DOCSLIB.ORG

Lung Growth and Lung Function Alter A) Fetal Lamb Tracheal Occlusion

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read 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. Glucocorticoids 16 F. Postnatal Interventions to Treat CDH • 1. Exogenous Surfactant At Birth 17 2. Selective Pulmonary Distention as a Means ofAccelerating Lung Growth 19 G. What Remains to Be Done 21 Materials and Methods 23 Results 34 Conclusion 38 Summary 43 References 44 Tables 54 Figures 56 • 2 ABSTRACT: This study sought to maximize prenatal and postnatal interventions in order to accelerate lung growth and improve lung function in two animal models. Prenatal • interventions consisted of fetal tracheal occlusion (TO), antenatal glucocorticoids and exogenous surfactant at birth (SURF) in an ovine model of congenital diaphragmatic hemia (CDH). CDH, CDH+TO, CDH+SURF, CDH+TO+SURF and unoperated twin control lambs were compared. Prenatal growth of both lungs was accelerated after fetal TO. Prophylactic surfactant did not improve gas exchange or ventilation but did increase lung compliance over 8 hours. The incidence of tension pneumothoraces was slightly decreased after exogenous surfactant. Fetal TO yields the best results in terms of overall postnatallung function, likely acting via surfactant independent mechanisms. Postnatal intervention involved perfluorocarbon (PFC) liquid distention of the right upper lobe in healthy newbom piglets. Postnatal lung growth, as measured indirectly by rates ofDNA synthesis, was not accelerated after PFC distention. • • 3 ABRÉGÉ Cette étude utilise des thérapies pré- et post-natales dans le but d'accélerer la croissance pulmonaire tout en améliorant la fonction pulmonaire dans 2 modèles • animaux. Dans un premier temps, les effets de diverses therapies pré-natales, dont l'occlusion de la trachée foétale (OT) et l'administration anténatale de glucocorticoides et de surfactant (SURF), a été étudiée dans un modèle ovin de hernie diaphragmatique congénitale (HDC). Cinq groupes expérimentaux ont été comparés: (a) HDC, (b) HDC+OT, (c) HDC+SURF, (d) HDC+TO+SURF et (e) un groupe contrôle. Seule l'OT, et non le traitment avec du surfactant, a accéleré la croissance pulmonaire. Malgré l'addition de surfactant, seulement la compliance pulmonaire, et non l'échange gazeux ni la ventilation, s'est amélioré au cours d'une période de huit heures. L'incidence de pneumothorax est un peu moins après le surfactant. L'OT produit les meilleurs résultats en ce qui concerne la fonction pulmonaire postnatale. On croit que des mécanismes indépendants du surfactant sont responsables de ces améliorations. Dans un deuxième temps, nous avons utilisé une thérapie post-natale dans le but d'accélerer la croissance pulmonaire. La distension du lobe supérieur droit (LSD) a été accomplie avec le liquide perfluorocarbon (PFC). Le taux de synthèse d'ADN n'a pas augmenté de façon significative après ce traitement. 4 ACKNOWLEDGEMENTS l would like to thank the following individuals for their invaluable help over the last year: • Dr. Hélène Flageole and Dr. Jean-Martin Laberge, my supervisors, for their constant encouragement, incredible support and infectious enthusiasm throughout the year. Their ability to transform potentially frustrating research experiments into an extremely enjoyable and rewarding experience is remarkable and highly commendable! Dr. Bruno Piedboeuf and Stéphane Guay for their work on the molecular aspects of this project Dr. Lajos Kovacs and Dr. Daniel Faucher for attending the numerous lamb resuscitations and providing expert advice on neonatal anaesthesia, ventilation and surfactant administration Steve, Anie, Diana and Cynthia, the animal care technicians at the MacIntyre Animal • Ressource Centre, for their help with the lamb experiments throughout the year Dr. Ioana Bratu for developing the resuscitation protocol in the CDH lamb and generating the data on three ofthe experimental groups Dr. Aurore Côté and Brian Meehan for their expert advice and assistance with the piglet model Dr. Xinying He for paraffin embedding, cutting and H & E staining the lung tissue from both animaIs Dr. David Bjarneson from BLES Biochemicals Inc. for graciously donating the BLES surfactant The Division ofGeneral Surgery at the University ofWestem Ontario for allowing me to • pursue my research year at the Montreal Children's Hospital 5 DEDICATION To Sean, whom l love very much and who never let the 401 come between us! • • 6 ABBREVIATIONS AaDOz = alveolar-arterial oxygen gradient • ABG = arterial blood gas BAL = bronchoalveolar lavage CDH = congenital diaphragmatic hernia CMV = conventional mechanical ventilation CPM = counts per minute DBP = diastolic blood pressure ECMO or ECLS = extracorporeal membrane oxygenation or life support ET = endotracheal FiOz = fraction ofinspired oxygen HR = heart rate • lM = intramuscular IV = intravenous LPS = left posterior segment ofleft upper lobe LIS ratio = lecithin-sphingomyelin ratio LUL = left upper lobe LW/BW ratio = lung weight-to-body weight ratio MAP = mean arterial pressure MTBD = mean terminal bronchiole density MVI = modified ventilatory index NaHC03 = sodium bicarbonate 01 = oxygenation index • PaCOz = partial pressure ofarterial carbon dioxide 7 Pa02 = partial pressure ofarterial oxygen • Paw = airway pressure PEEP = positive end-expiratory pressure PFC = per:tluorocarbon liquid PIP = peak inspiratory pressure PPHN = persistent pulmonary hypertension RPS = right posterior segment ofright upper lobe RR = respiratory rate RUL = right upper lobe Sa02 = arterial oxygen saturation SBP = systolic blood pressure SEM = standard error ofthe mean • SURF = surfactant VEI = ventilatory efficiency index TO = tracheal occlusion • 8 INTRODUCTION: Congenital diaphragmatic hernia, or CDH, remams a challenging neonatal condition to treat succesfully. CDH occurs in 1 in 2000-4000 live births (1-2). It • manifests around the 10th week of gestation when the fetal diaphragm fails to develop properly. Persistent communication between the fetal chest and abdominal cavity results, allowing intestinal contents to remain in the chest for the duration of the pregnancy. Growth of both lungs is then limited by lack of intrathoracic space. At birth, the CDH fetus possesses small, immature lungs which have difficulty adapting to extra-uterine life. Acute respiratory failure often develops with death occuring in 30-50% ofthese neonates (3). Despite many advances in neonatal care, mortality rates have remained at these e1evated levels. Prenatal ultrasound can diagnose fetuses with CDH in up to 93% of cases (4) and as early as the 16th week of gestation (5). If the mother e1ects to continue with the pregnancy, postnatal treatment with or without prenatal intervention is possible. Standard postnatal care involves the use of mechanical ventilation, either conventional (CMV) or high frequency (HFV), with or without nitric oxide (NO) followed by delayed repair of • the diaphragmatic defect (6-12). Extracorporeal membrane oxygenation (ECMO) may also be required and can increase survival in selected patients (13-17). However, ECMO is limited in that it cannot increase lung growth and the morbidity and mortality associated with ECMO remains significant (18). Liquid distention, using perfluorocarbon (PFC) liquid, is hypothesized to accelerate postnatal lung growth via stretch induced mechanisms. For CDH neonates, increased lung growth could translate into decreased time spent on ECMO with subsequent decreases in associated morbidity and mortality. Postnatal distention could be offered to those newboms with CDH who were never diagnosed prenatally and consequently, could never be offered fetal surgery. Prenatal intervention, in the form of fetal surgery, is only indicated for poor prognosisCDH babies i.e. those diagnosed prior to 25 weeks gestation with liver hemiation into their chest and a lung-head ratio less than 1 (19-20). Although in utero repair of the diaphragmatic defect has been attempted (21-22),
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]
  • 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]
  • Management of Labor
    Health Care Guideline Management of Labor How to cite this document: Creedon D, Akkerman D, Atwood L, Bates L, Harper C, Levin A, McCall C, Peterson D, Rose C, Setterlund L, Walkes B, Wingeier R. Institute for Clinical Systems Improvement. Management of Labor. Updated March 2013. Copies of this ICSI Health Care Guideline may be distributed by any organization to the organization’s employees but, except as provided below, may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc. If the organization is a legally constituted medical group, the ICSI Health Care Guideline may be used by the medical group in any of the following ways: • copies may be provided to anyone involved in the medical group’s process for developing and implementing clinical guidelines; • the ICSI Health Care Guideline may be adopted or adapted for use within the medical group only, provided that ICSI receives appropriate attribution on all written or electronic documents and • copies may be provided to patients and the clinicians who manage their care, if the ICSI Health Care Guideline is incorporated into the medical group’s clinical guideline program. All other copyright rights in this ICSI Health Care Guideline are reserved by the Institute for Clinical Systems Improvement. The Institute for Clinical Systems Improvement assumes no liability for any adap- tations or revisions or modifications made to this ICSI Health Care Guideline. www.icsi.org Copyright © 2013 by Institute for Clinical Systems Improvement Health Care Guideline and Order Set: Management of Labor 1 Pregnant patient > 20 Text in blue in this algorithm weeks with symptoms indicates a linked corresponding of labor Fifth Edition annotation.
    [Show full text]