birthweight and gestational age (GA). RESULTS Three hundred and sixteen neonates (27.3%) were born from twin or multiple pregnancies. Fourty-five (5.5%) of the mothers had been given corticosteroids for the week preceding delivery. 55.5% were delivered by cesarean section. Mean GA was 31.0 +/- 2.9 weeks and mean birth-weight was 1,603 +/- 625 g. Two hundred and sixty-six neonates (23%) were small for GA. Two hundred and twenty-three died after a mean survival of 4.2 days (63% before the end of the first week and 80% before the end of the third week). Fifty percent of these deaths were due to respiratory distress, 28% to severe brain disorders and 9% to infections. The bronchopulmonary dysplasia rate was 21.7%. Early ultrasound scan of the brain showed major injuries in 19.5% of cases; the second scan performed in 822 infants was normal in 84.3%. CONCLUSIONS Taking into account GA, mortality and morbidity rates were similar to those of the other non-French participating centres.

[Short and mid-term outcome of a cohort of 1157 newborn infants with respiratory distress syndrome].

Resume L'efficacite du surfactant artificiel chez les nouveau-nes atteints de detresse respiratoire aigue est maintenant bien demontree, mais les modalites optimales de son administration sont encore discutees. Population et methodes. —Les parametres gazometriques et le rapport alveoloarteriel (a/A) en oxygene ont ete etudies au cours des 24 premieres heures suivant l'administration d'Exosurf ® chez 400 nouveau-nes âges de 25 et 42 semaines d'amenorrhee. Resultats. —Apres la premiere dose, une reponse positive a l'administration de surfactant (obtention d'un rapport a/A superieur a 0,22 ou augmentation d'au moins 25 du rapport a/A) a ete obtenue dans 64 % des cas dans les 6 premieres heures et dans 11 % des cas entre 6 et 12 heures. Une reponse positive a la deuxieme dose a ete observee dans 75 % des cas. A la 24 e heure, 63 % des enfants ont atteint un rapport a/A superieur a 0,22. Conclusion. —L'existence de 18 % d'enfants ne repondant qu'a la deuxieme dose justifie l'usage de celle-ci meme en l'absence de reponse a la dose initiale. La qualite de la reponse au traitement est correlee a la severite de l'atteinte pulmonaire mais reste independante de l'âge gestationnel.

Évolution des paramètres gazométriques sur les 24 premières heures suivant l'administration d'Exosurf®

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[Short and mid-term outcome of a cohort of 1157 newborn infants with respiratory distress syndrome].

Évolution des paramètres gazométriques sur les 24 premières heures suivant l'administration d'Exosurf®