Pulmonary Surfactant Replacement Therapy for Respiratory Distress Syndrome in Neonates: a Nationwide Epidemiological Study in Korea.

BACKGROUND: Pulmonary surfactant (PS) replacement therapy, as a safe and effective treatment for respiratory distress syndrome (RDS) may have further increased with the extended insurance coverage since 2011 in Korea. Thus, this study aimed to investigate the epidemiologic data of PS replacement therapy for RDS in Korea and to analyze the complications associated with RDS. METHODS: We included 19,442 infants who were treated with PS and diagnosed with RDS (International Classification of Diseases-10 codes: P22.0) between 2014 and 2018 from the Health Insurance Review and Assessment database. Birth certificate data from Statistics Korea were used to estimate the incidence of RDS. RESULTS: The average incidence of RDS within the study period was 0.99% among live births. Repeated doses of PS were administered to 1,688 infants (8.7%), ranging from 2 doses in 929 infants (4.8%) to 9 doses in 1 infant (0.01%). The incidence of RDS in term infants markedly increased over 5 years from 0.2% to 0.34%. The incidence was similarly increased among the preterm infants. The RDS mortality rate was 6.3% and showed a decreasing trend according to year. The mortality rate was significantly higher in the lower gestational age group. A decreasing trend was observed in the incidence of the complications, such as patent ductus arteriosus, intraventricular hemorrhage, and bronchopulmonary dysplasia, except for pneumothorax in term infants. The complications were also higher in the lower gestational age group and the lower birth weight group. However, pneumothorax was the most frequent complication in the term infant group and in infants with birth weight ≥ 2,500 g. CONCLUSION: Advancements in neonatal care and extended insurance coverage have increased the use of PS replacement therapy for RDS. This, in turn, decreased neonatal mortality and the incidence of the associated complications. The appropriate therapeutic strategy for RDS should be decided according to the gestational age and lung pathology.

Cannot Extubate a Newborn Patient after an Arterial Switch Operation? Check Major Aortopulmonary Collaterals!

The standard treatment of transposition of the great arteries is the arterial switch operation (ASO). Despite successful surgical correction, patients cannot tolerate extubation after the operation. Major aortopulmonary collaterals (MAPCAs) are one of the rare causes of prolonged mechanical ventilation due to significant hemodynamic effects. We report a 28-day-old newborn with transposition of the great arteries and a ventricular septal defect (VSD) who underwent ASO and VSD closure. After postoperative extubation failed twice, four large MAPCAs were revealed during heart catheterization. After transcatheter closure of these four MAPCAs, the patient was extubated and discharged 27 days after the procedure.

Cannot extubate a newborn patient after an arterial switch operation? check major aortopulmonary collaterals!

Abstract The standard treatment of transposition of the great arteries is the arterial switch operation (ASO). Despite successful surgical correction, patients cannot tolerate extubation after the operation. Major aortopulmonary collaterals (MAPCAs) are one of the rare causes of prolonged mechanical ventilation due to significant hemodynamic effects. We report a 28-day-old newborn with transposition of the great arteries and a ventricular septal defect (VSD) who underwent ASO and VSD closure. After postoperative extubation failed twice, four large MAPCAs were revealed during heart catheterization. After transcatheter closure of these four MAPCAs, the patient was extubated and discharged 27 days after the procedure.

Early versus Late Parenteral Nutrition in Very Low Birthweight Neonates: A retrospective study from Oman.

OBJECTIVES: The aim of this study was to compare the biochemical parameters, weight gain, osteopenia and phosphate supplementation in very low birth weight (VLBW) neonates receiving early versus late parenteral nutrition (EPN versus LPN). METHODS: A RETROSPECTIVE STUDY WAS UNDERTAKEN IN THE LEVEL III NEONATAL INTENSIVE CARE UNIT AT SULTAN QABOOS UNIVERSITY HOSPITAL, OMAN: from January 2007 to October 2008 (LPN group, n = 47) and from January 2009 to June 2010 (EPN group, n = 44). Demographic data, anthropometric and laboratory parameters were extracted from the electronic record system. RESULTS: The mean age of PN initiation was LPN = 47.3 hours versus EPN = 14.3 hours. Biochemical parameters analysed during the first week of life revealed a reduction in hypernatraemia (12.7% versus 6.8%) and non-oliguric hyperkalemia (12.7% versus 6.8%) in EPN, with no significant differences in acidosis and urea levels between the two groups. Hyperglycemia >12 mmol/L in <1000g was higher in EPN. Nutritional parameters in 81 babies who survived/stayed in the unit up to a corrected gestational age (CGA) of 34 weeks (40 in LPN and 41 in EPN), revealed a reduction in metabolic bone disease (osteopenia of prematurity [OOP], 17.5% versus 7.3%) and the need for phosphate supplementation (22.5% versus 7.3%) in the EPN group. There was no increase in acidosis or cholestasis. No difference was noted in albumin levels, time to full feeds, time to regain birthweight and mean weight gain per day till 34 weeks corrected CGA. CONCLUSION: EPN in VLBW newborns is well tolerated and reduces hypernatraemia, non-oliguric hyperkalemia, OOP and the need for phosphate supplementation.

A prevalência do uso de sonda nasogástrica em bebês portadores de fissura de lábio e/ou palato / Prevalence of the use of nasogastric tube in babies with cleft lip and/or palate

OBJETIVO: Investigar a prevalência do uso de sonda nasogástrica em bebês com fissura labiopalatina, sua correlação com tipo de fissura, maternidade e cidade de origem, e a idade na primeira consulta. MÉTODOS: A amostra constituiu-se de 137 bebês de ambos os gêneros, com fissura de lábio e/ou palato, sem outros comprometimentos, nascidos a termo, e que chegaram para primeira consulta em um centro especializado em fissura entre zero e 12 meses (mediana=33 dias). Realizou-se análise estatística pelo teste de coeficiente de contingência (p<0,05). RESULTADOS: Da amostra total, 61 por cento eram do gênero masculino e 39 por cento do feminino, 51 por cento apresentavam fissura de lábio e palato, 35 por cento de palato e 14 por cento de lábio. Quanto ao nascimento, 36 por cento nasceram em maternidades particulares e 64 por cento em públicas, 60 por cento em Belo Horizonte, 15 por cento em outras cidades da região metropolitana e 25 por cento no interior do estado. O uso de sonda ocorreu em 23 por cento dos casos. Não houve associação entre tipo de fissura ou de maternidade e o uso de sonda, mas este foi mais frequente na região metropolitana (p=0,007). CONCLUSÃO: A prevalência do uso de sonda em bebês com fissura foi considerada alta, visto que nasceram a termo e não apresentavam comprometimentos associados que indicassem o uso da mesma. O uso de sonda é mais frequente em bebês nascidos em maternidades da região metropolitana de Belo Horizonte, quando comparados a outras cidades do estado de Minas Gerais.

PURPOSE: To investigate the prevalence of the use of nasogastric tube in babies with cleft lip and/or palate, and to correlate its use with type of cleft, maternity hospital (private or public) and city of origin, and age at the first visit to a cleft center. METHODS: The sample consisted of data collected from 137 babies of both genders with cleft lip and/or palate, without any other associated anomalies, born full-term, who attended their first consultation at a specialized cleft center with ages between zero and 12 months (median=33 days). Statistical analyses used the coefficient of contingency test (p<0,05). RESULTS: From the subjects, 61 percent were male and 39 percent were female; 51 percent presented cleft lip and palate, 35 percent cleft palate, and 14 percent cleft lip. Regarding place of birth, 36 percent were born in private and 64 percent in public maternity hospitals; 60 percent were born in the city of Belo Horizonte (Minas Gerais, Brazil), 15 percent in other cities of the metropolitan area, and 25 percent in other cities at the state of Minas Gerais (Brazil). The use of nasogastric tube was reported in 23 percent of the cases. There was no association between the type of cleft or maternity and the use of the tube, but the later was more frequent within the metropolitan area (p=0,007). CONCLUSION: The prevalence of the use of nasogastric tube in babies with cleft lip and/or palate was considered high since they were born full-term and without any other associated anomalies that would indicate the need of the tube. The use of nasogastric tube was more frequent in babies born at the metropolitan area of Belo Horizonte, when compared to other cities in the state of Minas Gerais (Brazil).