Background Neonatal respiratory distress syndrome (NRDS) is caused by a deficiency in pulmonary surfactant (PS) and is one of the main reasons of neonatal mortality. This study was conducted to evaluate the efficacy...Background Neonatal respiratory distress syndrome (NRDS) is caused by a deficiency in pulmonary surfactant (PS) and is one of the main reasons of neonatal mortality. This study was conducted to evaluate the efficacy and safety of intra-amniotic administration of pulmonary surfactant for prophylaxis of NRDS. Methods Forty-five pregnant women who were due for preterm delivery and whose fetuses’ lungs proved immature were divided into two groups. Fifteen women (study group) were administered one dose of pulmonary surfactant injected into the amniotic cavity and delivered within several hours. Nothing was injected into the amniotic cavity of 30 women of the control group. The proportion of neonatal asphyxia,NRDS,mortality and the time in hospital were analyzed to determine if there was any difference between the two groups. Results There was no significant difference between the two groups for neonatal asphyxia. Foam tests showed that higher proportion of neonates in the study group than in the control group (56.3% vs 13.3%, P <0.05) had lung maturity. A greater number of control neonates (11/30,32.3%) had NRDS,compared with the neonates given PS via the amniotic cavity before delivery (1/16,6.3%, P <0.05). The neonates in the study group spent nearly 10 days less in hospital than the control group [(32.4±7.6) days vs (42.0±15.7) days,P <0.05],but the difference in mortality between the two groups was not statistically significant. Conclusions Intra-amniotic administration of pulmonary surfactant can significantly reduce the proportion of NRDS and the time in hospital of preterm neonates. Whether this method can reduce the mortality of preterm neonates needs to be evaluated further. Intra-amniotic administration of pulmonary surfactant provides an additional effectual means for NRDS prophylaxis.展开更多
The management of preterm prelabor rupture of membranes (PPROM) before 34 weeks of gestation is intractable, due to pulmonary immaturity, many complications, poor pregnancy outcomes. In particular, the pre-viable PPRO...The management of preterm prelabor rupture of membranes (PPROM) before 34 weeks of gestation is intractable, due to pulmonary immaturity, many complications, poor pregnancy outcomes. In particular, the pre-viable PPROM (<23 weeks of gestation) is much more difficult to be treated. The clinical recommendation is to terminate the pregnancy as soon as possible. The pregnancy outcomes of PPROM in the early second-trimester of two twin pregnant women in our hospital were reported to explore the treatment protocols. The pregnancies of the two women developed PROM at 12 and 16 weeks of gestation, respectively. After expectant treatment, they were deliveried successfully at 34+6 and 34+4 weeks of gestation, respectively. The assessment of growth and development of infants was normal during the following six months after birth. Therefore, if PPROM occurs in the early second-trimester of pregnancy, the management of PPROM should be individualized, it’s a long process which should include comprehensive communication between patients and families regarding alternative treatment options (including expectant management) and risks and benefits of the procedure. In the absence of spontaneous labor or occurrence of complications that would prompt delivery (intra-amniotic infection, abruptio placenta, cord prolapse), and fetal status is normal, the patients should proceed with expectant treatment, induction of labor is commonly performed in pregnancies with PPROM ≥34 weeks of gestation.展开更多
文摘Background Neonatal respiratory distress syndrome (NRDS) is caused by a deficiency in pulmonary surfactant (PS) and is one of the main reasons of neonatal mortality. This study was conducted to evaluate the efficacy and safety of intra-amniotic administration of pulmonary surfactant for prophylaxis of NRDS. Methods Forty-five pregnant women who were due for preterm delivery and whose fetuses’ lungs proved immature were divided into two groups. Fifteen women (study group) were administered one dose of pulmonary surfactant injected into the amniotic cavity and delivered within several hours. Nothing was injected into the amniotic cavity of 30 women of the control group. The proportion of neonatal asphyxia,NRDS,mortality and the time in hospital were analyzed to determine if there was any difference between the two groups. Results There was no significant difference between the two groups for neonatal asphyxia. Foam tests showed that higher proportion of neonates in the study group than in the control group (56.3% vs 13.3%, P <0.05) had lung maturity. A greater number of control neonates (11/30,32.3%) had NRDS,compared with the neonates given PS via the amniotic cavity before delivery (1/16,6.3%, P <0.05). The neonates in the study group spent nearly 10 days less in hospital than the control group [(32.4±7.6) days vs (42.0±15.7) days,P <0.05],but the difference in mortality between the two groups was not statistically significant. Conclusions Intra-amniotic administration of pulmonary surfactant can significantly reduce the proportion of NRDS and the time in hospital of preterm neonates. Whether this method can reduce the mortality of preterm neonates needs to be evaluated further. Intra-amniotic administration of pulmonary surfactant provides an additional effectual means for NRDS prophylaxis.
基金National Key Research and Development Program of China(No. 2018YFC1002900)National Natural Science Foundation of China(No. 81671527)。
文摘The management of preterm prelabor rupture of membranes (PPROM) before 34 weeks of gestation is intractable, due to pulmonary immaturity, many complications, poor pregnancy outcomes. In particular, the pre-viable PPROM (<23 weeks of gestation) is much more difficult to be treated. The clinical recommendation is to terminate the pregnancy as soon as possible. The pregnancy outcomes of PPROM in the early second-trimester of two twin pregnant women in our hospital were reported to explore the treatment protocols. The pregnancies of the two women developed PROM at 12 and 16 weeks of gestation, respectively. After expectant treatment, they were deliveried successfully at 34+6 and 34+4 weeks of gestation, respectively. The assessment of growth and development of infants was normal during the following six months after birth. Therefore, if PPROM occurs in the early second-trimester of pregnancy, the management of PPROM should be individualized, it’s a long process which should include comprehensive communication between patients and families regarding alternative treatment options (including expectant management) and risks and benefits of the procedure. In the absence of spontaneous labor or occurrence of complications that would prompt delivery (intra-amniotic infection, abruptio placenta, cord prolapse), and fetal status is normal, the patients should proceed with expectant treatment, induction of labor is commonly performed in pregnancies with PPROM ≥34 weeks of gestation.
