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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