• Clinical and Experimental Pediatrics
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• v.53 no.1
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• pp.1-6
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• 2010

Transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and persistent pulmonary hypertension of the newborn (PPHN) are the three most common disorders that cause respiratory distress after birth. An understanding of the pathophysiology of these disorders and the development of effective therapeutic strategies is required to control these conditions. Here, we review recent papers on the pathogenesis and treatment of neonatal respiratory disease.

• Neonatal Medicine
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• v.25 no.2
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• pp.66-71
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• 2018

Purpose: Respiratory morbidity is the most common problem among neonates admitted to neonatal intensive care units. Therefore, the aim of this study was to make a differential diagnosis between transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and pneumonia through comparison of clinical features and test results. Methods: This retrospective study was conducted in 86 infants with TTN, RDS, or pneumonia. These were infants who had respiratory distress, were born after ${\geq}34$ weeks of gestation, and transferred to the neonatal intensive care unit of Kosin University Gospel Hospital between June 1, 2011 and June 30, 2016. Results: The numbers (percentage) of infants with TTN, RDS, and pneumonia were 51 (59.3%), 20 (23.3%), and 15 (17.4%), respectively. Late-preterm and early-term newborns accounted for 65.1% of the infants. Tachypnea was observed in 74.4% of the neonates. The median age at admission was 4 hours (0 to 116) after birth. The infants with RDS had significantly lower birth weights, pH levels, base excess and oxygen saturation levels at admission, longer duration of total ventilator therapy, and hospital stay than those in the other two groups. The infants with pneumonia showed significantly high initial high-sensitivity C-reactive protein levels and significant chest radiographic findings. Conclusion: Early differential diagnosis for TTN, RDS, and pneumonia is challenging because they show similar respiratory symptoms at an early stage. Clinical features and test results can be used to determine the etiology of respiratory distress and early antibiotic treatment.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.38-42
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• 1999

Background: In neonatal respiratory distress syndrome patients, various types of pulmonary air leak contributes to elevate morbity and mortality. Although early surgical interventions can provide better results in several cases, whole clinical outcomes are poor. This study was designed to investigate the clinical aspects of pulmonary air leak in the neonatal respiratory distress syndrome patients and major contributing factors to mortality. Material and Method : We retrospectively evaluated 48 cases of pulmonary air leak in the neonatal respiratory distress syndrome patients from September 1994 to May 1997. Result: There were 15 cases of primary and 33 cases of secondary pulmonary air leakages. The prominent manifestations were pure interstitial emphysema in 19 cases(39.9%) and combined pneumothorax in 19 cases(39.9%). In clinical aspects, normal birth weight was dominant(83.4%), the onset occurred within 24 hours was in 28 cases(58.8%). The pulmonary diseases were meconium aspiration syndrome(25.2%) and hyaline membrane disease(33.2%). The overall hospital mortality was 25.2%, and the majority were hyaline membrane diseases. Conclusion: Although the overral mortality rate of these diseases were high, more detailed studies about immediate treatement, perinatal prevention, intensive care to geriatric problems were needed individually to improve outcomes.

• Tuberculosis and Respiratory Diseases
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• v.40 no.2
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• pp.91-97
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• 1993

Pulmonary surfactant is a lipoprotein complex composed primarily of phospholipid and lung specific apoproteins that reduces surface tension in the alveolus and maintains alveolar stability at low lung volume. Adult respiratory distress syndrome still carries a very high morbidity and mortality. The surfactant system is vital to the maintenance of proper lung function, any type of surfactant deficiency, whether primary or secondary, will contribute significantly to the development of pulmonary pathophysiology. Various mechanisms in adult respiratory distress syndrome may be responsible for such alterations in the surfactant system. Surfactant replacement is now an established treatment for neonatal respiratory distress syndrome, reducing both incidence of complications and mortality. With the current knowledge of surfactant physiology and the pathophysiology of the adult respiratory distress syndrome exogenous surfactant treatment or stimulation of endogenous surfactant synthesis and secretion will prove to be beneficial in preventing and treating the adult respiratory distress syndrome. The study of clinical surfactant therapy for adult respiratory distress syndrome is just beginnig and this can be viewed as an area with exciting potential. As soon as surfactant preparations become more widely available trials should begin to define the role of surfactant treatment in the adult respiratory distress syndrome as an adjunct to available treatment techniques.

• Neonatal Medicine
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• v.16 no.2
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• pp.101-109
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• 2009

Pulmonary surfactant (PS) therapy in premature infants has a remarkable impact on improving survival and outcomes in neonatal respiratory distress syndrome (RDS). Early PS therapy involves instillation of PS upon delivery of very premature infants or if there is evidence of RDS, such as an increased requirement of oxygen 2 hours after birth, especially in infants <30 weeks gestation. Early PS treatment in very premature infants results in a significant reduction in the severity of RDS, mortality, and incidence of pneumothorax, pulmonary interstitial emphysema, and bronchopulmonary dysplasia in comparison with late PS treatment. According to European and American consensus guidelines on the management of neonatal RDS, early PS instillation should be considered for infants <30 weeks gestation, infants with a birth weight <1,250 g, or if the mother has not received antepartum corticosteroids. We suggest that the Korean health insurance policy on RDS be modified so that PS can be used for better clinical outcomes of very premature infants.

• Journal of Yeungnam Medical Science
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• v.35 no.2
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• pp.187-191
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• 2018

Background: Respiratory distress syndrome (RDS) is a one of the most common cause of respiratory morbidity and mortality in neonates. This study was conducted to investigate the risk factors for RDS in full-term neonates. Methods: We conducted this retrospective study using medical records. The study group included 80 full-term neonates diagnosed with RDS and hospitalized in the neonatal intensive care unit between January 2012 and December 2016, at Yeungnam University Hospital. We analyzed sex, gestational age, birth weight, delivery method, maternal age, number of pregnancy, history of abortion, and complication of pregnancy. The control group included 116 full-time neonates who were hospitalized with jaundice during the same period. Results: The incidence of full-term RDS was more common in males (odds ratio [OR], 3.288; 95% confidence interval [CI], 1.446-7.479), cesarean section (OR, 15.03; 95% CI, 6.381-35.423), multiparity (OR, 4.216; 95% CI, 1.568-11.335). The other factors rendered no significant results. Conclusion: The risk factors for RDS in full-tern neonates were identified as male sex, cesarean section, and multiparity. Further studies involving more institutions are needed to clarify the risk factors for RDS in full-term infants.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.851-854
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• 1987

Congenital diaphragmatic hernia remains a disease with high neonatal mortality rate despite recent advance in neonatal intensive care. We experienced one case of the congenital diaphragmatic hernia with acute respiratory distress and left pulmonary hypoplasia in the neonate. The simple closure was performed through left paramedian approach after diagnosis. The postoperative course was uneventful except wound disruption. The patient was follow-up with good general condition.

• Perinatology
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• v.29 no.4
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• pp.159-164
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• 2018

Objective: To compare neonatal respiratory morbidity of twins according to birth order related to gestational age and mode of delivery. Methods: We performed the retrospective research of the medical records of 3,224 neonates (1,612 twin pairs) born in a single center from January 2011 to December 2015. Subjects were classified into four gestational age groups: very (<32 weeks), moderate (32-33 weeks), late (34-36 weeks) preterm, and term (${\geq}37weeks$) groups. We investigated clinical characteristics and respiratory morbidity according to birth order related to gestational age group and mode of delivery. Results: We found increased risk of respiratory morbidity in second-born twin than first-born twin (P=0.039). Second-born twin was associated with increased risk of respiratory distress syndrome (RDS) in late preterm group (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.30-5.95), and transient tachypnea of newborn in term group (OR 1.4, 95% CI 1.03-1.81). In vaginal delivery mode, there was no difference of respiratory morbidity between first and second-born twin in each group, but in cases of Cesarean delivery, second-born twin was related with a greater risk of RDS in late preterm group (OR 2.3, 95% CI 1.07-5.09). Birth order and Cesarean section independently increased the risk of RDS (adjusted OR [aOR] 1.69, 95% CI 1.12-2.54; aOR 2.14, 95% CI 1.25-3.66, respectively). Conclusion: Second-born twin and Cesarean delivery are associated with increased risk of RDS, especially in late preterm twins.

• Clinical and Experimental Pediatrics
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• v.62 no.5
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• pp.166-172
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• 2019

Purpose: This study aimed to evaluate vitamin D status at birth in very-low-birth-weight infants (VLBWIs: <1,500 g) and to determine the association between vitamin D level and respiratory morbidity. Methods: A retrospective study was conducted at Soonchunhyang University Bucheon Hospital between November 2013 and November 2017. We collected blood samples and data on respiratory morbidity from 230 VLBWIs on the first day of life. Patients who were transferred to other hospitals (n=19), died before 36 weeks of gestational age (n=18), or whose blood samples were not collected immediately after birth (n=5) were excluded. Finally, 188 patients were enrolled. VLBWIs with different vitamin D levels were compared with respect to demographic features, maternal diseases, respiratory morbidities, and other neonatal diseases. Results: The mean serum vitamin D level, as measured by 25-hydroxyvitamin D (25(OH)D), was $13.4{\pm}9.3ng/mL$. The incidence of vitamin D deficiency (<20 ng/mL) was 79.8%, and 44.1% of preterm infants had severe vitamin D deficiency (<10 ng/mL). Logistic analysis shows that a low serum 25(OH)D level (<20 ng/mL) was a risk factor for respiratory distress syndrome (odds ratio [OR], 4.32; P=0.010) and bronchopulmonary dysplasia (OR, 4.11; P=0.035). Conclusion: The results showed that 79.8% of preterm infants in this study had vitamin D deficiency at birth. Low vitamin D status was associated with respiratory morbidity, but the exact mechanism was unknown. Additional studies on the association between vitamin D level and neonatal morbidity are required.

• Journal of Yeungnam Medical Science
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• v.16 no.1
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• pp.52-59
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• 1999

This study was conducted to evaluate the effect of the antenatal ambroxol administration to mothers who were in danger of imminent preterm delivery in preventing the neonatal respiratory distress syndrome(RDS). Forty-two preterm newborn infants who were delivered at Yeungnam University Hospital from January 1996 to December 1997 were divided into two groups, 21 in ambroxol-treated group and 21 in control group. Six cases of the respiratory distress syndrome were developed from 21 ambroxol-treated infants, but 13 cases of RDS, from 21 control infants. This result indicated a significant reduction of the occurrence of RDS by antenatal administration o[ ambroxol (p<0.05). There were no differences in the occurrence of adverse effects of ambroxol in mothers between the two groups. There was also no difference between pre- and post-treatment hematologic and biochemical parameters in ambroxol-treated group. In conclusion, when premature delivery is expected, the administration of ambroxol before delivery enhances lung maturation in premature newborn infants and prevents the occurrence of respiratory distress syndrome without significant adverse effects.