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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Prenatal and postnatal risk factors for developing bronchopulmonary dysplasia


Aim. To determine prenatal and postnatal risk factors for developing bronchopulmonary dysplasia in infants < 30 weeks of gestational age.
Methods. Over a 22-month period, 115 newborns were enrolled in the study. Details including gestational age, sex, birth weight, prenatal steroids, surfactant treatment, ventilatory support, days of postnatal oxygen requirement, late onset sepsis/pneumonia, air leaks, patency of ductus arteriosus, and fluid intake were collected. The presence of chorioamnionitis was diagnosed by histological examination. Commercial ELISA kits were used for the determination of the IL-6 and IL-8 levels.
Results. Twenty-five infants developed BPD and 90 were enrolled in the non BPD group. Lower gestational age and male sex increased the risk for BPD. There was no difference in the presence of chorioamnitis and the level of IL-6 and IL-8 measured in cord blood and gastric aspirate between the groups. Intubation in the delivery room (resuscitation), need for surfactant treatment, mechanical ventilation, late onset sepsis/pneumonia, increased oxygenation index increased the risk for BPD after adjustment for GA and gender.
Conclusion. In our cohort of infants with GA < 30 weeks exposure to prenatal inflammation did not increase the risk for BPD. However, low gestational age, male sex, need for resuscitation, mechanical ventilation and late onset sepsis were major risk factors for BPD development.

Key words: premature infant, bronchopulmonary dysplasia, respiratory distress syndrome, chorioamnionitis, interleukin 6, interleukin 8

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Surfactant administration in premature infants with RDS


Background. The significant advancement in the treatment of respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancement in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants.
Patients and methods. We analyzed data of 78 preterm babies with respiratory distress syndrome hospitalized in the NICU of the Pediatric Clinic, KCU Sarajevo. All children included in the study were mechanically ventilated and treated with one or more doses of bovine surfactant (Survanta) as rescue therapy. Surfactant was given to children with clinical and radiological signs of RDS, who required FiO2>0,40. We used the standard procedure of giving surfactant therapy to intubated children in sterile conditions, after we confirmed, by X-ray, correct tube placement.
Results. We investigated the clinical efficacy of surfactant in relation to time of administration, O2 requirement and necessity of one or more doses of surfactant. We found that early treatment with surfactant replacement- within 6 hours of birth- is more effective, and resulted in a significant reduction of mortality rate (p<0,01). Treatment with multiple doses is more effective in comparison to one dose, although there was not a significant difference (p<0,20) between the treated groups. There is a significant difference (p<0,01) between groups related to O2 requirement. In the group of babies which required 60% or more O2 concentration in inhaled air at the time of surfactant replacement, mortality rate was significantly higher (p<0,01).
Conclusion. Our study confirmed the benefits of surfactant therapy in preterm babies with respiratory distress syndrome. We confirmed the advantages of early treatment vs. late treatment, but we could not confirm the obvious advantage of multiple over single doses. So, a reasonable recommendation is to treat the infants as soon as clinical signs of developing respiratory distress appear with an individual dose for each infant.

Key words: respiratory distress syndrome, surfactant, preterm

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