Clinical characteristics, diagnosis and management of respiratory distress syndrome in full-term neonates
- Author:
- No author available
- Journal Title:
- CHINESE MEDICAL JOURNAL
- Issue:
- 19
- DOI:
- 10.3760/cma.j.issn.0366-6999.2010.19.004
- Key Word:
- respiratory distress syndrome;clinical characteristics;diagnostic criteria;management strategies;newborn;full-term
Abstract： Background Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and neonatal death, however, its clinical characteristics are very different from premature RDS, and these characteristics have not been well documented as yet. This study was to investigate the pathogenesis, clinical characteristics and management strategies of RDS in full-term neonates, with the aim of developing a working protocol for improving the outcome in full-term neonates with RDS.Methods A total of 125 full-term infants with RDS were enrolled in this study. Their clinical and laboratory data were collected for analyzing the characteristics of full-term neonatal RDS.Results (1) The 125 cases included 94 male and 31 female infants, vaginal delivery occurred in 80 cases and cesarean section in 45 cases. (2) The onset time of RDS was (3.11±3.59) hours after birth. (3)The possible reasons included severe perinatal infections in 63 patients, elective cesarean section in 34 cases, severe birth asphyxia in 12 patients,meconium aspiration syndrome in 9 patients, pulmonary hemorrhage in 4 patients and matemal diabetes in 3 patients. (4)Complications included multiple organ system failure (MOSF) in 49 patients, persistent pulmonary hypertension of newborn (PPHN) in 25 patients, acute renal failure in 18 patients, severe hyperkalemia in 25 patients, severe metabolic acidosis in 6 cases, severe myocardial injury in 9 cases, pulmonary hemorrhage in 3 cases, disseminated intravascular coagulation in 14 patients and shock in 12 patients.(5) Four patients died, the mortality was therefore 3.2% with the main cause of septicemia complicating of MOSF, but their prognosis was improved while comprehensive treatment measures including early mechanical ventilation and broad spectrum antibiotics were taken into account.Conclusions RDS is not an uncommon disease in full-term infants and is associated with a higher mortality, its clinical characteristics are very different from premature RDS, and its onset is earlier and is more likely to develop into PPHN and/or MOSF. The main cause of death is severe infection complicating of MOSF and most patients require prolonged mechanical ventilation. Comprehensive management strategies will help to improve patient's prognosis.
- [1]GUO Feng-mei,DING Jing-jing,SU Xin,etc.Effects of different levels of end-expiratory positive pressure on lung recruitment and protection in patients with acute respiratory distress syndrome[J].2008,(22).
- [2]ZHAO Xiao-gang,WU Jun-song,HE Xiao-di,etc.Risk factors of mortality in road traffic injury patients with acute respiratory distress syndrome[J].2008,(11).
- [3]S, Farchi,D, Di Lallo,A, Polo,etc.Timing of repeat elective caesarean delivery and neonatal respiratory outcomes.[J].2010,95(1).
- [4]Anne Kirkeby Hansen,Niels Uldbjerg,Kirsten Wisborg,etc.Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study[J].2008,336(7635).
- [5]Hoehn T.Therapy of pulmonary hypertension in neonates and infants.[J].2007,114(3).
- [6]Asma, Bouziri,Sonia, Ben Slima,Asma, Hamdi,etc.[Acute respiratory distress syndrome in infants at term and near term about 23 cases].[J].2007,85(10).
- [7]McGowan FX,D'Agostino D,Simplaceanu E,etc.Administration of fructose 1,6-diphosphate during early reperfusion significantly improves recovery of contractile function in the postischemic heart.[J].1998,116(2).
- [8]R G, Faix,R M, Viscardi,M A, DiPietro,etc.Adult respiratory distress syndrome in full-term newborns.[J].1989,83(6).
- [9]Ghodrat M.Lung surfactants.[J].2006,63(16).
- [10]Soll RF.Inhaled nitric oxide in the neonate.[J].2009,29(Suppl.2).
- [11]Kimoto H,Takahashi S,Harada K,etc.Developmental outcomes in persistent pulmonary hypertension treated with nitric oxide therapy.[J].2009,51(1).
- [12]Miodovnik M,Varner MW,Mercer BM,etc.Timing of elective repeat cesarean delivery at term and neonatal outcomes.[J].2009,360(2).
- [13]Aaron, Hamvas,F Sessions, Cole,Lawrence M, Nogee.Genetic disorders of surfactant proteins.[J].2007,91(4).
- [14]Martiri G,De-Benedictis F,Verlato G,etc.Surfactant status in preterm neonates recovering from respiratory distress syndrome.[J].2008,122(1).
- [15]Abdul, Aziz,Arne, Ohlsson.Surfactant for pulmonary hemorrhage in neonates.[J].2008,(2).
- [16]Simpson KN,Johnson DD,Villers MS,etc.Timing of elective repeat cesarean delivery at term and neonatal outcomes: a cost analysis.[J].2010,202(6).
- [17]Hermansen CL,Lorah KN.Respiratory distress in the newborn.[J].2007,76(7).
- [18]Bernard, G. R.,Artigas, A.,Brigham, K. L.,etc.Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination[J].1994,20(3).
- [19]REBECCA ABRAHAM,RAJNEESH CALTON,REEMA SOOD,etc.Changes in Vitamin C and Vitamin E During Oxidative Stress in Myocardial Reperfusion[J].2007,51(2).
- [20]Nkadi PO,Merritt TA,Pillers DA.An overview of pulmonary surfactant in the neonate: genetics, metabolism, and the role of surfactant in health and disease.[J].2009,97(2).
- [21]Engle WA.Surfactant-replacement therapy for respiratory distress in the preterm and term neonate.[J].2008,121(2).
- [22]A, Ayachi,V, Rigourd,F, Kieffer,etc.[Hyaline membrane disease in full-term neonates].[J].2005,12(2).