DOCSLIB.ORG

Clinical Review

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Review Clinical review Recent advances Paediatric surgery Paul D Losty Department of Introduction Paediatric Surgery, Institute of Child Paediatric surgery—the surgical care of children from Summary points Health, Alder Hey Children’s Hospital, the fetus to adolescent—is a comparatively new surgical Liverpool L12 2AP specialty, which began shortly after the second world Exploring mechanisms to modulate abnormal Paul D Losty, war.12 Pioneering work during the formative years of fetal development pharmacologically may provide senior lecturer the specialty has enabled many lethal congenital alternatives to fetal surgery and invasive fetal Paul.Losty@rlchtr. malformations to be corrected. The surgical treatment interventions nwest.nhs.uk of childhood disease has also progressed enormously. Progress in neonatal surgery has resulted in the BMJ 1999;318:1668–72 This review focuses on recent advances in paediatric surgery and its relation with scientific research, which is survival of children with many types of congenital rapidly translating state of the art care from research to lethal malformations the patient. Advances in paediatric gastroenterology include a greater understanding of biological mechanisms Methods regulating normal and abnormal gut motility This article is based on a personal awareness of devel- New treatments are needed to induce biological opments in paediatric surgery and relevant contribu- regression of tumours and tumour maturation tions from major paediatric surgical journals, review articles, and the proceedings from meetings of various Several laparoscopic techniques are now feasible, international associations. safe, and effective Fetal surgery and interventions Future developments include tissue engineering, antiangiogenic agents, scarless healing, in utero The close liaison between paediatric surgeons and col- gene replacement, and treatments with growth leagues in fetomaternal medicine enabled fetal defects factors to be diagnosed with ultrasonography and the clinical course and pathophysiology of many of these disorders to be observed (box). surgery immediately after birth can be effectively The antenatal detection of a fetal structural abnor- planned and a good outcome anticipated (fig 1). Some mality often entails referral to a paediatric surgeon, abnormalities, however, may result in the death of the who can counsel parents and discuss the likely fetus or neonate. In such cases fetal surgery or outcomes for the fetus. For some structural abnormali- intervention may be required.3 This has led to the ties, such as the abdominal wall defect, gastroschisis, emergence of fetal surgery programmes, with a few centres mainly concentrated in North America.3 Abnormalities considered amenable to surgery in Fetal malformations detected by antenatal utero include benign forms of cystic lung lesions, ultrasonography which may lead to hydrops. Fetal lung resection is Spina bifida and hydrocephalus technically feasible, with reasonable outcome for high 3 Gastroschisis risk cases treated at specialist centres. Oesophageal atresia In fetuses affected by moderate to severe maternal Exomphalos oligohydramnios associated with reduced amniotic Cystic lung lesions fluid volume and obstruction of the urinary tract in Renal tract disease males, intervention can protect renal function and Congenital diaphragmatic hernia 3 Bladder exstrophy maintain lung growth. In such cases, usually Cardiac defects secondary to posterior urethral valves, lung hypoplasia Cloacal exstrophy can be avoided by bladder decompression using ultra- Duodenal atresia sound guided percutaneous catheters to divert urine from the fetal bladder to the amniotic cavity 1668 BMJ VOLUME 318 19 JUNE 1999 www.bmj.com Clinical review (vesicoamnioticshunting) or at open fetal surgery to create a vesicostomy.3 Attention has also focused recently on the potential role of fetal surgery in spina bifida (1 in 2000 live births), a disability causing lower limb paralysis, skeletal deformity, incontinence, hydrocephalus, and mental impairment.4 Exposure of fetal neural tissue to the effects of chemicals in the amniotic fluid, and mechani- cal injury during birth and vaginal delivery, may cause deterioration in neurological function. In an effort to ameliorate ongoing neurological damage, experimen- tal work in fetal sheep has confirmed that repair of the spina bifida defect in utero stops spinal cord destruction and restores normal neurological function at birth. This work has led to the first successful repair of an extensive thoracolumbar open spina bifida lesion in utero associated with hydrocephalus in a human 4 fetus. Although fetal surgery for spina bifida is at an Fig 1 Gastroschisis defect in neonate experimental stage, such pioneering advances merit careful consideration. Neonatal surgery Other fetal structural abnormalities have proved more difficult to treat—for example, congenital Neonatal surgery has undergone many major develop- diaphragmatic hernia, which occurs in 1 in 2500 live ments.213Oesophageal atresia (1 in 5000 live births) is births (fig 2). Despite diagnosis by antenatal ultra- most commonly characterised by the presence of a sonography, innovations in intensive care, and the sim- blind ending upper oesophagus and a fistula between ple nature of the defect, 40%-50% of cases die.5 This the lower oesophagus and airway. Such babies are high mortality is due to a primary abnormality in lung unable to swallow and classically present with excessive development and the prolapse of abdominal organs salivation, and choking episodes or respiratory distress into the chest, which severely further compromises on feeding due to pulmonary aspiration (fig 3) Survival fetal lung growth and development. Fetal surgery has from this condition remained poor until the early been restricted to fetuses with a poor outcome. 1960s, and neonates weighing as little as 1500 g Selection criteria now include early antenatal diagnosis currently have a predicted survival of 97% in specialist (less than 25 weeks of gestation), isolated congenital centres.14 diaphragmatic hernia defect with liver herniated into Hirschsprung’s disease (1 in 5000 live births) is the the chest, and fetuses without chromosomal abnor- commonest cause of intestinal obstruction in neonates malities.6 Two decades of experimental work have now (fig 4). Infants typically present with bile stained vomi- refined the surgical procedure to exploit mechanisms tus after initiation of feeds, abdominal distension, and that promote normal lung growth.78 The seminal delayed passage of meconium stool beyond 24 hours observation that congenital laryngeal obstruction in an after delivery. Fewer babies are now presenting beyond infant with an absence of both kidneys and Fraser’s the neonatal period owing to an increased awareness syndrome resulted in large lungs stimulated research of this disorder: the gold standard for diagnosis is a into “plugging” the trachea to encourage lung rectal biopsy that shows an absence of ganglion cells. growth.910 This procedure—now termed PLUG (plug Traditionally, a “levelling” colostomy was performed in the lung until it grows)—is performed in some centres by open fetal surgery.10 Advances in minimally invasive surgery with a laparoscope, coupled with attempts to override the problem of preterm labour, have further led to tracheal plugging using video fetoscopic technology (FETENDO) to visualise, access, and occlude the fetal airway.6 Six of eight (75%) fetuses with congenital diaphragmatic hernia have survived after surgery using video fetoscopic technology. Less invasive strategies are being explored to stimu- late fetal lung development pharmacologically com- bined with postnatal repair of the diaphragmatic hernia defect.11 This is based on the observation that the lungs of babies with severe congenital diaphragmatic hernia resemble the immature lungs of premature newborn babies with respiratory distress syndrome.11 In experi- mental models of congenital diaphragmatic hernia, antenatal steroid treatment, widely used to stimulate lung maturation in premature babies, has been shown to reverse immature lung growth at the biochemical, mor- 11 12 phological, functional, and molecular level. An inter- Fig 2 Chest x ray film of neonate with congenital diaphragmatic national collaborative clinical trial is currently evaluating hernia. Note presence of air filled intestinal loops in thoracic cavity its efficacy in humans. and shift of mediastinum and heart BMJ VOLUME 318 19 JUNE 1999 www.bmj.com 1669 Clinical review to appreciate the significance of normal and abnormal anorectal anatomy,17 and PSARP (posterior sagittal anorectoplasty) has significantly improved the quality of life, continence, and functional outcome for affected children. This operation comprises an initial colostomy then a major anorectal reconstruction in the first year of life. Although Goon previously studied the posterior sagittal anorectoplasty procedure as a primary operation in neonates with imperforate anus, few surgeons considered it of practical advantage to the infant.18 Albanese and colleagues have recently evaluated the operation as a single stage procedure, thereby avoiding colostomy in the newborn period, and outcome data are encouraging in the short term (CT Albanese et al, report of a meeting on one stage correction of high imperforate anus in the male neonate, Surgical Section of the American Academy of Pediatrics, San Francisco, 1998). Surgical gastroenterology Paediatric surgical gastroenterology is evolving
Load more

Recommended publications
  • The Conclusion Report of 13Th National Perinatology Congress
    Perinatal Journal 2011;19(1):35-50 e-Adress: http://www.perinataljournal.com/20110191009 doi:10.2399/prn.11.0191009 The Conclusion Report of 13th National Perinatology Congress Ayfle Kafkasl›1, Alper Tanr›verdi2, Yeflim Baytur3, Özlem Pata3, Ertan Adal›3, Hakan Camuzcuo¤lu3, Arif Güngören3, ‹lker Ar›kan3 1Head of the Congress, 13th National Perinatology Congress, ‹stanbul Türkiye 2Congress Secretary, 13th National Perinatology Congress, ‹stanbul Türkiye 3Congress Reporter, 13th National Perinatology Congress, ‹stanbul Türkiye The Conclusion Report of 13th The subject of “Fetal Postmortem Examination National Perinatology Congress and Chromosomal Analysis of Abortion Material” 13th National Perinatology Congress was held was presented by Dr. Gülay Ceylaner. According in ‹stanbul Military Museum and Culture Site in to the results of this presentation, postmortem between 13th and 16th April, 2011. examination should be performed on congenital anomalies, intrauterine growth retardation, non- Before the congress, 3 pre-congress courses immune hydrops fetalis, fetal-neonatal death histo- were held on 13th April, 2011. ry of unknown etiology or in fetuses with unknown death reason or maser (high frequency 1. Perinatal Genetic and Postmortem of chromosomal disorder). Findings should cer- Diagnosis Course tainly be recorded during examination, pho- In the first session, Assoc. Prof. Serdar Ceylaner tographs and X-ray should be taken and skin biop- made a presentation about “Basic Genetics and sy should be done. Fetus evaluation is really an Management of Genetic Diseases for the Clinician” easy and convenient examination method. and he explained that chromosomal analysis indi- In the presentation of “Fetal Autopsy: The cations are recurrent gestational losses, intrauterine Influence on Perinatal Mortality”, Prof.
    [Show full text]
  • Lung Growth and Lung Function Alter A) Fetal Lamb Tracheal Occlusion
    • Lung Growth and Lung Function Alter a) Fetal Lamb Tracheal Occlusion and Exogenous Surfactant at Birth in Congenital Diaphragmatic Hernia and b) Selective Perfluorocarbon Distention in Healthy Newborn Piglets Andreana Bütter Department ofExperimental Surgery McGill University, Montreal • Submitted June, 2001 A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment ofthe requirements ofthe degree ofMaster ofScience © Andreana Bütter, 2001 • Nationallibrary BibbolhèQue nationale 1+1 of·Canada duClnadi Acquisitions et services bibliographiques _.rueW~ 0ftaM ON K1A ClN4 0INdlI The author bas anmted a DOD­ L'auteur a acconIé une licence DOn Bdusiwlicence aBowÎDI the exclusive pametbmt à la Natioual LiI:ny ofCuada to Biblioth6que DltiODlle du CaDada de œproduco, 1oaD, distribute or sen reproduire, Jdter. distribua- ou copi. oItbis tbesis ÎD microfonn, vendre des caP- de celte daàe sous pep«or electrorûc formats. la forme de mic:rofidleIfiJ de reproduction sur papier ou sur format Sectronique. The author ret- 0WMrSbip ofthe L'auteur CODIeI'W la propri6t6 .. copyriabt in tbis thesïs. Neitber the droit d'auteur qui P'Otèae cette". thesis .......tiaI exIrads hmil Ni la th6se Di des eJdJills substantiels may be priDted or otbawise de ceJle.ci De doiwDt an impIimés reproduced without the 8UthÔr's ou autremeoI repJoduits saas son permission. autorisation. 0-612-B0111-X Canadl TABLE OF CONTENTS Page Abstract 3 Abrégé 4 • Acknowledgements 5 Dedication 6 Abbreviations 7 Introduction 9 Review ofthe Literature: A. Normal Lung Development 11 B. Normal Diaphragm Development 12 C. Pathophysiology ofCDH 12 D. Animal Models ofCDH 14 E. Prenatal Interventions to Treat CDH 1. Tracheal Occlusion 14 2.
    [Show full text]
  • Prenatal Corticosteroids for Reducing Morbidity and Mortality After Preterm Birth
    PRENATAL CORTICOSTEROIDS FOR REDUCING MORBIDITY AND MORTALITY AFTER PRETERM BIRTH The transcript of a Witness Seminar held by the Wellcome Trust Centre for the History of Medicine at UCL, London, on 15 June 2004 Edited by L A Reynolds and E M Tansey Volume 25 2005 ©The Trustee of the Wellcome Trust, London, 2005 First published by the Wellcome Trust Centre for the History of Medicine at UCL, 2005 The Wellcome Trust Centre for the History of Medicine at UCL is funded by the Wellcome Trust, which is a registered charity, no. 210183. ISBN 978 0 85484 102 8 Histmed logo images courtesy of the Wellcome Library, London. All volumes are freely available online at: www.history.qmul.ac.uk/research/modbiomed/wellcome_witnesses/ Please cite as: Reynolds L A, Tansey E M. (eds) (2005) Prenatal Corticosteroids for Reducing Morbidity and Mortality after Preterm Birth. Wellcome Witnesses to Twentieth Century Medicine, vol. 25. London: Wellcome Trust Centre for the History of Medicine at UCL. CONTENTS Illustrations and credits v Witness Seminars: Meetings and publications; Acknowledgements vii E M Tansey and L A Reynolds Introduction xxi Barbara Stocking Transcript 1 Edited by L A Reynolds and E M Tansey Appendix 1 85 Letter from Professor Sir Graham (Mont) Liggins to Sir Iain Chalmers (6 April 2004) Appendix 2 89 Prenatal glucocorticoids in preterm birth: a paediatric view of the history of the original studies by Ross Howie (2 June 2004) Appendix 3 97 Premature sheep and dark horses: Wellcome Trust support for Mont Liggins’ work, 1968–76 by Tilli Tansey (25 October 2005) Appendix 4 101 Prenatal corticosteroid therapy: early Auckland publications, 1972–94 by Ross Howie (January 2005) Appendix 5 103 Protocol for the use of corticosteroids in the prevention of respiratory distress syndrome in premature infants.
    [Show full text]
  • Antenatal Steroids for Women at Risk of Preterm Delivery
    Revised: November 2020 ANTENATAL STEROIDS FOR WOMEN AT RISK OF PRETERM DELIVERY CHOICE OF AGENT: Two regimens of antenatal glucocorticoid treatment have evolved and are effective for accelerating fetal lung maturity 1. Betamethasone (two doses of 12 mg given intramuscularly 24 hours apart) preferred agent if available. 2. Dexamethasone (four doses of 6 mg given intramuscularly 12 hours apart). GESTATIONAL AGE AT ADMINISTRATION: 1. Administration of steroids for patients with threatened and imminent periviable birth at less than 220/7 weeks is not recommended. 2. Administration of steroids for patients with threatened and imminent periviable birth between 220/7 and 236/7 weeks can be considered after counseling by both MFM and NICU based on existing evidence.1-4 3. All fetuses between 240/7 and 336/7 weeks of gestation at risk of preterm delivery should be considered candidates for antenatal treatment with corticosteroids regardless of membrane status (intact or ruptured). 4. In women with a singleton pregnancy between 340/7 and 366/7 weeks who are at high risk for preterm birth within next 7 days (and before 370/7 weeks of gestation), we recommend treatment with a course of betamethasone (without tocolysis) provided they meet eligibility criteria. a. Inclusion criteria: i. Singleton pregnancy ii. Gestational age at presentation between 340/7 and 366/7 weeks iii. High probability of delivery (any one of the following): 1. Preterm labor with intact membranes and at least 3cm dilation or 75% effacement 2. Delivery expected by induction of labor or cesarean section in no less than 24 hours and no more than 7 days, as deemed necessary by the provider.
    [Show full text]
  • RMHP Perinatal Care Guideline
    Perinatal Care Guideline Gestational Assessments Routine Lab/Diagnostic Routine Patient Education High Risk Lab/ High Risk Counseling Age Procedures Diagnostic Procedure Up to 12 Weeks Screen for Preterm labor (PTL) risk Complete Blood Count or Premature labor signs and symptoms Chorionic villi sampling Domestic Violence factorsat first visit HCT/HGB Appropriate weight gain based on BMI (CVS)if indicated Remain alert for signs Screen for sexually transmitted disease Urinalysis with culture and E x e r c i s e Ultrasound (US) Chronic Hypertension Calculate BMI and set weight gain goals follow up with test for cure if N u t r i t i o n Offer Cystic fibrosis screen Early and frequent visits for pregnancy positive Smoking Cessation - referral to CO Quit Offer nuchal translucency Advise about the adverse effects of smoking and alcohol and drug Assess fundal height measurements, Blood Group & Rh Type Toxoplasmosis measurements and abuse FHT’s, weight, and blood pressure biochemical markers to Antibody screen Communicable diseases Nutritional counseling regarding diet and salt intake Assess for gestational diabetes mellitus detect Down syndrome and Syphilis screen Sexual activity Obesity (GDM) risk factors and screen if high other genetic disorders Cervical Cytology Breastfeeding Importance of optimal weight gain and exercise risk Other genetic testing Hepatitis B Seat belt use during pregnancy Dietician consult as needed Assess oral health and refer for dental Rubella Antibodies Dental hygiene, flossing and
    [Show full text]
  • NICU Data Manual of Definitions
    NICU Data Manual of Definitions 2020 2 Table of Contents Table of Contents ............................................................................................................... 2 Introduction ....................................................................................................................... 12 NICU Data Eligibility ......................................................................................................... 13 NICU Data DRD Form and Admission/Discharge Form ................................................. 17 Demographics ............................................................................................................... 17 Hospital ID [HOSPNO] .............................................................................................. 17 Infant ID [ID] .............................................................................................................. 17 Year of Birth [BYEAR] ............................................................................................... 17 Deleted Flag .............................................................................................................. 17 Item 1. Birth Weight [BWGT] .................................................................................... 17 Item 2. Head Circumference at Birth [BHEADCIR] .................................................. 18 Item 3. Best Estimate of Gestational Age [GAWEEKS], [GADAYS] ....................... 18 Infant's Date and Time of Birth ................................................................................
    [Show full text]
  • WHO Recommendations on Interventions to Improve Preterm Birth Outcomes
    WHO recommendations on interventions to improve preterm birth outcomes For more information, please contact: Department of Reproductive Health and Research World Health Organization ISBN 978 92 4 150898 8 Avenue Appia 20, CH-1211 Geneva 27, Switzerland Fax: +41 22 791 4171 E-mail: [email protected] www.who.int/reproductivehealth WHO recommendations on interventions to improve preterm birth outcomes WHO Library Cataloguing-in-Publication Data WHO recommendations on interventions to improve preterm birth outcomes. Contents: Appendix: WHO recommendations on interventions to improve preterm birth outcomes: evidence base 1.Premature Birth – prevention and control. 2.Infant, Premature. 3.Infant Mortality – prevention and control. 4.Prenatal Care. 5.Infant Care. 6.Guideline. I.World Health Organization. ISBN 978 92 4 150898 8 (NLM Classifi cation: WQ 330)Contents © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
    [Show full text]
  • Corticosteroids Antenatal Use Of
    King Edward Memorial Hospital Obstetrics & Gynaecology CLINICAL PRACTICE GUIDELINE Corticosteroids: antenatal use of This document should be read in conjunction with the Disclaimer Contents Dosage and administration of course of antenatal corticosteroids .. 2 Key points ............................................................................................................... 2 Background information .......................................................................................... 3 Administering corticosteroids to women with Diabetes .................... 4 Glycaemic management when receiving corticosteroids .................. 5 Management of women who have NOT had an Oral Glucose Tolerance Test (OGTT) in pregnancy .............................................................................................. 5 Normal glucose tolerance test ................................................................................. 6 Diet controlled gestational diabetes ........................................................................ 6 Gestational diabetes requiring insulin ..................................................................... 6 Type 1 or type 2 diabetes ....................................................................................... 7 References ............................................................................................ 8 Page 1 of 9 Corticosteroids: Antenatal use of Aim To provide clinical staff with the information necessary to ensure the safe management of women who are receiving corticosteroids
    [Show full text]
  • Pocket Book of Hospital Care for Obstetric Emergencies Including Major Trauma and Neonatal Resuscitation
    POCKET BOOK OF HOSPITAL CARE FOR OBSTETRIC EMERGENCIES INCLUDING MAJOR TRAUMA AND NEONATAL RESUSCITATION © 2014 Maternal & Childhealth Advocacy International (MCAI) This pocketbook is a summary of the emergency components of obstetrics and resuscitation of the newborn infant from our textbook “International Maternal & Childhealth Care. A practical manual for hospitals worldwide”. The reader is referred to the textbook when more details on the medical problem under consideration are required. Editor: David Southall Associate Editors: Alice Clack, Johan Creemers, Angela Gorman, Assad Hafeez, Brigid Hayden, Ejaz Khan, Grace Kodindo, Rhona MacDonald, Yawar Najam, Barbara Phillips, Diane Watson, Dave Woods, Ann Wright. Every effort has been made to ensure that the information in this book is accurate. This does not diminish the requirement to exercise clinical judgement, and neither the publisher nor the authors can accept any responsibility for its use in practice. All rights reserved. The whole of this work, including all text and illustrations, is protected by copyright. No part of it may be copied, altered, adapted or otherwise exploited in any way without express prior permission, unless in accordance with the provisions of the Copyright Designs and Patents Act 1988 or in order to photocopy or make duplicating masters of those pages so indicated, without alteration and including copyright notices, for the express purpose of instruction and examination. No parts of this work may otherwise be loaded, stored, manipulated, reproduced, or transmitted in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without prior written permission from the publisher, on behalf of the copyright owner.
    [Show full text]
  • Fetal-Placental Inflammation, but Not Adrenal Activation, Is Associated
    Research www.AJOG.org OBSTETRICS Fetal-placental inflammation, but not adrenal activation, is associated with extreme preterm delivery Sunita Trivedi, MD; Maria Joachim, BS; Thomas McElrath, MD, PhD; Harvey J. Kliman, MD, PhD; Elizabeth N. Allred, MS; Raina N. Fichorova, MD, PhD; Andrew Onderdonk, PhD; Fernanda Heitor, MD; Leila Chaychi, MD; Alan Leviton, MD; Joseph A. Majzoub, MD; for the Extremely Low Gestational Age Newborns (ELGAN) study investigators OBJECTIVE: Spontaneous labor at term involves the activation of pla- RESULTS: Among infants delivered at less than 28 weeks’ gestation, cental corticotropin-releasing hormone and the fetal adrenal axis, but spontaneous (vs induced) delivery was associated with less placental the basis for extreme preterm labor is unknown. Our objective was to corticotropin-releasing hormone expression and more frequent signs of determine whether placental corticotropin-releasing hormone is acti- placental inflammation and infection. vated in extreme preterm labor. STUDY DESIGN: One thousand five hundred six mothers delivering at less CONCLUSION: Inflammation and infection, rather than premature acti- than 28 weeks’ gestation were enrolled. Each mother/infant pair was as- vation of the fetal adrenal axis, should be the major focus of research to signed to the category that described the primary reason for hospitalization. prevent extremely preterm human birth. Observers who had no knowledge of patient categorization assessed pla- centa microbiology, histology, and corticotropin-releasing hormone expres- Key words: corticotropin-releasing hormone, infection, inflammation, sion. These were correlated with the primary reason for hospitalization. preterm delivery Cite this article as: Trivedi S, Joachim M, McElrath T, et al. Fetal-placental inflammation, but not adrenal activation, is associated with extreme preterm delivery.
    [Show full text]
  • Neonatal Respiratory Distress Syndrome As a Function of Gestational Age and the Lecithin/ Sphingomyelin Ratio Caryn M
    Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 2007 Neonatal Respiratory Distress Syndrome as a Function of Gestational Age and the Lecithin/ Sphingomyelin Ratio Caryn M. St. Clair Yale University Follow this and additional works at: http://elischolar.library.yale.edu/ymtdl Part of the Medicine and Health Sciences Commons Recommended Citation St. Clair, Caryn M., "Neonatal Respiratory Distress Syndrome as a Function of Gestational Age and the Lecithin/Sphingomyelin Ratio" (2007). Yale Medicine Thesis Digital Library. 378. http://elischolar.library.yale.edu/ymtdl/378 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale Medicine Thesis Digital Library by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale. For more information, please contact [email protected]. Neonatal Respiratory Distress Syndrome as a Function of Gestational Age and the Lecithin/Sphingomyelin Ratio A Thesis Submitted to the Yale University School of Medicine in Partial Fulfillment of the Requirement for the Degree of Doctor of Medicine By Caryn M. St. Clair 2007 2 NEONATAL RESPIRATORY DISTRESS SYNDROME AS A FUNCTION OF GESTATIONAL AGE AND THE LECITHIN/SPHINGOMYELIN RATIO Caryn M. St. Clair, Jessica L. Illuzzi, and Errol R. Norwitz. Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT. This study was designed to derive predictive logistic regression equations to allow the risk of neonatal respiratory distress syndrome (RDS) to be defined as a function of both the lecithin/sphingomyelin (L/S) ratio and gestational age.
    [Show full text]
  • In Preterm Babies
    Original Article A study of clinical profile of respiratory distress syndrome(RDS) in preterm babies Sambhaji S Wagh 1, Dee pa S Phirke 2, Sudhakar Bantewad 3* 1Associate Professor, 2Associate Professor, 3Resident, Department of Pediatrics, Government Medical College Miraj, Maharashtra, INDIA. Email: [email protected] Abstract Objective: Study of clinical profile of Respiratory Distress Syndrome in preterm babies. Design: Prospective observational study. Settings: Neonatal Intensive Care unit at tertiary care hospital. Outcome measures: To study role of antenatal steroid, surfactant and a ssisted ventilation in RDS and outcome in terms of morbidity and mortality in preterms with RDS. Results: 150 neonates with gestational age <37wk with diagnosed as RDS as per clinical investigational guidelines were included.97.3% babies received antenatal steroid while 2.7% did not. Out of the babies who received antenatal steroid 80% survived and 20% died. All (100%) who did not receive antenatal steroid died. Out of them 57.3% received surfactant and 42.7% did not receive. Out of babies who received surf actant 88% survived 12% died. Out of babies who did not receive surfactant 64% survived 36% died. All babies (100%) receiving only CPAP (SA score <4) survived. Out of babies receiving both CPAP and surfactant (SA score 4 –7) 98.6% survived and 1.4% died. Al l babies receiving only assisted ventilation for >10 days died. Morbidity in RDS was sepsis 14.66%, PDA 14%, NEC 8.66% and pulmonary hemorrhage 5.33%. At the end of study 118 (78.66%) babies survived while 32(21.33%) died. Conclusion: We conclude that admi nistration of antenatal steroids in pregnant women during preterm delivery significantly improves lung maturity.
    [Show full text]