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Objectives of the studyObjectives of the study
To study the severe newborn’s To study the severe newborn’s
respiratory diseases, especially RDS.respiratory diseases, especially RDS.
To know about relationship of To know about relationship of
gestational age, body weight of gestational age, body weight of
newborns and RDS.newborns and RDS.
To evaluate the effectiveness of To evaluate the effectiveness of
antibiotic treatment in severe antibiotic treatment in severe
newborn’s respiratory diseases.newborn’s respiratory diseases.
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Study designStudy design
۞30 newborns in Neonatal Department 30 newborns in Neonatal Department
and Neonatal Intensive Care Unit, and Neonatal Intensive Care Unit,
Thushinskaya Children Hospital.Thushinskaya Children Hospital.
۞Data collected from January 2008 to Data collected from January 2008 to
February 2008.February 2008.
۞Data included both male and female, Data included both male and female,
Preterm and term newborns.Preterm and term newborns.
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Frequency of Respiratory Distress Frequency of Respiratory Distress SyndromeSyndrome
RDS has been reported in all races worldwide, RDS has been reported in all races worldwide,
especially in premature infants.especially in premature infants.
RDS affects about 1% of newborn infants and is RDS affects about 1% of newborn infants and is
the leading cause of death in preterm infants.the leading cause of death in preterm infants.
In US, RDS occurs in 20,000- 30,000 newborns In US, RDS occurs in 20,000- 30,000 newborns
each yeareach year
50% of RDS occurs at 26-28wks of gestation50% of RDS occurs at 26-28wks of gestation
<30% of RDS occurs at 30-31wks of gestation<30% of RDS occurs at 30-31wks of gestation
RDS is encountered less frequently in the RDS is encountered less frequently in the
developing countries, because most deliveries developing countries, because most deliveries
occur at home and accurate records are occur at home and accurate records are
unavailable.unavailable.
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Percentage of Term and Preterm newborn Percentage of Term and Preterm newborn
Total 30 patients: Boys 20(67%) & Girls 10(30%)
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Body weight of patients6
Pathologic events in RDSPathologic events in RDSRosario N. Santos--Chua, et al , UpToDate, 2009.
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Investigation of Respiratory Distress Investigation of Respiratory Distress Syndrome in newbornSyndrome in newborn
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Radiographic appearance of Radiographic appearance of children in Respiratory Distress children in Respiratory Distress
SyndromeSyndrome
• The chest radiograph demonstrates low lung volume and The chest radiograph demonstrates low lung volume and the characteristic diffuse reticulogranular ground-glass the characteristic diffuse reticulogranular ground-glass appearance with air bronchograms. appearance with air bronchograms.
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Differential Diagnosis of Differential Diagnosis of Respiratory Distress SyndromeRespiratory Distress Syndrome
• Transient Tachypnea of NewbornTransient Tachypnea of Newborn
• Bacterial pneumoniaBacterial pneumonia
• Aspiration syndrome e.g. MeconiumAspiration syndrome e.g. Meconium
• Pulmonary air leaks e.g. PneumothoraxPulmonary air leaks e.g. Pneumothorax
• Congenital anomaliesCongenital anomalies
• Diaphragmatic HerniaDiaphragmatic Hernia
• Cardiac anomaliesCardiac anomalies
• AnemiaAnemia
• HypoglycemiaHypoglycemia
• HypothermiaHypothermia
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Treatment of Respiratory Distress Syndrome
Surfactant therapy
CPAP and Mechanical Ventilation
Inhaled Nitric Oxide
Antenatal, natal and postnatal
corticosteroids
Supportive care
Surfactant therapy
CPAP and Mechanical Ventilation
Inhaled Nitric Oxide
Antenatal, natal and postnatal
corticosteroids
Supportive care
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Surfactant therapySurfactant therapy
Alveofact, Curosurf, Infasurg, Survanta Alveofact, Curosurf, Infasurg, Survanta CurosurfCurosurf
Dosage: Intratracheal: Initial: 2.5 Dosage: Intratracheal: Initial: 2.5
mL/kg/dose (200 mg/kg/dose); may repeat 1.25 mL/kg/dose (200 mg/kg/dose); may repeat 1.25
mL/kg/dose (100 mg/kg/dose); at 12-hour mL/kg/dose (100 mg/kg/dose); at 12-hour
intervals for up to 2 additional doses; maximum intervals for up to 2 additional doses; maximum
total dose: 5 mL/kg.total dose: 5 mL/kg.
CurosurfCurosurf
It produces rapid improvements in lung It produces rapid improvements in lung
oxygenation and compliance that may require oxygenation and compliance that may require
immediate reductions in ventilator settings and immediate reductions in ventilator settings and
FiO2.FiO2.
Alveofact, Curosurf, Infasurg, Survanta Alveofact, Curosurf, Infasurg, Survanta CurosurfCurosurf
Dosage: Intratracheal: Initial: 2.5 Dosage: Intratracheal: Initial: 2.5
mL/kg/dose (200 mg/kg/dose); may repeat 1.25 mL/kg/dose (200 mg/kg/dose); may repeat 1.25
mL/kg/dose (100 mg/kg/dose); at 12-hour mL/kg/dose (100 mg/kg/dose); at 12-hour
intervals for up to 2 additional doses; maximum intervals for up to 2 additional doses; maximum
total dose: 5 mL/kg.total dose: 5 mL/kg.
CurosurfCurosurf
It produces rapid improvements in lung It produces rapid improvements in lung
oxygenation and compliance that may require oxygenation and compliance that may require
immediate reductions in ventilator settings and immediate reductions in ventilator settings and
FiO2.FiO2.
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Surfactant versus placebo treatmentSurfactant versus placebo treatmentfrom Liechty EA; et al, July 1991.
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Differences between the percentage of Differences between the percentage of following cases in Newborn’s Department and following cases in Newborn’s Department and
NICUNICU
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Antibiotics in NICU(N=21)
Antibiotics in Newborn Department
(N=9)
Antibiotics in Newborn department
after treated from NICU (N=21)
Netilmicin (Нетилмицин) 13 Cefotaxime (Клафоран) 8 Ceftriaxone 10Ceftriaxone (Роцефин) 13 Fluconazole 2 Ciprofloxacin 8Ciprofloxacin (Ципробай) 10 Amikacin 1 Fluconazole 7Vancomycin (Ванкомицин) 6 Netilmicin 4Fluconazole (Дифлюкан) 6 Vancomycin 2Metronidazole (Метрогил) 5 Metronidazole 2Ceftazidime (Фортум) 4 Ceftazidime 1Rifampicin (Рифампицин) 3 Imipenem (Имипенем) 1Amikacin (Амикацин) 3 Imipenem+Cilastatin (Тиенам) 1 Linezolide (Линизолед) 1
Antibiotic usage for newborn’s 3 Antibiotic usage for newborn’s 3 diseases in following departmentdiseases in following department
*3 diseases are Aspiration pneumonia, Respiratory distress syndrome & Congenital pneumonia. Pt.no= Patient’s number
Pt.no
Pt.no
Pt.no
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Differences between antibiotics Differences between antibiotics combination in Newborn Department, combination in Newborn Department,
Newborn Department after treated from Newborn Department after treated from NICU and NICUNICU and NICU
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Combine antibiotic treatment according to following diseases
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CPAP and Mechanical VentilationCPAP and Mechanical Ventilation19
Duration of stay in Neonatal Intensive Care Duration of stay in Neonatal Intensive Care Unit and Newborn’s departmentUnit and Newborn’s department
NICU Newborn’s department
duration
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Conclusion1.1.According to my study results, aspiration pneumonia is one of the According to my study results, aspiration pneumonia is one of the
common cause of newborns admission in Neonatal Intensive Care Unit and common cause of newborns admission in Neonatal Intensive Care Unit and
Newborn’s department, but RDS is common among preterm newborn. Newborn’s department, but RDS is common among preterm newborn.
2.2.Antibiotic is one of the best treatments for aspiration pneumonia, Antibiotic is one of the best treatments for aspiration pneumonia,
congenital pneumonia and some cases of respiration distress syndrome. congenital pneumonia and some cases of respiration distress syndrome.
3.3.The amount and duration of antibiotic depends on the diagnosis and The amount and duration of antibiotic depends on the diagnosis and
severity of newborn. Most of the cases in NICU need 2 or more combine severity of newborn. Most of the cases in NICU need 2 or more combine
antibiotics, but in Newborn’s department could be successfully treat with antibiotics, but in Newborn’s department could be successfully treat with
1-2 antibiotics.1-2 antibiotics.
4.4.Finally the general principles of neonatal care and a team approach Finally the general principles of neonatal care and a team approach
should be applied to maximize the occurrence of good short-term and should be applied to maximize the occurrence of good short-term and
long-term outcomes.long-term outcomes.
1.1.According to my study results, aspiration pneumonia is one of the According to my study results, aspiration pneumonia is one of the
common cause of newborns admission in Neonatal Intensive Care Unit and common cause of newborns admission in Neonatal Intensive Care Unit and
Newborn’s department, but RDS is common among preterm newborn. Newborn’s department, but RDS is common among preterm newborn.
2.2.Antibiotic is one of the best treatments for aspiration pneumonia, Antibiotic is one of the best treatments for aspiration pneumonia,
congenital pneumonia and some cases of respiration distress syndrome. congenital pneumonia and some cases of respiration distress syndrome.
3.3.The amount and duration of antibiotic depends on the diagnosis and The amount and duration of antibiotic depends on the diagnosis and
severity of newborn. Most of the cases in NICU need 2 or more combine severity of newborn. Most of the cases in NICU need 2 or more combine
antibiotics, but in Newborn’s department could be successfully treat with antibiotics, but in Newborn’s department could be successfully treat with
1-2 antibiotics.1-2 antibiotics.
4.4.Finally the general principles of neonatal care and a team approach Finally the general principles of neonatal care and a team approach
should be applied to maximize the occurrence of good short-term and should be applied to maximize the occurrence of good short-term and
long-term outcomes.long-term outcomes.
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