We studied pulmonary function 1 year after neonatal respiratory distress (RD) in 54 infants who had been treated at birth in the same neonatal intensive care unit. RD was related to hyaline membrane disease in 36 cases (group I) and to other causes in 18 cases (group II). Compared with predicted values, dynamic lung compliance (CL) was lower (less than -2 SD) and total pulmonary resistance (RL) was higher (+2 SD) in 18 (33%) and 12 (22%) infants, respectively. The relationships between these functional abnormalities at 1 year of age and the characteristics of the neonatal respiratory disease were assessed using a multifactorial analysis (multiple correspondences analysis). We found that elevated RL (greater than +2 SD) at 1 year of age was very significantly related with hyaline membrane disease, involving both high rate of positive pressure ventilation and prolonged intubation, and with the presence of both tachypnea and abnormal chest X rays at the time of discharge. Compared with elevated RL, the relationships between low CL (less than -2 SD) and the same neonatal characteristics were less significant; in particular, there was no strong link between low CL and hyaline membrane disease. Finally, birth before 30 weeks gestation was an index of severity.
The very early establishment of certain sensory faculties turns the fetus into a being capable of perceiving multiple stimuli. This perceptive capability forms part of many interchanges between the mother and her developing child. These interchanges are doubtless not only biological and metabolic in nature, but also sensorial and sensitive. The importance of a good quality of psychoaffective communication between mother and child during pregnancy has been shown to be decisive for fetal growth and also for the perinatal period and further development of the child. Maternal psychological stress leads to adverse pregnancy outcome. Chronic anxiety causes an increased stillbirth rate, fetal growth retardation and altered placental morphology. Experimental studies have demonstrated a relationship between specific episodes of maternal psychological stress and exacerbation of fetal asphyxia in utero. It is concluded that all the psychoaffective interchanges between the mother and child are decisive for harmonious fetal growth and brain development.
This prospective study was designed to assess pulmonary function (functional residual capacity, FRC; dynamic lung compliance, C<sub>Ldyn</sub>; and total pulmonary resistance, R<sub>L</sub>) at 1 year of corrected age in infants with neonatal respiratory distress syndrome treated with natural porcine surfactant (Curosurf) (n = 13), as compared to nontreated control infants (n = 9). Values from 21 healthy infants of similar age served as reference. We found similar pulmonary dysfunction (decreased C<sub>Ldyn’</sub> elevated R<sub>L</sub>) in both patient groups. These results suggest that surfactant replacement therapy does not affect pulmonary function at 1 year of age in infants who survive respiratory distress syndrome.
There is now convincing evidence that the severity of neonatal respiratory distress syndrome can be reduced by surfactant replacement therapy; however, the optimal therapeutic regimen has not been defined. This randomized European multicenter trial was designed to determine whether the beneficial effects of a single large dose of Curosurf (200 mg/kg) in babies with severe respiratory distress syndrome (arterial to alveolar oxygen tension ratio approximately 0.10) could be enhanced by using multiple doses of surfactant. Preterm neonates (birth weight 700 to 2000 g) with severe respiratory distress syndrome requiring artificial ventilation with fraction of inspired oxygen greater than or equal to 0.6 were randomized into two groups at an age of 2 to 15 hours. Both groups received the usual dose of Curosurf (200 mg/kg) immediately after randomization. In neonates randomized to receive multiple-dose treatment, two additional doses of Curosurf (100 mg/kg each) were instilled into the airways (12 and 24 hours after the initial dose) provided that the patients still needed artificial ventilation with fraction of inspired oxygen greater than 0.21. In both groups (single dose: n = 176, multiple doses: n = 167) there was a rapid improvement in oxygenation as reflected by a threefold increase in arterial to alveolar oxygen tension ratio within 5 minutes after surfactant instillation (P less than .001), and peak inspiratory pressure and mean airway pressure could be reduced significantly during the first 6 hours after surfactant treatment. In addition, ventilatory requirement (peak inspiratory pressure, ventilatory efficiency index) was reduced in the multiple-dose group 2 to 4 days after randomization (P less than .05 to .01).(ABSTRACT TRUNCATED AT 250 WORDS)
Serum angiotensin I-converting enzyme activity (SCEA) was investigated in 15 healthy premature (gestational age ranging from 30 to 36 weeks) and in 14 healthy full-term (gestational age ranging from 37 to 41 weeks) newborns as well as in 16 healthy adults (32.0 ± 2.6 years). SCEA mean values in the three groups, respectively, 23.3 ± 1.3, 24.4 ± 1.6 and 23.2 ± 1.7 n<i>M</i>·min<sup>––</sup><sup>1</sup>·ml<sup>––1</sup>, did not differ significantly from each other and in the newborns there was no correlation between SCEA values and gestational age.
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