Search

To compare continuous positive airway pressure (CPAP) with nasal cannula (NC) as primary noninvasive respiratory therapy in hypoxic infants for transient tachypnea of the newborn (TTN). Retrospective cohort study of infants born at ≥34 weeks of gestation between January 1, 2015 and December 31, 2018. After adjusting for gestational age and birth weight, the maximum fractional inspired oxygen (FiO2) was significantly lower in the CPAP group with an incidence rate ratio (IRR) of 0.85 (95% CI: 0.76–0.96). Although nonsignificant, the CPAP group needed 32% fewer hours on oxygen with an IRR of 0.68 (95% CI: 0.38–1.22). The duration of respiratory support and the incidence of pneumothorax were similar between both groups. Comparing CPAP with NC as initial noninvasive respiratory therapy for TTN, significantly lower maximum FiO2 was observed in the infants of CPAP group without increase in the incidence of pneumothorax.

Background Transient tachypnea of the newborn (TTN), as a common cause of neonatal respiratory distress, needs to be distinguished from respiratory distress syndrome (RDS). Various modalities such as lung ultrasonography, cytokine analysis, and electrical cardiometry for the evaluation of lung fluid can be helpful for the exact diagnosis, however, clinical diagnosis has been applied mainly. This study aimed to evaluate the usefulness of the various tools for the diagnosis of TTN and RDS in neonates. Methods This study evaluated 22 late-preterm and term infants admitted to the neonatal intensive care unit of Gangnam Severance Hospital because of respiratory distress. Total 9 neonates were diagnosed with TTN and 13 had RDS. In addition to chest radiography, the LUS score was calculated by a neonatologist using the portable ultrasound device. Cytokines in the bronchoalveolar lavage fluid supernatant were measured. Thoracic fluid content was measured using an electrical cardiometry device. Results We enrolled 22 patients with median gestational age, 37.1 weeks, and birth weight 3100 g. There is no difference in patient characteristics between RDS and TTN group. Lung ultrasound score was significantly higher in RDS than TTN (11 vs 6, p = 0.001). Score 0 is shown in all infants with TTN. Score 1 is shown as significantly more in RDS than TTN. Between the TTN and RDS groups, there were significant differences in the changes of thoracic fluid content (2 vs − 1.5, p p = 0.02), and TNF-α levels (20.1 vs 11.2, p = 0.04). Conclusion We found lung ultrasound and electrical cardiometry to be reliable diagnostic tools for assessing infants with respiratory distress among late-preterm and term infants. Further studies with a large number of patients are needed to confirm their clinical usefulness.

Transient tachypnea of newborn (TTN) results from failure of the newborn to effectively clear the fetal lung fluid soon after birth. TTN represents the most common etiology of respiratory distress in term gestation newborns and sometimes requires admission to the neonatal intensive care unit. TTN can lead to maternal-infant separation, the need for respiratory support, extended unnecessary exposure to antibiotics and prolonged hospital stays. Recent evidence also suggests that TTN may be associated with wheezing syndromes later in childhood. New imaging modalities such as lung ultrasound can help in the diagnosis of TTN and early management with distending pressure using continuous positive airway pressure may prevent exacerbation of respiratory distress.

BackgroundTransient tachypnea of the newborn (TTN) is a common cause of early neonatal respiratory distress. It is due to delayed clearance of fetal lung fluid.AimTo evaluate the effect of inhaled salbutamol, a beta-2 adrenergic agonist (β2AA), in management of TTN and to detect any side effects as a result of using itMethodsA total of 100 infants with TTN were randomly divided into two groups to receive either inhaled salbutamol (treatment group) or an equal volume of normal saline solution (placebo group) at the time of diagnosis. At enrollment (by the 6th hour), complete blood count, blood glucose, serum potassium (K+), arterial blood gasses, respiratory rate, heart rate, blood oxygen saturation (O2Sat), fraction of inspired oxygen (FiO2), and TTN clinical score were determined for all patients. At 0.5, 1, and 4 h after drug administration, respiratory rate, heart rate, O2Sat, FiO2, and the clinical TTN score were recorded. At 4 h after treatment, arterial blood gasses, serum K+, and blood glucose levels were measured again. The duration of total respiratory support and the duration of hospitalization were recorded as well.ResultsNo statistically significant differences existed between both groups in terms of gestational age, birth weight, gender, mode of delivery, Apgar score, or maternal risk factors. The duration of respiratory support and duration of hospitalization were significantly shorter in the treatment (salbutamol) group (P P 2and TTN score were significantly lower after treatment (P P P 2significantly increased (P P 2(P ConclusionInhaled salbutamol, a β2AA, was effective in reducing the duration of respiratory support and hospitalization in TTN, with no detected side effects.

Our aim was to investigate the association between vaginal Ureaplasma species (spp.) and the subsequent occurrence of chorioamnionitis (CAM), perinatal death, neonatal morbidity, and long-term neurodevelopmental impairments (NDIs) at 3 years of age. We analyzed 55 pregnant women with singleton pregnancy who had preterm premature rupture of the membranes (pPROM) at

Infants with transient tachypnea of the newborn (TTN) have relatively low levels of epinephrine, which is known to mediate fetal lung fluid absorption. Providing exogenous epinephrine could be a valuable diagnostic and therapeutic intervention for this common condition. Our primary objective was to determine if inhaled racemic epinephrine is safe for the treatment of TTN. Our secondary objective was to determine its efficacy. We conducted a randomized, blinded, placebo-controlled pilot trial. Inhaled racemic epinephrine or placebo was administered to 20 newborns with TTN. Physiologic variables of cardiopulmonary function were measured during and after treatment. No infant in either the treatment or control arm experienced an adverse event, including tachycardia or hypertension. We did not detect a difference between the two groups regarding rate of resolution of tachypnea. We did not observe any adverse effects of inhaled racemic epinephrine when administered for the treatment of TTN. Larger studies are necessary to determine efficacy.

Pulmonary imaging in the neonatal intensive care unit (NICU) relies traditionally on the conventional chest radiogram. Translating evidences from adult emergency medicine, pediatricians and neonatologists have recently started to apply lung ultrasonography to the critical infant and child with respiratory problems [1]. Because of the high impedance of a normally aerated lung, an ultrasound scan does not render an anatomical image of the organ. However, ultrasounds clearly define the pleural surface with the normal sliding movement. Pleural effusions and lung consolidations can also be reliably diagnosed with ultrasonography. However, ultrasounds penetrating the lung will also generate artifacts (i.e. structures not naturally present in the living that appear as authentic images). These imagery anomalies come from the machine acquisition of the ultrasound beam path through means with markedly different acoustic impedance in close proximity. The horizontal reverberations of the pleural line (aka the A lines - see Figure ​Figure1A)1A) and the vertical hyperecoic image departing from the pleura (aka the B lines- see Figure ​Figure1B)1B) are commonly seen artifacts. Figure 1 1A: reverberations of the pleural image (aka A-lines) in the normally aerated lung. 1B: the prevalence of vertical B-lines (in between arrows) has been linked to the interstitial syndrome in the adult and to a progressive aeration of the neonatal lung ... Real and artefactual images have been combined in disease specific ultrasound profiles. Using these profiles, adult emergency physicians have shown that lung ultrasound outperforms conventional radiology in relevant diagnoses such as pleural effusion, pneumonia or pneumothorax. Pediatricians have started to use lung ultrasound with success to their patients affected by pneumonia but also by bronchiolitis [2]. In the NICU, lung ultrasound has found its specific applications, not without controversies [3]. Transient Tachypnea of the Newborn and Respiratory Distress Syndrome have been described with ultrasound profiles that are both highly sensitive and specific [4]. A relevant limitation of chest ultrasound is that surfactant administration gives a persistent white lung image rendering any follow-up essentially unfeasible. Ultrasounds can, however, accurately describe the fluid to air transition after birth and identify those neonates who will fail to adapt to extrauterine life needing respiratory support [5]. In a series of preterm neonates with moderate respiratory distress, recent work by our group shows that chest ultrasound is significantly more accurate than conventional radiograph in predicting the failure of non invasive ventilation [6]. Lung ultrasound is a very promising clinical tool in the NICU whose potential applications are well worth future multicenter trials.

Background Late preterm (LP) infants [gestational age (GA): 3436 weeks] are at increased risk of neonatal acute respiratory morbidity compared with term infants (GA: 3741) [1,2]. The observed rate of acute respiratory morbidity, in a population of about 20,000 LP infants, was 10-12% vs 1.4% of term infants [1]. Transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) are the most common diagnosis, with RDS rate reaching 10.5% in infants born at 34 weeks of GA [1,2]. Major causes of respiratory morbidity in LP are: prematurity and birth by Cesarean Section (CS) [1,3]. Material and methods We retrospectively studied 830 LP and moderate preterm (MP) infants (GA: 33-36 weeks) admitted to our unit from June 2009 to December 2013. Infants were classified according to GA: 33 weeks (n = 129), 34 weeks (n = 176), 35 weeks (n = 225), 36 weeks (n = 300). Clinical charts for each patient were reviewed and main diagnosis recorded.

Several studies have shown that late preterm infants (LPI) are at higher risk for respiratory disorders than term infants. Objective: To evaluate occurrence of respiratory disorders, need for respiratory support, use and timing of specific adjunctive pulmonary therapies in LPI. Methods: Using electronic medical charts, we performed a retrospective analysis of all LPI (34 0/7 to 36 6/7 wks) born from January 2005 to December 2009 in a tertiary level NICU. Results: During the study period, 856/14443 infants born alive were LPI (5.9%). They accounted for 58.9% of preterm births. Majority of LPI were 36 weeks (53.9%), followed by 35 weeks (28.4%) and 34 weeks (17.8%). Transient tachypnea of the newborn (5.8%) was the most common pulmonary illness, followed by respiratory distress syndrome (4.7%), apnea (1.5%), air leak (1.3%) and persistent pulmonary hypertension (0.5%). Composite respiratory morbidity was 12.4%: A total of 69 (8.1%) patients received NCPAP only, 19 (2.2%) mechanical ventilation, 17 (2%) surfactant, 8 (0.9%) chest tube and 4 (0.5%) inhaled nitric oxide. Fig 1 shows the highest levels of respiratory support for each GA. Fig 2 shows times at which each treatment was started. Median length of positive pressure ventilation was 40.5 hours (IQR 16.9-91.6). Mortality was 0.4%. Conclusion: Compared with literature, our population showed lower incidence of mortality, respiratory disorders and need for assisted ventilation, probably due to a great proportion of more mature infants.

Background: TTN from delayed clearance of fetal lung fluid (FLF) is common NICU admission among FT infants and require clinical management involving expensive resources,excessive and empiric antibiotics use. The increased risk of TTN among ECS born infants (CS in absence of labor) is a consequence of having excessive FLF with subsequent decreased release of counter regulatory hormones at delivery. Aims: To determine whether prophylactic CPAP in the DR via T piece based Neopuff to neonates at risk for TTN, would decrease the incidence of TTN and NICU hospitalization. Methods: IRB approved RCT, Inclusion: FTs born via ECS. Exclusion: presence of risk factors for sepsis, congenital malformations. Eligible infants randomized prior to delivery to intervention (I) group to receive CPAP of 5 cm {administered to spontaneously breathing infants after a notable cry, for 10 minutes with 21% O2} or control (C) group managed with provision of standard care in the DR. Infant and maternal clinical data collected. All infants assessed for respiratory distress and any adverse complications. Results: n=66{C=30, I=36}, enrolled in the ongoing trial are included. No significant difference seen between C and I group including incidence of TTN or adverse complications (Air-leaks) from NCPAP. 7 % of the mothers had history of previous babies with TTN. Conclusions: In this interim analysis we did not see any adverse or beneficial effects of prophylactic CPAP in DR. Inclusion of data from all patients enrolled at time of presentation will permit more complete evaluation of the benefits in this patient cohort.

Introduction: Air leaks, especially pneumothorax, are not rare events in NICU. The chest drain is one of the most painful procedures among the many that are performed on newborns. The breathing of 100% oxygen causes the capillary pressure becomes too low hastening the absorption of the pneumothorax. Objectives: To describe the cases of pneumothorax in NICU and its evolution with the strategy of a hundred percent oxygen therapy. Method: A descriptive study of cases of pneumothorax during the period of 36 months, using the database, software Epi-info, version 3.2, the CDC - made the measurements of frequency, average and standard deviation. Results: In 36-month period, 827 hospitalized children. Of these, 17 had pneumothorax during their hospitalization - 2%. The average weight was 2.418 g and gestational age was 35 weeks. The base lung disease was hyaline membrane disease in 6, transient tachypnea of the newborn in 7, pneumonia in 2 and meconium aspiration syndrome in 2. Of the 17 newborns in the study 53% of newborns did not require chest tube drainage. Discussion: The concern for invasive and painful procedures has increased in recent years in neonatal units. The drainage and retention of the drain are painful. Pneumothorax that few symptoms, can be treated and solved with oxygen supply of 100%, since there is monitoring of color, respiratory rate and heart rate. Our sample shows the effectiveness of this strategy and security in its broad implementation.

Objective: Reabsorption of lung fluid is critical for the adaptation of the newborn infant. Defective reabsorption may result in transient tachypnea of the newborn or contribute to respiratory distress syndrome. Perinatally, epithelial sodium channel (ENaC) is crucial for lung fluid reabsorption. ENaC is composed of 3 homologous subunits, the α-subunit being indispensable to ENaC function. Exogenous glucocorticoids (GC) regulate ENaC gene expression, but little is known whether an association exists between endogenous cortisol and ENaC. Subjects and methods: 69 term infants delivered vaginally (n=22) or by elective cesarean section (CS) (n=47) were included. We collected cord blood and saliva for cortisol analyzes with ELISA. Airway epithelium ENaC mRNA was quantified with real-time RT-PCR and normalized to cytokeratin 18 (CK18). Saliva and airway epithelial sampling was performed < 3h, 24 ± 5 and 48 ± 8 h postnatally. In a subset of infants delivered by elective CS (n = 26) first airway samples were obtained < 30 min postnatally. Results: αENaC mRNA < 30 min postnatally correlated with cord cortisol; r = 0.64, p = 0.001 (n=22). Adjusted for GA the correlation remained significant; r = 0.59, p = 0.005. At < 3h postnatally αENaC correlated with salivary cortisol; r = 0.52, p = 0.004 (n=29). Conclusion: Cortisol seems to be an important physiologic regulator of ENaC expression at birth. Our finding suggests that lung fluid transport may respond to GC even in the term infant. This underlines the potentials of regulation of perinatal lung fluid reabsorption by GC.

Phosphatidylglycerol (PG) was absent from lung effluent in 41 infants with respiratory distress syndrome of the newborn (RDS), whereas effluent from healthy control subjects of similar gestational age contained this phospholipid (4.9 +/- 2.4% of lipidphosphorus (P), n = 32). Control infants of 28 weeks of gestation or less with various respiratory disturbances other than RDS also had low PG (0.2 +/- 0.2% of lipid-P, n = 5). In RDS surfactant complex often could be isolated from the airways using differential and density gradient centrifugation. The material thus obtained had prominent phosphatidylinositol (PI) (13.6 +/- 2.8% of lipid-P, n = 6), but no PG. Of those 18 infants who had such surfactant even in the early stages of RDS, 13 were 35 weeks of gestation or more, 3 were offspring of diabetic mothers, and 2 had severe perinatal asphyxia. In healthy control subjects PG sometimes appeared first within an hour of birth, but in RDS PG did not appear until recovery from RDS. In RDS type II (transient tachypnea of the newborn) PG in lung effluent also was abnormally low (1.3 +/- 0.6% of lipid-P, n = 5) and PI was correspondingly prominent (9.7 +/- 3.6% of lipid-P, n = 5), indicating immaturity of surfactant similar to RDS. Surfactant with PG and PI has superior surface-active properties compared to that containing PI, but no PG. Surfactant without PG does not seem to stabilize the alveoli of the newborn as well as does surfactant with PG. The failure of PG appearance following birth therefore may precipitate RDS, especially beyond 35 weeks of gestation.

Transient Tachypnea of the Newborn (TTN) prolongs neonatal hospitalization and occasionally results in serious complications. The most widely accepted theory of the etiology of TTN is a delay in the absorption of fetal lung fluid. Furosemide has been shown to affect fluid dynamics in the lung. We hypothesized that a pharmacologically-induced diuresis of body water may reverse the mechanism of TTN and shorten the course of the illness. We designed a controlled, prospective trial of oral furosemide in infants with TTN. 50 consecutive infants presenting with the clinical and radiographic findings of TTN were randomly assigned to two groups. Infants in the treatment group received 2 mg/kg of oral furosemide at the time of diagnosis followed by a 1 mg/kg dose 12 hours later if the tachypnea (RR> 60) persisted. Infants in the control group received an equal volume of placebo. There were no significant differences in the prenatal and perinatal courses, nor in the demographic characteristics between the two groups. Although mean weight loss at discharge was similar in the two groups, the furosemide-treated group lost significantly more weight in the first 24 hours after birth (p

A new pulmonary disease distinct from either respiratory distress syndrome (RDS), transient tachypnea of the newborn, or RDS type II, has been studied in 7 infants of diabetic mothers (IDM). Both standard A-P and lateral, and magnification (mag.) chest x-rays revealed a segmentally distributed coarse reticulogranular pattern and increased lung volumes but no significant increase in perihilar bronchovascular markings or thickened fissures. All mothers were insulin dependent and 6/7 had C-sections. Clinical profile of patients (means): wt. 3.1 kg., gestational age 37 wks., mechanical ventilation 2/7, CPAP 4/7. All patients survived and most were in FiO2 ≥ .25 by day 6. 3 pts. had pulmonary function tests on day 3: Mean compliance 3.2 ml/cm H2O. Mean insp. and exp. lung resist. were 32 and 30 cm H2O/L/sec. respectively. Funct. residual cap. was low in 2 pts. (mean 17 ml/kg) and normal in 1 pt. (38 ml/kg). A new clinical syndrome in large IDM's is described. It is characterized by a mild clinical course (hypercapnia, tachypnea, and hypoxemia) and a segmental coarse reticulogranular lung infiltrate confirmed by mag. chest radiographs. Although x-rays showed increased lung volumes, 2 pts. had decreased FRC.

In neonatal disease states where lung compliance is reduced (e.g., inadequate resorption of fetal lung fluid, or, surfactant deficiency) an infant's normally low functional residual capacity (FRC) decreases even further. Tachypnea is an efficient compensatory maneuver for the newborn. We evaluated the effect of different bed and body positions on the increased respiratory rate observed in infants with transient tachypnea of the newborn (TTN), infant respiratory distress syndrome (IRDS) and bronchopulmonary dysplasia (BPD). Seventeen infants were studied (TTN: n=6; RDS: n=6; BPD: n=5) in 4 different positions: supine flat, supine elevated, prone flat and prone elevated. Respiratory rate and heart rate were evaluated in each position. Analysis of variance for the three patient groups showed a lower respiratory rate when the bed was elevated compared to flat (p=.0001), in the prone posture compared to supine (p=.031), and no significant difference in heart rate. The lowest mean respiratory rate occurred when patients were in the prone elevated position. The significant improvement in tachypnea seen in the prone and elevated positions was likely related to improved FRC resulting from reduced cephalad stress on the diaphragm from the abdomen. Positioning neonatal patients with respiratory insufficiency was a simple and safe therapeutic maneuver with prompt and demonstrable benefit.

Pulmonary epithelium changes after birth from Cl− secretion to Na+ absorption. To evaluate this transition, the maximal potential difference (PD) and the voltage response to superfusion with 10−5 M amiloride (Am), an inhibitor of Na+ absorption, were recorded between a Ringer perfused bridge placed on the nasal mucosa and a subcutaneous reference electrode. The PD was sequentially measured during the first 72 hrs of life across the nasal epithelium of healthy term neonates, healthy preterm neonates (29.7±0.3wks). neonates (30.2± 1.2wks) with Respiratory Distress Syndrome (RDS), and neonates (37.6± l.lwks) with Transient Tachypnea of the Newborn (TTNB). PDs (mean±SEM) and Am inhibition (%; at

We designed a microcomputer-based information system (IS), using commercially-available relational data base management software, to track the succession of patient management encounters. The IS includes an algorithm for computing the average daily patient load (ADPL) of residents providing either primary care, or in a supervisory role on the general inpatient service. The IS yields a compilation of the patients managed by each resident (a patient “log”), a frequency distribution of diagnoses for the total program, and a computation of the ADPL on the inpatient service. To minimize the data-submission burden on the resident, much of the raw data was culled by secretarial level personnel from daily reports provided by the data processing department. We analyzed 1900 consecutive patient-encounters, both intra- and extramural, and derived the following distribution of the 10 most frequent diagnoses (decreasing frequency): prematurity; unspecified septicemia; non-infectious gastroenteritis; asthma; pneumonia (unspecified); status asthmaticus; convulsions; asthmatic bronchitis; toxic-effect, lead; and transient tachypnea of the newborn. The above distribution reflects the composite experience of a primary-care oriented program and a tertiary children's hospital (where residents spend about one-third of their overall training experience). Separate ICDA codes assigned for asthma-related conditions were aggregated. This yielded a composite of 200 patient-encounters (10.5% of the sample). The asthma-related category was the most frequent diagnostic group encountered.

Cystic fibrosis (CF) patients have an increased nasal transepithelial potential difference (PD) which reflects an increased Na+ absorption across a relatively Cl− impermeable membrane. To evaluate respiratory epithelial function in CF neonates, the maximal PD and the voltage response to superfusion of 10−5M amiloride (Am), an inhibitor of Na+ transport, were recorded between a Ringer perfused bridge on the nasal mucosa and a reference electrode in the subcutaneous space. We studied two term CF neonates presenting with meconium ileus (MI) and compared the results to 15 term healthy neonates including 1 obligate heterozygote (OH) for CF, and 12 term disease control (DC) neonates including 2 with ileal atresia, 2 with meconium aspiration, 1 with pneumonia, and 7 with Transient Tachypnea of the Newborn. Both neonates with MI had raised sweat Cl− values (x = 110meq/l) at 2 mo. The CF neonates had higher PDs than normal or disease controls (fig). Superfusion with Am induced a 72% reduction in PD in the CF neonates as compared to healthy (40.0 ± 3.7%) and disease (41.0 ± 2.6%) neonates. Also the neonatal PDs are comparable to values in older infants (2-24mo) where a similar PD pattern is present (fig). Moreover, the PD and Am response in CF neonates are similar to older (>6yr) CF children and adults (-64.9.+9.3mV; 77.7±1.8%, n=51). These results suggest that: (1) nasal epithelial dysfunction is present in CF patients shortly after birth, and (2) the nasal PD may be a diagnostic adjunct to the sweat test in the early diagnosis of CF.