Osteosarcoma in an Adolescent with Kniest Dysplasia: A Case Report.

CASE: A 19-year-old adolescent with Kniest dysplasia was incidentally found to have osteosarcoma of the proximal aspect of the humerus after having a chest radiograph for evaluation of an upper respiratory infection. He underwent chemotherapy and resection of the tumor, and there was no evidence of metastasis at the 16-month follow-up. CONCLUSION: Patients with osteochondrodysplasias often have multiple orthopaedic symptoms. Changes in chronic pain symptoms should be investigated to rule out insidious secondary causes of musculoskeletal pain, such as osteosarcoma.

Scenario of Neonatal Respiratory Distress in Tertiary Hospital.

BACKGROUND: Respiratory distress is one of the most common reasons for admission in Neonatal Intensive Care Unit. However, studies of newborn admitted with respiratory distress in our setup are limited. This study aims to look for incidence of neonatal respiratory distress in our setup, to analyze the common causes of respiratory distress and to determine possible strategic plan needed for better clinical outcome. METHODS: A cross sectional study was conducted from March 2013 to December 2014 in Nepal Medical College and Teaching Hospital. Data of all the neonates with respiratory distress admitted during this period were analyzed. RESULTS: Total 317 (13.4%) neonates were admitted to Neonatal Intensive Care Unit during the study period.109 neonates developed respiratory distress comprising 34.3% of all Neonatal Intensive Care Unit admissions. Incidence of neonatal respiratory distress was 4.6%. The common causes of respiratory distress in our study were meconium aspiration syndrome in 21.1%, septicemia in 16.5%, transient tachypnea of newborn in 15.5%, pneumonia in 14.6%, birth asphyxia and hyaline membrane disease were in each 11.9% of the neonates. Caesarean section was the most common predisposing factor associated with the development of transient tachypnea of newborn in 82.3% newborns (p=.001). The overall mortality rate due to respiratory distress was 12.8%. CONCLUSIONS: Meconium aspiration syndrome, septicemia and hyaline membrane disease are the most important causes of respiratory distress in our setup. Good obstetric care, proper training of health care personnel in neonatal resuscitation and early recognition of potential risk factors of respiratory distress will be helpful.

Enfermedad de la membrana hialina en el Hospital Ginecobstétrico Mariana Grajales / Hyaline membrane disease at Mariana Grajales Gynecology and Obstetrics Hospital

Se realizó un estudio descriptivo de cuatro años sobre las complicaciones y la supervivencia de los recién nacidos con enfermedad de la membrana hialina, atendidos en la Unidad de Cuidados Intensivos Neonatales del Hospital Ginecobstétrico Mariana Grajales; se estudiaron 49 recién nacidos que desarrollaron la enfermedad; el 63,2 por ciento nacieron con menos de 1 500 gramos y menos de 30 semanas; esta última variable, el sexo masculino, la rotura prematura de membranas y la preclampsia fueron los factores de mayor influencia. El 89,8 por ciento de los pacientes fueron tratados con surfactante y soporte ventilatorio invasivo. Aunque se presentaron complicaciones, como el conducto arterioso permeable, la sepsis y la hemorragia intraventricular, la mayoría de los pacientes sobrevivieron. La mortalidad continuó elevada en el grupo de niños en los que el surfactante se aplicó tardíamente. Se recomienda su empleo de manera precoz, para disminuir las complicaciones y mejorar el pronóstico(AU)

Postoperative complications following neonatal and infant surgery: Common events and predictive factors.

BACKGROUND: Data on major non-surgical postoperative complications following neonatal and infant surgery is lacking. The goal of the present study was to describe common major complications and their predictive factors. MATERIAL AND METHODS: The study consisted of a retrospective review of medical charts of patients less than 6months of age operated in our institution over one calendar year, excluding herniorraphy surgery. The data collected included demographics, preoperative ICU bed status, ASA status, a history of cardiac malformation, hyaline membrane disease (HMD) or necrotizing enterocolitis (NEC), preoperative haemoglobin, emergent surgery status, surgery type and duration, duration of anaesthesia and the need for intraoperative fluid boluses. Complications were analysed until the 30th postoperative day. Analyses included descriptive statistics and the determination of factors associated with non-surgical complications using univariate and multivariate statistics. RESULTS: The study included 168 patients. Their postnatal age was 48±48days. Overall, 37 patients experienced major postoperative non-surgical complications. The most common major complications were haemodynamic compromise (n=19, 11.3%), multiple organ dysfunction syndrome (MODS, n=8, 4.8%) and respiratory failure requiring ventilation (n=3, 1.8%). Surgical complications occurred in 8 cases (4.8%). Four factors were identified as being predictive of non-surgical complications: PCA<40 weeks, a history of cardiac malformation, HMD or NEC, preoperative ICU status and intraoperative fluid bolus administration. CONCLUSION: This study describes common non-surgical postoperative complications in neonates and infants, and their risk factors. They were much more common than surgical complications. Further studies should focus on preventive strategies addressing these complications.

Recomendaciones para la asistencia respiratoria en el recién nacido (III). Surfactante y óxido nítrico / Recommendations for respiratory support in the newborn (III). Surfactant and nitric oxide

Las recomendaciones incluidas en este documento forman parte de una revisión actualizada de la asistencia respiratoria en el recién nacido. Están estructuradas en 12 módulos y en este trabajo se presenta el módulo 7. El contenido de cada módulo es el resultado del consenso de los miembros del Grupo Respiratorio y Surfactante de la Sociedad Española de Neonatología. Representan una síntesis de los trabajos publicados y de la experiencia clínica de cada uno de los miembros del grupo (AU)

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group (AU)

Relación entre el uso de surfactante exógeno y la morbimortalidad de los neonatos pretérmino con enfermedad de membrana hialina atendidos en el Hospital Nacional Dos de Mayo durante el año 2012 / Relationship between the use of exogenous surfactant and the morbidity and mortality of the preterm newborns with hyaline membrane disease treated at the National Hospital Dos de Mayo during the year 2012

OBJETIVO: Determinar la relación entre el uso de surfactante exógeno y la morbimortalidad de los neonatos pretérmino con enfermedad de Membrana Hialina atendidos en el Hospital Nacional Dos de Mayo durante el Año 2012. METODOLOGIA: Estudio de tipo observacional, analítico, retrospectivo de corte trasversal. La muestra fue 60 neonatos pretérmino con enfermedad de Membrana Hialina. Para el análisis descriptivo de variables numéricas se utilizó el promedio y la desviación estándar, para el análisis de variables cualitativas se utilizó frecuencias absolutas y porcentajes, mientras para el análisis bivariado se usó la prueba de Chi-cuadrado con un nivel de confianza del 95 por ciento. RESULTADOS: Entre las características generales de los neonatos pretérmino con enfermedad de Membrana Hialina, la mayoría tenían entre 10 a 30 minutos de tiempo de vida (45.0 por ciento). El 60 por ciento eran de sexo masculino. Predominaron los neonatos con peso mayor o igual 2000 gramos (51.7 por ciento), la edad gestacional al nacer, en la mayoría de casos fue entre 32 a 36 semanas (95.0 por ciento). El 83.3 por ciento de los partos nacieron por cesárea, el 21.7 por ciento fue producto de un embarazo múltiple, al 11.7 por ciento de las gestantes se les administro corticoides prenatales y el 20.0 por ciento presentaron rotura prematura de membranas. En cuanto al peso medio al nacer del neonato fue de 1948,1±519,0 gramos. Asimismo, la puntuación Apgar al minuto fue en promedio de 7,6±1,5 y a los 5 minutos fue de 8,52±0.77. Las características del tratamiento permitieron observar que el 58.3 por ciento de neonatos recibió surfactante exógeno, la edad en la cual recibió el tratamiento fue en la mayoría de casos menor a 1 hora y entre 1 a 12 horas (40.0 por ciento, en cada grupo respectivamente), al 48.6 por ciento se le administró solo una dosis, 42.9 por ciento dos dosis y al 8.6 por ciento tres dosis, el volumen promedio de la dosis administrada fue de 6,5±1,4cc; observándose una...

OBJECTIVE: To determine the relationship between the use of exogenous surfactant and morbimortality of preterm neonates with Hyaline Membrane disease treated at the National Hospital Dos de Mayo during 2012. METHODOLOGY: Observational, analytical, cross-sectional retrospective study. The sample was 60 preterm neonates with Hyaline Membrane Disease. For the descriptive analysis of numerical variables, the mean and standard deviation were used; for the analysis of qualitative variables, absolute frequencies and percentages were used, while for the bivariate analysis, the chi-squared was used with a confidence level of 95 per cent. RESULTS: Among the most important general characteristics of preterm neonates with Hyaline Membrane disease, most were between 10 to 30 minutes of life (45.0 per cent), 60 per cent were male. Predominated neonates with weight greater than or equal to 2000 grams (51.7 per cent), gestational age at birth, in most cases were between 32 to 36 weeks (95.0 per cent). The 83.3 per cent of births were delivered by cesarean, 21.7 per cent were result of multiple pregnancy, 11.7 per cent of pregnant women were administered antenatal corticosteroids and 20.0 per cent had premature rupture of membranes. As for the mean birth weight of the newborn was 1948.1±519.0 grams. Also, the Apgar score at one minute was 7.6±1.5 and at 5 minutes was 8.52±0.77. The characteristics of treatment revealed that 58.3 per cent of neonates received exogenous surfactant, the age at which they received the treatment was in most cases less than 1 hour and between 1 to 12 hours (40.0 per cent, in each group respective1y), 48.6 per cent of patient were administered one dose, at 42.9 per cent two doses and at 8.6 per cent three doses, the average volume of the administered dose was 6.5±1.4cc; being observed a satisfactory response to treatment in all cases. The main complementary therapeutic measures at treatment were: mechanical ventilation (60.0 per cent), oxygen...

Re-alignment-procedures for skeletal dysplasia in three patients with genetically diverse syndromes.

OBJECTIVE: Disruption to endochondral ossification leads to delayed and irregular bone formation and can result in a heterogeneous group of genetic disorders known as osteochondrodysplasias. These genetic disorders arise through disturbances in the complex processes of skeletal growth causing development of unsightly skeletal deformities. METHODS : Each syndrome was diagnosed on the basis of detailed clinical and radiographic assessment. Lower limb deformities were the prime presenting feature. RESULTS: Here are presented three patients with diverse genetic syndromes, namely Wolcott-Rallison syndrome (WRS), Kniest dysplasia (KD) and Desbuquois dysplasia (DS). Genetic testing was performed in the patients with WRS and DS. The diagnosis of KD was made purely on a clinical and radiographic basis. Variable orthopaedic interventions to realign these patients' lower limbs were implemented with the aim of improving their balance and gait. CONCLUSIONS: The aim of this paper is twofold. The first part is to outline the importance of diagnosing the causes of various skeletal abnormalities in patients with osteochondrodysplasias by phenotypic and genotypic characterization. The second part is to demonstrate our techniques for surgical corrections in patients with joint laxity and malalignment and show how far techniques for growth modulation, re-alignment and ligament reconstruction have advanced.

[Risk factors on the occurrence and prognosis of neonatal hyaline membrane disease].

OBJECTIVE: To identify risk factors with related to the occurrence and prognosis of neonatal hyaline membrane disease (HMD) and to develop effective measures to prevent and treat the disease. METHODS: A case control (1 : 4 paired) study was undertaken, with 62 neonates with HMD as a case group paired with 248 sick neonates without HMD and respiratory disorders as a control group. The controls were matched with the cases by admission time (+/- 7 d), birth weight (+/- 200 g) and gestational age (+/- 3 d). All of the patients came from the neonatal intensive care unit (NICU) in the West China Second University Hospital from June 2008 to January 2009. Conditional logistic regression analysis was performed to identify risk factors associated with the development and prognosis of HMD. RESULTS: Fetal distress, placenta previa, preeclampsia, placental abruption, maternal diabetes, and multiple births were identified as risk factors associated with the development of HMD, with an OR 10.459, 9.382, 8.884, 7.817, 7.727, and 7.217, respectively (P < 0.05). The Cochran Armitage trend test showed that the mortality of HMD decreased with the increase of gestational age and birth weight (P < 0.05). The mortality of HMD increased significantly in the patients with complication such as pulmonary hemorrhage, respiratory failure, neonatal asphyxia, and gastrointestinal hemorrhage (P < 0.05). CONCLUSION: Prevention of premature birth and treatment with high risk pregnancy and complications can reduce the mortality of HMD.

Neumotórax en el recién nacido: experiencia de un servicio de cirugía de tórax / Pneumothorax in the newborn: experience of a thoracic surgery department

Objetivos: Evaluar la experiencia del Servicio de Cirugía de Tórax del Hospital Universitario de Maracaibo en el diagnóstico y tratamiento del neumotórax en el recién nacido. Métodos: 23 recién nacidos con neumotórax fueron evaluados por el Servicio de Cirugía de Tórax en la Emergencia Pediátrica, Unidad de Cuidados Intensivos Pediátricos y en el Servicio de Neonatología entre los años 2000–2004. Se recolectaron los datos relacionados con: la duración de la gestación, complicaciones maternas durante el embarazo, examen físico, estudios diagnósticos, tratamiento yevolución de los pacientes. Resultados: 13(56.52%) delos recién nacidos eran varones y la edad gestacional promedio fue de 35.25 +/- 2.49 semanas. 12(52.17%) nacieron por cesárea y 10(43.47%) tenían antecedentes de maniobras de reanimación al nacer. El neumotórax se localizó en el hemitórax izquierdo en 8 recién nacidos (34.78%), hemitórax derecho en 14 recién nacidos (60.86%) y en ambos hemitórax en 1 recién nacido (4.47%). 22 (95.65%) presentaron dificultad respiratoria El tratamiento incluyó una conducta expectante en 2 recién nacidos con neumotórax menor de 25%, y la colocación de tubo de toracostomía en 21 recién nacidos (91.30%) con neumotórax mayor de 25% Conclusión: el neumotórax es una complicación que se observa principalmente en el recién nacido con Apgar bajo al nacer o querequieren maniobras de reanimación y se presenta con dificultad respiratoria. Los neumotorax menores de 25% pueden manejarse con observación y radiología seriada, pero aquellos mayores de 25% requerirán colocación de tubo de toracostomía.

Objectives: To evaluate the experience of Thoracic Surgery Service in the diagnosis and treatment of pneumothorax in newborn at theHospital Universitario de Maracaibo.Methods: 23 newborn with pneumothorax were evaluated by the Thoracic Surgery Service in the Pediatric Emergency Unit, PediatricIntensive Care Unit and Neonatology Service between the years 2000-2004. Data was collected regarding gestational age, complications during the pregnancy, physical exam, diagnostic studies, treatment and evolution of the patients. Results: 13 (56.52%) were males, with mean gestational age of 35 +/- 2.5 weeks. 12 (52.17%) were born by caesarean section and 11(47.82%) by vaginal delivery. 10 newborns had history of resuscitation manoeuvres (43.47%). Pneumothorax was located in lefthemithorax in 8 newborn (34.78%), right hemithorax in 14 newborn (60.86%) and both hemithorax in 1 newborn (4.47%). 22 (95.65%)presented respiratory distress. Treatment included observation in 2 newborns with pneumothorax < 25%, and tube thoracostomy in 21 (91.30%) with pneumothorax > 25%. Conclusion: Pneumothorax is a complication seen mainly in newborns with low Apgar score and those who required resuscitation manoeuvres and almost always presents with respiratory distress. Pneumothorax < 25% can be treated with observation and serialradiology but those > 25%.will require tube thoracostomy.

Factores de riesgo del Síndrome Dificultad Respiratoria de origen pulmonar en el recién nacido / Risk factors of pulmonar respiratory difficulty in newborn

El Síndrome de Dificultad Respiratoria constituye una de las afecciones más frecuentes en el recién nacido y se comporta como uno de los principales indicadores de morbilidad y mortalidad. Con el objetivo de caracterizar las causas más frecuentes de dificultad respiratoria de origen pulmonar en los neonatos, se realizó un estudio retrospectivo de corte transversal, descriptivo, en un grupo de pacientes con este diagnóstico que ingresaron en la Unidad de Cuidados Especiales Neonatales (UCEN) del Hospital Ginecoosbstétrico Ramón González Coro, en el período del 1ro de enero al 31 de diciembre de 2006. Se registraron 133 neonatos con dificultades respiratorias de origen pulmonar, para una frecuencia de 4,7 por ciento. La mayor parte de los pacientes estudiados nacieron por cesárea (61,7 por ciento) y el factor de riesgo materno más frecuente fue la rotura prematura de membrana (18 por ciento). Los recién nacidos a término (55,6 por ciento) y con sexo masculino (65,4 por ciento) fueron los que mayor morbilidad presentaron. La taquipnea transitoria fue la afección respiratoria que más se diagnosticó, con un total de 92 casos para el 69,2 por ciento y la mayoría de los pacientes evolucionaron favorablemente. La enfermedad de la membrana hialina fue la entidad respiratoria que más complicaciones reportó. El índice de ventilación fue el 18,8 por ciento y la neumonía postnatal fue la complicación que más se observó con 8 casos (6,1 por ciento). La tasa de mortalidad en este grupo fue el 1,7 por cada 1000 nacidos vivos(AU)

Syndrome of Respiratory Difficulty is one of more frequent afections in newborn and behaves as one of the main indicators of morbidity and mortality. To characterize the more frequent causes of pulmonar respiratory difficulty in neonates, we made a retrospective, descriptive and cross-sectional study in a group of patients presenting with this diagnosis admitted in Unit of Neonatal Special Care of Ramn Gonzlez Coro Gynecologic and Obstetrics Hospital from January 1 to December 31 2006. There was 133 neonates with pulmonary respiratory difficulty, for a frequency of 4,7 percent. Most of study patients were born by cesarian section (61,7 percent), and the more frequent mother risk factor was premature rupture of membrane (18 per cent). Term newborns (55,6 percent) and of male sex (65,4 percent) presented the greatest morbidity. Transient tachypnea was the more diagnosed respiratory afection with a total of 92 cases (69,2 percent), and most of patients evolved favourably. Hyaline membrane disease was the entity with more complications. Ventilation rate was of 18,8 percent and postnatal pneumonia was the more observed condition with 8 cases (6,1 percent). Mortality rate in this group was of 1,7 for each 1000 live births(AU)

Factores en la morbilidad respiratoria de los recién nacidos de muy bajo peso con membrana hialina / Factors related to respiratory complications in very low birth weight infants with respiratory distress syndrome

Introducción: Los recién nacidos de muy bajo peso (RNMBP), menor de 1.500 g al nacer, con un pulmón estructuralmente inmaduro, tienen un alto riesgo de desarrollar una displasia broncopulmonar (DBP), aún mayor si estuvieran afectados de enfermedad de membrana hialina (EMH). Además pueden presentar otras patologías pulmonares agudas como son el aire ectópico o la hemorragia pulmonar. Analizamos la importancia estadística de una serie de variables neonatales recogidas en una muestra de RNMBP con EMH que presentaron alguna de estas complicaciones. Pacientes y métodos: En 209 RNMBP con EMH estudiamos las variables 'sexo', 'tipo de gestación', 'administración de corticoides prenatales', 'amniorrexis', 'semanas de gestación', 'tipo de parto', 'fecha de parto', 'procedencia', 'peso al nacimiento', 'puntuación Apgar al primer y quinto minuto de vida', 'EMH', 'administración de sustancia tensoactiva' y 'sepsis precoz'. Con la metodología de selección de variables de Hosmer-Lemeshow se realizó un análisis de regresión logística múltiple. Resultados: En el análisis multivariante la aparición de aire ectópico se relacionó con el grado de EMH y con la administración de surfactante. El diagnóstico de hemorragia pulmonar se vinculó con la falta de administración de corticoides prenatales y con el menor peso del niño. En la DBP encontramos una relación estadística peyorativa cuando hubo una gestación única, carencia de administración prenatal de corticoides, menor peso al nacimiento, baja puntuación Apgar al primer minuto y mayor gravedad de EMH. Conclusiones: En la aparición de morbilidad respiratoria en el RNMBP con EMH podrían influir interrelacionándose variables intrínsecas y extrínsecas al neonato

Introduction: Very low birth weight (VLBW) infants, with a birth weight below 1500 g and a structurally immature lung, are at high risk for developing bronchopulmonary dysplasia. This risk is even higher if respiratory distress syndrome is present. Other acute lung diseases, such as air leak and pulmonary hemorrhage, can also be present. The aim of this study was to analyze the statistical relevance of several neonatal factors in the development of pulmonary complications in a sample of VLBW infants with respiratory distress syndrome. Patients and methods: A total of 209 VLBW infants with respiratory distress syndrome were studied. The variables analyzed were delivery date, respiratory distress syndrome grade, sex, birth weight, gestational age, referral (from within the hospital or elsewhere), prenatal corticosteroid administration, type of gestation, type of delivery, amniorrhexis time, Apgar test at 1 and 5 minutes, surfactant administration, hours of life at which the first dose of surfactant was administered, and early sepsis. A multiple logistic regression analysis was developed using Hosmer-Lemeshow methodology. Results: In the multivariate analysis, air leak was related to respiratory distress syndrome grade and surfactant administration. Pulmonary hemorrhage was related to lower birth weight and absence of prenatal corticosteroid administration. Bronchopulmonary dysplasia was related to single pregnancies, absence of prenatal corticosteroid administration, lower birth weight, lower Apgar score at 1 minute, and higher respiratory distress syndrome grade. Conclusions: Respiratory morbidity in VLBW infants with respiratory distress syndrome could be influenced by several interrelated intrinsic and extrinsic variables

Resolution of pulmonary interstitial emphysema following selective left main stem intubation in a premature newborn: an old procedure revisited.

Pulmonary interstitial emphysema (PIE) contributes to worsening respiratory status in already compromised premature infants. Various treatments for PIE include high-frequency ventilation, postural therapy, pneumonectomy or lobectomy and selective bronchial intubation. While right main stem bronchus intubation is easy to perform at the bedside for treatment of PIE in the left lung, left main stem bronchus intubation for the treatment of right-sided PIE remains challenging and the technique was rarely reported and poorly described. In this case report, we revisit this procedure and describe successful treatment of right lung PIE with hyperinflation by selective left main stem intubation at 2 weeks of life in a 24-week-old premature infant who had respiratory distress syndrome and pulmonary hemorrhage. A detailed description is given to allow clinical bedside replication following specific anatomic landmarks.

Repair of coarctation of the aorta in infants weighing less than 2 kilograms.

BACKGROUND: We retrospectively reviewed our experience in aortic coarctation repair on infants weighing less than 2 kg to evaluate the results and assess the rate of recoarctation in this group of patients. METHODS: Twenty-four consecutive babies weighing 2 kg or less were operated on over a period of 15 years. Median gestational age was 33 weeks (range, 30 to 36), and median weight was 1.6 kg (range, 1.0 to 2.0). Seventeen of them had associated cardiac anomalies. The methods of repair undertaken were resection with extended end-to-end anastomosis (n = 13), subclavian flap angioplasty (n = 9), carotid flap angioplasty (n = 1), and patch repair using pulmonary homograft tissue (n = 1). RESULTS: Mean follow-up was 52.5 months (range, 0.5 to 151). There were 3 in-hospital deaths and 2 late deaths. Recoarctation developed in 7 babies. Four underwent balloon dilatation; 1 of them required further surgery; 3 others have mild recoarctation, but have not required further intervention. Risk factor analyses revealed that the presence of preoperative congestive cardiac failure, and coexisting noncardiac lesions as well as the duration of descending aortic cross-clamp and postoperative ventilation had a significant influence on mortality after repair. CONCLUSIONS: Coarctation repair in infants less than 2 kg can be performed safely. The incidence of recoarctation is acceptable and comparable with that of other pediatric cohorts that have been reported. Preoperative cardiac function and associated noncardiac lesions may influence the incidence of mortality after repair. Delaying the timing of surgical repair to achieve growth is not necessary.

[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.

Retinopathy of prematurity--risk factors.

OBJECTIVE: Improved survival of low birth weight, premature babies have increased the incidence of retinopathy of prematurity. This hospital-based, prospective, study was undertaken to determine its incidence and risk factors in our neonatal unit. METHODS: Neonates with gestational age < or = 35 weeks and/or birth weight < or = 1500 gm born over a one-year period were examined by indirect ophthalmoscopy between 2 to 4 weeks after birth, and followed up till retinal vascularisation was complete. Maternal and neonatal risk factors were noted and data analyzed by statistical package SPSS-10.0. RESULTS: Sixty babies were thus examined. The incidence of retinopathy was 21.7% in the cohort, 33.3% in babies < or = 32 weeks gestation and 36.4% in babies weighing < or = 1250 gm. Oxygen (p=0.01), sepsis (p=0.04) and apnoea (p=0.02) were independent risk factors. Retinopathy was significantly more severe in babies with hyaline membrane disease (p=0.02) and lower birth weight (p=0.02). Severe disease was never seen before 6.5 weeks of age. CONCLUSION: Indirect ophthalmoscopy should be performed at 4 weeks of post natal age in all preterm babies with birth weight < or = 1500 gm, and intensified in the presence of risk factors like oxygen administration, apnoea and septicemia.

Long versus short inspiratory times in neonates receiving mechanical ventilation.

BACKGROUND: When intermittent positive pressure ventilation (IPPV) was introduced in newborn infants with hypoxic respiratory failure from hyaline membrane disease (HMD), mortality was high and air leaks problematic. This barotrauma was caused by the high peak inspiratory pressures (PIP) required to oxygenate stiff lungs. The primary determinants of mean airway pressure (and thus oxygenation) on a conventional ventilator are the inspiratory time (IT), PIP, positive end expiratory pressure and gas flow rates. In the 1970s uncontrolled studies on a small number of infants demonstrated a benefit in reducing barotrauma using a long IT and slow rates. This strategy was subsequently widely adopted. Current neonatal ventilators have been designed to minimise lung injury but rates of bronchopulmonary dysplasia (BPD) remain high. It is therefore important that the inspiratory time causing least harm is used. OBJECTIVES: To determine in mechanically ventilated newborn infants whether the use of a long rather than a short IT reduces the rates of death, air leak and BPD. SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group (CNRG) was used. Searches of electronic and other databases were performed. These included MEDLINE (1966 - April 2004) and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2003). In order to detect trials that may not have been published, the abstracts of the Society for Pediatric Research, and the European Society for Pediatric Research were searched from 1998 - 2003. SELECTION CRITERIA: All randomised and quasi-randomised controlled trials enrolling mechanically ventilated infants with or without respiratory pathology evaluating the use of long versus short IT (including randomised crossover studies with outcomes restricted to differences in oxygenation). DATA COLLECTION AND ANALYSIS: The standard method of the Cochrane Collaboration and its Neonatal Review Group were used. Two authors independently assessed eligibility, and the methodological quality of each trial, and extracted the data. The data were analysed using relative risk (RR) and risk difference (RD) and their 95% confidence intervals. A fixed effect model was used for meta-analyses. MAIN RESULTS: In five studies, recruiting a total of 694 infants, a long IT was associated with a significant increase in air leak [typical RR 1.56 (1.25, 1.94), RD 0.13 (0.07, 0.20), NNT 8 (5, 14)]. There was no significant difference in the incidence of BPD. Long IT was associated with an increase in mortality before hospital discharge that reached borderline statistical significance [typical RR 1.26 (1.00, 1.59), RD 0.07 (0.00, 0.13)]. REVIEWERS' CONCLUSIONS: Caution should be exercised in applying these results to modern neonatal intensive care, because the studies included in this review were conducted prior to the introduction of antenatal steroids, post natal surfactant and the use of synchronised modes of ventilatory support. Most of the participants had single pathology (HMD) and no studies examined the effects of IT on newborns ventilated for other reasons such as meconium aspiration and congenital heart disease (lungs with normal compliance). However, the increased rates of air leaks and deaths using long ITs are clinically important; thus, infants with poorly compliant lungs should be ventilated with a short IT.