The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study.

BACKGROUND: Hyaline membrane disease (HMD) is a leading cause of morbidity and mortality in preterm newborn babies. Though, there are studies related to Hyaline membrane disease inclusive of all neonates, studies related to the burden among preterm neonates were limited. In addition, increasing neonatal mortality in Ethiopia could be related to increase in the burden of hyaline membrane disease among preterm neonates. Therefore, this study was aimed to assess the burden of hyaline membrane disease, mortality and its associated factors among preterm neonate admitted at neonatal intensive care unit, North Central Ethiopia. METHODOLOGY: An institution-based retrospective follow-up study was conducted among 535 preterm neonates admitted at neonatal intensive care unit from January 1, 2014-December 30, 2017. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for statistical analysis. Binary logistic regression was used for the analysis. All variables with P-value < 0.25 during bi-variable analysis were considered for multivariable logistic regression. Level of statistical significance was declared at P value ≤0.05. RESULTS: In the current study, proportion of hyaline membrane disease was 40% (95% CI; 35.8, 44.3) of which 49.5% died. Preterm neonate born with Gestational age of less than 34 weeks of age (Adjusted odd ratio (AOR = 2.64; 95 CI: 1.49, 4.66)), 5th minute Apgar score less than 7 (AOR = 2.2; 95% CI: 1.20, 4.07), and newborn with birth weight of less than 1500 gram (AOR = 2.4, 95% CI: 1.3, 4.3) were predictors of hyaline membrane disease. CONCLUSIONS: The mean gestational age (±) was 33.46 (±2.55) weeks. The incidence of hyaline membrane disease among preterm admissions was high. Preterm neonate born with gestational age of less than 34 weeks of age, asphyxiated newborns and newborn with birth weight of less than 1500 gram were predictors of hyaline membrane disease. So, emphasis should be given on early screening, follow up and timely interventions for preterm neonate.

Predictors of Neonatal mortality in Neonatal intensive care unit at referral Hospital in Southern Ethiopia: a retrospective cohort study.

BACKGROUND: The first one month of life; the neonatal period is the most risky time for child survival. In Ethiopia, neonatal mortality is unacceptably high, and the trend in reduction is slower as compared to infant and child mortality. The magnitude and associated factors of neonatal mortality in a tertiary care facility were not well documented. Therefore, the aim of this study was to determine neonatal mortality and predictors among neonates admitted to neonatal intensive care unit of Wolaita Sodo University Teaching and Referral Hospital, South Ethiopia. METHODS: A retrospective cohort study design was done among neonates admitted to neonatal intensive care unit of a University Teaching and Referral Hospital from 2015 to 2017. Data were collected using data extraction checklist from the medical registry. The main outcome was the occurrence of death within the first four weeks. The survival time was calculated in days between the date of admission and the date of death. Kaplan-Meier survival was used to depict the pattern of death in 28 days and Cox-Proportional model was used to identify the predictors of the neonatal mortality. RESULTS: A total of 964 neonates which contributed to 5889 neonates-days were included in the study. There were 159 neonatal deaths during the follow-up time. Overall, the neonatal mortality incidence was 27 per 1000 neonates-days. Predictors of neonatal mortality were: multiple birth, mothers who did not attend antenatal care visits, neonates born by cesarean section, not initiated breast feeding within 1 h of birth, neonates resuscitated, hyaline membrane disease and perinatal asphyxia. CONCLUSION: Neonatal mortality at neonatal intensive care unit was high. Managing neonatal complications, initiating breast feeding within 1 h of birth, promoting antenatal care visits, improving quality of services and ensuring continuum of care are recommended to increase survival of neonates.

Survival and predictors among preterm neonates admitted at University of Gondar comprehensive specialized hospital neonatal intensive care unit, Northwest Ethiopia.

BACKGROUND: Prematurity accounts about 1 million neonatal deaths worldwide and the second causes of both neonatal and under five-child mortality. Neonatal mortality accounts for 43% of under-five child mortality in Ethiopia. From this preterm is the second leading cause of death and is steadily increased in low-income countries. Therefore, the aim of this study was to assess time to death and predictors among preterm neonates admitted in University of Gondar comprehensive specialized hospital neonatal intensive care unit North West Ethiopia 2018. METHODS: Institution-based retrospective follow-up study was conducted among 516 preterm neonates from January 2016 to March 2018. Data were extracted retrospectively from patients' records using a pretested structured checklist. Descriptive summary statistics like median survival time, Kaplan Meier failure estimation curve and Log-rank test were computed. Bivariate and multivariable Gompertz parametric hazards models were fitted to identify the predictors of mortality. Hazard ratio with a 95% confidence interval was calculated and p-values < 0.05 were considered statistically significant. RESULTS: The proportion of preterm neonatal death in this study was 28.8% (95%CI (25.1, 32.9)). Home delivery (AHR = 2.25, 95% CI (1.03, 4.88)), hyaline membrane disease (AHR =3.21, 95% CI (1.96, 5.25)), gestational age, (AHR = 0.82, 95% CI (0.74, 0.91)), cry immediately at birth (AHR = 1.74, 95% CI (1.19, 2.53)), kangaroo mother care (AHR = 0.24, 95%CI (0.11, 0.52)), presence of jaundice (AHR = 1.62, 95%CI (1.12, 2.54)) and hypoglycemia at admission (AHR = 1.75, 95%CI (1.21, 2.54)) were found to be significant predictors of time to death for preterm neonates. CONCLUSION: Proportion of preterm neonatal death in this study was high. Home delivery, Jaundice, hypoglycemia, gestational age, cry immediately at birth, kangaroo mother care and hyaline membrane disease were significant predictors of time to death.

Morbilidad y mortalidad por enfermedad de la membrana hialina en el Hospital General Docente Dr Agostinho Neto, Guantánamo 2016-2018 / Morbidade e mortalidade por doença da membrana hialina no Hospital Geral Dr Agostinho Neto, Guantánamo 2016-2018 / Morbidity and mortality due to hyaline membrane disease at the Dr Agostinho Neto General Teaching Hospital, Guantanamo 2016-2018

Introducción: la enfermedad de la membrana hialina es un problema de salud en la etapa neonatal. Objetivo: caracterizar a los recién nacidos ingresados en la unidad de cuidados intensivos neonatales del Hospital General Docente Dr Agostinho Neto por enfermedad de la membrana hialina durante los años 2016-2018. Método: se hizo un estudio observacional, descriptivo, prospectivo y longitudinal de 163 recién nacidos que ingresaron en la unidad. Resultados: el 16,4 por ciento de los neonatos ingresados en dicha unidad tenía esta enfermedad y la letalidad fue de 11,0 por ciento. La mayor proporción de éstos eran varones (55,8 por ciento), tenían entre 31,0 y 33,6 semanas de edad gestacional al nacer (28,2 por ciento), pesaron entre 1500,9 y 1999,9 g (27,0 por ciento), tuvieron un Apgar a los 5 minutos de nacidos entre 8 y 10 puntos (58,9 por ciento) y estuvieron en la unidad de 7 a 14 días (40,4 por ciento). El 93,3 por ciento se trató con fármacos inductores de maduración pulmonar y 100,0 por ciento con surfactante y ventilación mecánica convencional (100,0 por ciento). El 84,7 por ciento presentó complicaciones y el 55,6 por ciento falleció por hemorragia intracraneal (55,6 por ciento). Fue común que las madres tuvieran edad entre 19 y 35 años (76,6 por ciento), fueran cesareadas (65,0 por ciento) y presentaron complicaciones relacionadas con el embarazo (82,2 por ciento). Conclusión: la letalidad fue superior en la medida que disminuye la edad gestacional y el peso al nacer, en los que no fueron tratados con fármacos inductores de maduración pulmonar y que presentaron meningoencefalitis(AU)

Introduction: hyaline membrane disease is a health problem in the neonatal stage. Objective: to characterize the newborns admitted to the neonatal intensive care unit of the General Teaching Hospital Dr Agostinho Neto " due to hyaline membrane disease during the years 2016-2018. Method: an observational, descriptive, prospective and longitudinal study of 163 newborns who entered the unit was made. Results: 16.4per cent of the infants admitted to this unit had this disease and the lethality was 11.0per cent. The largest proportion of these were male (55.8per cent), were between 31.0 and 33.6 weeks of gestational age at birth (28.2per cent), weighed between 1500.9 and 1999.9 g (27.0 per cent), had an Apgar after 5 minutes of birth between 8 and 10 points (58.9per cent) and were in the unit for 7 to 14 days (40.4per cent). 93.3per cent were treated with pulmonary maturation inducing drugs and 100.0per cent with surfactant and conventional mechanical ventilation (100.0per cent). 84.7per cent presented complications and 55.6per cent died from intracranial hemorrhage (55.6per cent). It was common for mothers to be between 19 and 35 years old (76.6per cent), to be ceased (65.0per cent) and had pregnancy-related complications (82.2per cent). Conclusion: lethality was higher as the gestational age and birth weight decreased, in those who were not treated with pulmonary maturation inducing drugs and who presented meningoencephalitis(AU)

Introdução: a doença da membrana hialina é um problema de saúde no estágio neonatal. Objetivo: caracterizar os recém-nascidos internados na unidade de terapia intensiva neonatal do Hospital Geral de Ensino Dr Agostinho Neto por doença da membrana hialina durante os anos de 2016 a 2018. Método: estudo observacional, descritivo, prospectivo e longitudinal de 163 recém-nascidos que ingressaram na unidade. Resultados: 16,4 por cento dos lactentes internados nessa unidade apresentavam essa doença e a letalidade era de 11,0 por cento. A maior proporção deles era do sexo masculino (55,8 por cento), tinha entre 31,0 e 33,6 semanas de idade gestacional ao nascer (28,2 por cento), pesava entre 1500,9 e 1999,9 g (27,0 por cento), apresentou Apgar após 5 minutos de nascimento entre 8 e 10 pontos (58,9 por cento) e permaneceu na unidade por 7 a 14 dias (40,4 por cento). 93,3 por cento foram tratados com fármacos indutores de maturação pulmonar e 100,0 por cento com surfactante e ventilação mecânica convencional (100,0 por cento). 84,7 por cento apresentaram complicações e 55,6 por cento morreram de hemorragia intracraniana (55,6 por cento). Era comum as mães ter entre 19 e 35 anos (76,6 por cento), cessar (65,0 por cento) e apresentar complicações relacionadas à gravidez (82,2 por cento). Conclusão: a letalidade foi maior com a diminuição da idade gestacional e do peso ao nascer naqueles que não foram tratados com fármacos indutores da maturação pulmonar e que apresentaram meningoencefalite(AU)

Hyaline membrane disease (HMD): an historical and Oslerian perspective.

Hyaline membrane disease (HMD) offers an illustration of a disease discovered during the lifetime of William Osler and effectively treated in the twentieth century-the perspective that suggests that there was a straightforward progressive identification of the disease process, a discovery of the underlying biochemical agent responsible for the pathophysiology, and the pharmacological refinement of that agent to be used to treat the disease is illusory. By reviewing the timeline from the earliest pathological description of what was to be later termed HMD to the discovery of surfactant and its impact on infant mortality, this narrative will demonstrate how various random historical events served to affect the progress of developing a treatment for HMD; how the marked reduction in deaths due to HMD may have set the stage for unrealistic expectations; and how the humanities have warned us of the potential for excessive optimism in our understanding of nature.

Neonatal respiratory distress in a reference neonatal unit in Cameroon: an analysis of prevalence, predictors, etiologies and outcomes.

INTRODUCTION: Neonatal respiratory distress (NRD) is a main cause of neonatal morbidity and mortality in developing countries. Early detection of its risk factors and early treatment of its etiologies are major challenges. However, few studies in developing countries have provided data needed to tackle it. We aimed to determine the prevalence, predictors, etiologies and outcome of NRD in a tertiary health care centre of Cameroon. METHODS: We analyzed the hospital files of all newborns admitted to the Neonatal unit of Douala General Hospital from 1(st) January 2011 to 28(th) February 2013. NRD was diagnosed based on the presence of one or more of the following signs: an abnormal respiratory rate, expiratory grunting, nasal flaring, chest wall recessions and thoraco-abdominal asynchrony with or without cyanosis, in their files. Socio-demographic and clinical variables of newborns and their mothers were analyzed using logistic regression analysis. RESULTS: The prevalence of NRD was 47.5% out of the 703 newborns studied. Acute fetal distress, elective caesarean delivery, APGAR score < 7 at the 1(st) minute, prematurity, male gender and macrosomia were independent predictors of NRD. The main etiologies were neonatal infections (31%) and transient tachypnea of the newborn (25%). Its neonatal mortality rate was 24.5%, mainly associated with neonatal sepsis and hyaline membrane disease. CONCLUSION: NRD is a frequent emergency and causes high morbidity and mortality. Most of its risk factors and etiologies are preventable. Adequate follow-up of pregnancy and labor for timely intervention may improve the neonatal outcomes.

[Nasal CPAP versus mechanical ventilation in 28 to 32-week preterm infants with early surfactant administration]. / Presión positiva continua en la vía aérea comparada con la respiración mecánica asistida en prematuros de 28 a 32 semanas de gestación con administración precoz de surfactante pulmonar.

INTRODUCTION: Continuous positive airway pressure (CPAP) is useful in low birth weight infants with respiratory distress, but it is not known if it is a better alternative to mechanical ventilation after early pulmonary surfactant administration. OBJECTIVE: To compare the incidence of adverse events in 28 to 32-week newborns with respiratory distress managed with mechanical ventilation or CPAP after early surfactant administration. MATERIALS AND METHODS: In total, 176 newborns were treated with CPAP and 147 with mechanical ventilation, all with Apgar scores >3 at five minutes and without apnea. RESULTS: The incidence of CPAP failure was 6.5% (95% CI: 11.3-22.8%); 29 patients died: 7 with CPAP (4.0%) and 22 with mechanical ventilation (15.0%, p<0.001). The relative risk of dying with CPAP versus mechanical ventilation was 0.27 (95% CI: 0.12-0.61), but after adjusting for confounding factors, CPAP use did not imply a higher risk of dying (RR=0.60; 95% CI: 0.29-1.24). Mechanical ventilation fatality rate was 5.70 (95% CI: 3.75-8.66) deaths/1,000 days-patient, while with CPAP it was 1.37 (95% CI: 0.65-2.88, p<0.001). Chronic lung disease incidence was lower with CPAP than with mechanical ventilation (RR=0.71; 95% CI: 0.54-0.96), as were intracranial hemorrhage (RR=0.28, 95% CI: 0.09-0.84) and sepsis (RR=0.67; 95%CI: 0.52-0.86), and it was similar for air leaks (RR=2.51; 95% CI: 0.83-7.61) and necrotizing enterocolitis (RR=1.68, 95% CI: 0.59-4.81). CONCLUSION: CPAP exposure of premature infants with respiratory distress syndrome is protective against chronic lung disease, intraventricular hemorrhage and sepsis compared to mechanical ventilation. No differences were observed regarding air leak syndrome or death.

Presión positiva continua en la vía aérea comparada con la respiración mecánica asistida en prematuros de 28 a 32 semanas de gestación con administración precoz de surfactante pulmonar / Nasal CPAP versus mechanical ventilation in 28 to 32-week preterm infants with early surfactant administration

Introducción. La presión positiva continua en la vía aérea ( Continuous Positive Airway Pressure , CPAP) es útil en prematuros de 28 a 32 semanas de gestación con síndrome de dificultad respiratoria, pero no se ha precisado si es mejor que la respiración mecánica asistida después de la administración precoz de surfactante pulmonar. Objetivo. Comparar la incidencia de eventos adversos en prematuros de 28 a 32 semanas de gestación con síndrome de dificultad respiratoria atendidos con surfactante y respiración mecánica asistida o CPAP de burbuja. Materiales y métodos. Se atendieron 147 neonatos con respiración mecánica asistida y 176 con CPAP, ninguno de los cuales presentaba asfixia perinatal o apnea. Resultados. La incidencia de fracaso de la CPAP fue de 6,5 % (IC 95% 11,3-22,8 %). Fallecieron 29 pacientes, 7 de los cuales habían recibido CPAP (4,0 %) y, 22, respiración mecánica asistida (15,0 %; p<0,001). El riesgo relativo (RR) de morir de quienes recibieron CPAP, comparado con el de quienes recibieron respiración mecánica asistida, fue de 0,27 (IC 95% 0,12-0,61), pero, al ajustar por los factores de confusión, el uso de CPAP no implicó mayor riesgo de morir (RR=0,60; IC 95% 0,29-1,24). La letalidad con respiración mecánica asistida fue de 5,70 (IC 95% 3,75-8,66) muertes por 1.000 días-paciente, mientras que con CPAP fue de 1,37 (IC 95% 0,65-2,88; p<0,001). La incidencia de neumopatía crónica fue menor con CPAP (RR=0,71, IC 95% 0,54-0,96), al igual que la de hemorragia cerebral (RR=0,28; IC 95% 0,09-0,84) y la de sepsis (RR=0,67; IC 95% 0,52-0,86), pero fue similar en cuanto a escapes de aire (RR=2,51; IC 95% 0,83-7,61) y enterocolitis necrosante (RR=1,68; IC 95% 0,59-4,81). Conclusión. La incidencia de neumopatía crónica, hemorragia ventricular y sepsis es menor con el uso de CPAP.

Introduction: Continuous positive airway pressure (CPAP) is useful in low birth weight infants with respiratory distress, but it is not known if it is a better alternative to mechanical ventilation after early pulmonary surfactant administration. Objective: To compare the incidence of adverse events in 28 to 32-week newborns with respiratory distress managed with mechanical ventilation or CPAP after early surfactant administration. Materials and methods: In total, 176 newborns were treated with CPAP and 147 with mechanical ventilation, all with Apgar scores >3 at five minutes and without apnea. Results: The incidence of CPAP failure was 6.5% (95% CI: 11.3-22.8%); 29 patients died: 7 with CPAP (4.0%) and 22 with mechanical ventilation (15.0%, p<0.001). The relative risk of dying with CPAP versus mechanical ventilation was 0.27 (95% CI: 0.12-0.61), but after adjusting for confounding factors, CPAP use did not imply a higher risk of dying (RR=0.60; 95% CI: 0.29-1.24). Mechanical ventilation fatality rate was 5.70 (95% CI: 3.75-8.66) deaths/1,000 days-patient, while with CPAP it was 1.37 (95% CI: 0.65-2.88, p<0.001). Chronic lung disease incidence was lower with CPAP than with mechanical ventilation (RR=0.71; 95% CI: 0.54-0.96), as were intracranial hemorrhage (RR=0.28, 95% CI: 0.09-0.84) and sepsis (RR=0.67; 95%CI: 0.52-0.86), and it was similar for air leaks (RR=2.51; 95% CI: 0.83-7.61) and necrotizing enterocolitis (RR=1.68, 95% CI: 0.59-4.81). Conclusion: CPAP exposure of premature infants with respiratory distress syndrome is protective against chronic lung disease, intraventricular hemorrhage and sepsis compared to mechanical ventilation. No differences were observed regarding air leak syndrome or death.

[Early neonatal mortality in the Russian Federation in 2010].

The paper analyzes the data of the Federal State Statistics Service on early neonatal mortality in the Russian Federation as a whole and its federal districts in 2010. There was a steady decline (ranging from 6.52 to 2.75%) in the mean early neonatal mortality rates in the Russian Federation in 2000-2010. In 2010, there were low, moderate, and high early neonatal mortality rates in 59 (71.1%), 20 (24.1%), 4 (4.8%) federal subjects, respectively. Most neonatal deaths were noted within the first 24 hours of life. According to the Federal State Statistics Service data, the commonest cause of early neonatal death in Russia is respiratory distress (103.2 deaths per 100,000 live births), hyaline membrane disease in particular. Among the causes of neonatal death, maternal diseases unrelated to pregnancy are indicated most commonly (in 22.7% of cases).

Incidencia y evolución de membrana hialina en menores de 35 semanas según crecimiento intrauterino / Incidence and evolution of hyaline membrane in newborns under 35 weeks of gestational age according intrauterine growth

Introduction: It is thought that intrauterine growth restriction induces respiratory maturation. The information varies if the studies consider analysis based on birth weight or gestational age. Objective: The goal of this study is to compare the incidence and evolution of hyaline membrane disease (HMD) between small and adequate premature babies under 35 weeks of gestational age (< 35 wGA) based on data in the literature. Patients and Methods: Two databases were created and analyzed: a) 2 022 newborns < 35 wGA admitted to the Service, whose incidence of HMD was calculated, and b) 733 newborns < 35 wGA with HMD and treated with surfactant, to describe the evolution. Results: Analysis of GA group shows a higher incidence of HMD (35.2 percent) among small for GA, and less (29.1 percent) among those who are not small for GA (p: 0.026). If a subset is formed for the newborns < 1 500 g in birth weight, those small for gestational age have a lower incidence (47.5 percent) than those adequate for GA (60.7 percent). Logistic regression analysis for discharge with oxygen of newborns with HMD shows association with lower z score for birth weight, corticosteroid use and oxygen dependence at 36 weeks. Conclusions: Preterm newborns small for GA show a higher incidence of HMD and oxygen dependence when comparing for GA.

Introducción: Tradicionalmente se ha considerado que la restricción de crecimiento intrauterina produce maduración respiratoria, pero la información es diferente según si los estudios consideran el análisis por grupos de peso de nacimiento o edad gestacional. Objetivo: El objetivo de este análisis fue comparar la incidencia y evolución de membrana hialina, de los prematuros menores de 35 semanas de edad gestacional según fueran pequeños o no para edad gestacional. Pacientes y Método: Se analizaron dos bases de datos: 2 022 menores de 35 semanas hospitalizados en el Servicio para determinar incidencia de membrana hialina y 733 menores de 35 semanas tratados con surfactante con diagnóstico de membrana hialina para comparar evolución de ésta. Resultados: El análisis por grupos de edad gestacional muestra una incidencia de membrana hialina mayor, de 35,2 por ciento, en los pequeños para la edad gestacional, y de 29,1 por ciento en los no pequeños (p: 0,026). Si se analiza sólo menores de 1 500 gramos de peso de nacimiento, el grupo pequeño tiene una incidencia menor, de 47,5 por ciento, y los no pequeños de 60,7 por ciento. El análisis de regresión logística para alta con oxígeno de los que tuvieron membrana hialina, muestra asociación con menor puntaje z de peso de nacimiento, uso de corticoides y dependencia de oxígeno a las 36 semanas. Conclusiones: El recién nacido pretérmino pequeño para edad gestacional tiene mayor incidencia de membrana hialina y evoluciona con mayor dependencia de oxígeno al comparar por edad gestacional.

Outcome of neonates requiring assisted ventilation.

Over a two-year period, we studied a total of 100 newborns delivered in our hospital, needing ventilation. The indications for ventilation, complications, outcome, and factors influencing outcome were analyzed. Of the 100 babies, 54 were preterm, 44 term and 2 post-term. Overall survival was 58%. The commonest indication for ventilation was meconium aspiration syndrome in term babies and hyaline membrane disease in preterms. Babies ventilated for pneumonia had the best outcome, while the poorest outcome was in sepsis. Survival increased significantly with increasing birth weight and gestational age. Downes score, Apgar score and pH at birth did not correlate significantly with outcome. The maximum peak inspiratory pressure requirement was significantly higher in the non-survivors. In pneumonia and sepsis, increased FiO2 requirement significantly impaired survival. The commonest complication was shock. Incidence of disseminated intravascular coagulation, pulmonary hemorrhage and pneumothorax was significantly higher in non-survivors; however, none of these factors was independently predictive of mortality.

Estrategia de intervención para disminuir la mortalidad por Síndrome de Dificultad Respiratoria del recién nacido en Maternidad Provincial, de Matanzas / Interventional strategy to diminish mortality by Respiratory Distress Syndrome of the newborn at the Provincial Maternity Hospital, of Matanzas

En la presente investigación se expone una estrategia de intervención dirigida a disminuir la mortalidad por Síndrome de Dificultad Respiratoria del Recién Nacido, en el Hospital Provincial Ginecobstétrico Docente Julio Alfonso Medina, de Matanzas. Sobre la base de la propia experiencia de los autores y mediante la aplicación de métodos científicos, basados en la literatura internacional actual, se presenta el resultado de un minucioso estudio de 48 recién nacidos que padecieron la enfermedad y que fueron tratados en la Unidad de Cuidados Intensivos Neonatales de esa institución hospitalaria durante los años 2006 y 2007. Las acciones estratégicas que se dan a conocer como resultado de la investigación, unido a las recomendaciones ofrecidas por los autores, constituyen una herramienta imprescindible para emprender un mejor manejo con los pacientes que padecen la enfermedad. Apoyados en el uso de una secuencia correcta del CPAP y del surfactante porcino cubano denominado SURFACEN, se dan a conocer nuevos enfoques en el tratamiento del Síndrome de Dificultad Respiratoria del Recién Nacido. Se propone el nuevo término de Enfermedad Pulmonar por Inmadurez Congénita (EPIC), para designar esta patología en lugar del término anatomopatológico de membrana hialina...

In the current investigation we expose the interventional strategy to diminish mortality by Respiratory Difficulty Syndrome of the Newborn, in the Provincial Gynecoobstetric Teaching Hospital Julio Alfonso Medina, of Matanzas. On the basis of the authors' proper experience and applying scientific methods, taking into account the current international literature, we present the results of a detailed study of 48 newborns who suffered the disease and were treated in the Neonatal Intensive Care Unit of this institution during 2006 and 2007. The strategic actions resulting from our investigation, together with the recommendations offered by the authors are indispensable for a better management of the patients suffering the disease. We offer new approaches in the treatment of the Respiratory Distress Syndrome of the Newborn on the basis of the usage of a correct sequence of the Continuous Positive Airway Pressure and the porcine Cuban surfactant called SURFACEN. We propose the new term Pulmonary Disease by Congenital Immaturity, to denominate this pathology in the place of the anatomopathologic term of hyaline membrane...

[Short-term respiratory outcome of late preterm newborn in a center of level III]. / Devenir respiratoire à court terme d'une population d'enfants nés à 34, 35 et 36 SA dans une maternité de niveau III.

The rate of infants born at 34-36 weeks gestation has increased over the last 10 years. These babies are at higher risk of morbidity and mortality than full-term infants. At present, prenatal steroids are given until 34 weeks. The purpose of this study was to present the epidemiologic data of the late preterm infants and look for respiratory distress risk factors. This is a descriptive, single-center study including 59, 55 and 72 children born at 34, 35 and 36 weeks gestation, respectively, in a level III center in 2005 and 2006 for babies born at 34 weeks and in 2006 for the babies born at 35 and 36 weeks. Of the mothers who delivered at 34 and 35 weeks, 63% and 49%, respectively, had a morbidity. The cesarean-section delivery rate before labor was 36% for the infants born at 34 weeks and 25% for the infants born at 35 weeks. Prenatal steroids were used for 57% of the mothers who delivered at 34 weeks and for 27% of the mothers who delivered at 35 weeks. In the population of the babies born at 34 weeks, a mean delay between the last dose of steroid and delivery was 18.9 days. Of the infants born at 34, 35 and 36 weeks, 27%, 18% and 8% suffered from respiratory distress. The mechanical ventilation rate was 8.5% and 5.5% for the infants born at 34 and 35 weeks' gestation. Surfactant was given to all infants born at 34 weeks who were intubated. Twenty percent of the 34-week-gestation infants and 12.7% of the 35-week-gestation infants required mechanical ventilation or noninvasive continuous positive airway pressure. Respiratory distress was mainly caused by respiratory distress syndrome or transient tachypnea of the newborn. There were no cases of meconium aspiration syndrome. There was 1 case of infection and 2 cases of pneumothorax. One-third of the infants born at 34-35 weeks were admitted to the neonatal intensive care unit. The number dropped to 11% at 36 weeks' gestation. The gestational age was the only significant risk factor for respiratory distress. There was a strong tendency of the respiratory distress rate to decrease in the babies whose mothers had received steroids (odds ratio = 0.39, p = 0.06).

Prevención del neumotórax por barotrauma en los neonatos con enfermedad pulmonar por inmadurez congénita / Preventing pneumothorax by barotraumas in newborns with pulmonary disease caused by congenital immaturity

En el presente trabajo se expresan las causas y la fisiopatología de los neumotórax que se producen por las altas presiones usadas durante la Ventilación Artificial en los neonatos portadores de Enfermedad Pulmonar por Inmadurez Congénita o Enfermedad de la Membrana Hialina por déficit de surfactante endógeno y se proponen un grupo de acciones para el período pre- natal y postnatal que utilizadas sistemáticamente pudieran contribuir a la disminución de la incidencia de esta entidad y a la larga a disminuir la morbimortalidad debida a esta grave complicación propia de esta etapa de la vida.

In the current work we report the cause and physiopathology of pneumothorax produced due to the high pressures used during mechanical ventilation in newborns with Pulmonary Disease for Congenital Immaturity or Hyaline Membrane Disease caused by deficit of endogenous surfactant. We also propose several actions for the pre-and postnatal periods that used systematically would contribute to diminish the incidence of this entity and, at the end, to reduce morbidity and mortality due to this serious complication typical of this life period.

Comparison outcomes of surfactant therapy in respiratory distress syndrome in two periods.

BACKGROUND: Exogenous surfactant replacement therapy has been a part of the routine care of preterm neonates with respiratory distress syndrome (RDS) since 1990s. In Thailand, the utilization of surfactant replacement therapy had been limited due to the high cost until the National Health Insurance Policy began in 2003 which covered the cost of surfactant. Nowadays surfactant replacement therapy is more frequently used at Queen Sirikit National Institute of Child Health, so the authors were interested in evaluating its use in RDS. OBJECTIVES: To compare the outcome and complications of surfactant replacement therapy in newborns who were diagnosed with moderate to severe RDS during two times period. STUDY DESIGN: Retrospective study. MATERIAL AND METHOD: The data of infants who were diagnosed as moderate to severe RDS and treated with surfactant at Queen Sirikit National Institute of Child Health between January 1st, 2003 and December 31th, 2005 were reviewed. The outcome of this study (Group II) was compared to the previous study conducted in 1999-2002 (Group I). The complications, mortality rate, association time of start surfactant and duration of ventilation were reviewed. RESULTS: The data of ninety-one moderate to severe RDS patients who received surfactant replacement therapy were reviewed. The mean birth weight and gestational age in this group were 1250 +/- 435.57 gm and 29.38 +/- 2.2 week less than in the first group 1,344 +/- 452.37gm and 29.69 +/- 2.61 week. The second group showed statistical differences in antepartum hemorrhage (4.4%) and pregnancy induced hypertension (PIH) (17.6%) while the first group had 33.3% ofantepartum hemorrhage and 3% of PIH. In neonatal conditions, there were statistical significant differences in anemia 28.6% in group II compared to 9% in group I and patent ductus arteriosus 67% in group II compared to 39.4% in group I. Surfactant was given earlier in life (4.75 +/- 2.76 hours) in the second group compared to the first group (7.21 +/- 4.92 hour) and the overall duration ofpatients on mechanical ventilation in Group II (6 days) was shorter than in Group I (16 days). This was especially more evident in patients who received surfactant within the first six hours of life. The immediate complication, pulmonary hemorrhage was found in more cases in Group I (33.3%) than in Group II (12.1%) but bronchopulmonary dysplasia (BPD) was found to be a late complication in more cases in Group II (46.1%) than in Group I (21.2%). The mean length of admission was longer in Group II (61.23 +/- 41.08 days) compared to Group I (38.5 +/- 23.48 days) and the mortality rate in Group II was 18.7% (17 cases) lower than Group I 33.3% (11 cases). CONCLUSION: Surfactant therapy in moderate to severe RDS can shorten the duration of ventilation and decrease the mortality rate, but has no effect in decreasing the incidence of chronic lung disease. Nevertheless the earlier the surfactant therapy is started, the higher the survival rate.

[Hyaline membrane disease: mortality and maternal and neonatal risk factors]. / Enfermedad de membrana hialina: mortalidad y factores de riesgo maternos y neonatales.

OBJECTIVE: To identify maternal and neonatal risk factors associated with hyaline membrane disease and its mortality. PATIENTS AND METHOD: A case-control study with 41 newborns with hyaline membrane disease and 123 controls was made between September 2001 and February 2002 in the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. The diagnosis of hyaline membrane disease was done with clinical and radiographic data. Maternal risk factors were obtained by direct interview with the mother; the newborn data were obtained of the clinical files. The association was measured with the odds ratios (OR) and the confidence interval of 95%. RESULTS: The frequency of hyaline membrane disease was of 6.8 per 1,000 live births. Mortality rate was of 2.8 per 1,000 live births. There were 17 deaths (41%). The risk factors associated with hyaline membrane were: illness during the first and second trimester of pregnancy, (OR: 3.28 [1.16-9.31]; OR: 8.88 [3.56-22.50], respectively), Apgar score lower than seven at the first minute (OR: 18.57 [4.50-88.67]), and masculine gender (OR: 2.58 [1.15-5.83]). CONCLUSIONS: Frequency and mortality were similar to the reported by other studies made in population samples. The exposure to illnesses during pregnancy and the low Apgar score were associated with the increased frequency of hyaline membrane disease.

[Treatment of hyaline membrane disease in the preterm newborn with exogenous lung surfactant: a controlled study]. / Estudio controlado del tratamiento de la enfermedad de membrana hialina del recién nacido pretérmino con surfactante pulmonar exógeno (porcino vs. bovino).

BACKGROUND: Hyaline membrane disease (HMD) due to lung surfactant deficiency in the preterm newborn is an important cause of neonatal morbidity and mortality. Exogenous lung surfactant has transformed HMD therapy in developed countries, but an equivalent benefit has not been accomplished in developing countries due to a variety of factors. Porcine surfactant developed in Cuba is an inexpensive alternative to other surfactants, and its use has not been studied in our settings. METHODS: A randomized, open, prospective and controlled trial was undertaken in 44 preterm newborns with HMD diagnosis. One group received bovine surfactant (BS) (Survanta) and the other Cuban porcine surfactant (PS) (Surfacen). The following clinical response variables were evaluated: oxygenation and ventilation indexes, days with supplementary oxygen, days with mechanical ventilation, incidence of complications, time of hospitalization, and mortality. RESULTS: 23 Patients received bovine surfactant and 21 the porcine type. The two groups were clinically similar, with patterns of oxygenation and ventilation response that were the same between groups, with a tendency to higher initial oxygenation increase in the PS group. The incidence of complications was similar between groups. 10 Patients (47.6%) died in the PS group, versus 12 (52.2%) in the BS group (p > 0.05). CONCLUSIONS: Porcine surfactant had similar clinical effects than bovine surfactant in the oxygenation and ventilation variables, with no significant differences in complications ormortality. Porcine surfactant is an effective and lower cost altenative to bovine surfactant in the treatment of HMD.

Estudio controlado del tratamiento de la enfermedad de membrana hialina del recién nacido pretérmino con surfactante pulmonar exógeno (porcino vs. bovino) / Treatment of hyaline membrane disease in the preterm newborn with exogenous lung surfanctant. A controlled study

Introducción: La enfermedad de membrana hialina (EMH) por deficiencia de surfactante pulmonar en el neonato prematuro es una causa importante de morbimortalidad. El surfactante pulmonar exógeno ha revolucionado el tratamiento de esta entidad en países desarrollados, aunque este beneficio ha sido menor en países en vías de desarrollo. El surfactante porcino de manufactura cubana es económico, y su uso comparado con otros surfactantes es desconocido. Material y métodos: Se llevó a cabo un estudio prospectivo, controlado, aleatorizado, abierto, en 44 recién nacidos prematuros con EMH. Un grupo recibió surfactante bovino (SB) (Survanta), y el otro surfactante porcino (SP) de fabricación cubana (Surfacen). Se evaluó la respuesta en variables de oxigenación y ventilación, días de oxígeno suplementario, ventilación mecánica, incidencia de complicaciones, tiempo de hospitalización y mortalidad. Resultados: 23 pacientes recibieron el surfactante bovino, y 21 el porcino. Los dos grupos fueron similares clínicamente y en sus patrones de respuesta de oxigenación y ventilación, con una tendencia a mayor incremento inicial en la oxigenación en el grupo tratado con SP. La incidencia de complicaciones fue similar en los dos grupos. Fallecieron 10 pacientes (47.6%) en el grupo SP, y 12 (52.2%) en el grupo SB (p>0.05). Conclusiones: El surfactante porcino tuvo efectos clínicos similares al bovino en las variables de oxigenación y ventilación estudiadas; no hubo diferencia significativa en complicaciones y mortalidad. El surfactante porcino es una alternativa efectiva y de menor costo que el surfactante bovino para el tratamiento de la EMH.

Background: Hyaline membrane disease (HMD) due to lung surfactant deficiency in the preterm newborn is an important cause of neonatal morbidity and mortality. Exogenous lung surfactant has transformed HMD therapy in developed countries, but an equivalent benefit has not been accomplished in developing countries due to a variety of factors. Porcine surfactant developed in Cuba is an inexpensive alternative to other surfactants, and its use has not been studied in our settings. Methods: A randomized, open, prospective and controlled trial was undertaken in 44 preterm newborns with HMD diagnosis. One group received bovine surfactant (BS) (Survanta) and the other Cuban porcine surfactant (PS) (Surfacen). The following clinical response variables were evaluated: oxygenation and ventilation indexes, days with supple mentary oxygen, days with mechanical ventilation, incidence of compli cations, time of hospitalization, and mortality. Results: 23 Patients received bovine surfactant and 21 the porcine type. The two groups were clinically similar, with patterns of oxygenation and ventilation response that were the same between groups, with a tendency to higher initial oxygenation increase in the PS group. The incidence of complications was similar between groups. Ten Patients (47.6%) died in the PS group, versus 12 (52.2%) in the BS group (p>0.05) Conclusions: Porcine surfactant had similar clinical effects than bovine surfactant in the oxygenation and ventilation variables, with no significant differences in complications or mortality. Porcine surfactant is an effective and lower cost alternative to bovine surfactant in the treatment of HMD.

Continuous tracheal gas insufflation in preterm infants with hyaline membrane disease. A prospective randomized trial.

In mechanically ventilated neonates, the instrumental dead space is a major determinant of total minute ventilation. By flushing this dead space, continuous tracheal gas insufflation (CTGI) may allow reduction of the risk of overinflation. We conducted a randomized trial to evaluate the efficacy of CTGI in reducing airway pressure over the entire period of mechanical ventilation while maintaining oxygenation. A total of 34 preterm newborns, ventilated in conventional pressure-limited mode, were enrolled in two study arms, to receive or not receive CTGI. Transcutaneous Pa(CO(2)) (tcPa(CO(2))) was maintained at 40 to 46 mm Hg in both groups to ensure comparable alveolar ventilation. Respiratory data were collected several times during the first day and daily until Day 28. Both groups were similar at the time of inclusion. During the first 4 d of the study, the difference between peak pressure and positive end-expiratory pressure was significantly lower in the CTGI group by 18% to 35%, with the same tcPa(CO(2)) level and with no difference in the ratio of tcPa(O(2)) to fraction of inspired oxygen (245 +/- 29 versus 261 +/- 46 mm Hg [mean +/- SD] over the first 4 d). Extubation occurred sooner in the CTGI group (p < 0.05), and the duration of mechanical ventilation was shorter (median: 3.6 d; 25th to 75th quartiles: 1.5 to 12.0 d; versus median: 15.6 d; 25th to 75th quartiles: 7.9 to 22.2; p < 0.05) than in the non-CTGI group. CTGI allows the use of low-volume ventilation over a prolonged period and reduces the duration of mechanical ventilation.