Neonatal lung disease

Robertson, B., Johansson, J., and Cur-STEDT, T. Synthetic surfactants to treat neonatal lung disease. Mol. Med. Today 2000, 6, 119-124. 

Gross I, Moya FR. Is there a role for antenatal TRH therapy for the prevention of neonatal lung disease Semin Perinatol 2001 25(6) 406-16. 

Neonatal Lung Disease and Subsequent Airway Function... 

Stahlman, M. T. (1984). Chronic lung disease following hyaline membrane disease. In "Neonatal Medicine" (L. Stern and P. Vert, eds.), pp. 454-4 73. Masson, New York. 

In an analysis of 595 preterm infants born at 26-32 weeks gestation during a randomized controlled trial for the prevention of lung disease, glucocorticoids given to women at risk of preterm delivery promoted fetal lung maturation, reduced the incidence of respiratory distress syndrome, and reduced neonatal morbidity and mortality (370). Dexamethasone was given as either two doses of 12 mg 24 hours apart or four doses of 6 mg every 6 hours. Mortality was 9.2% after three or more courses, compared with 4.8% after one or two courses. This association was not explained by other factors (maternal or other common preterm morbidities). 

Garland JS, Alex CP, Pauly TH, Whitehead VL, Brand J, Winston JF, Samuels DP, McAuliffe TL. A three-day course of dexamethasone therapy to prevent chronic lung disease in ventilated neonates a randomized trial. Pediatrics 1999 104(1 Part 1) 91—9. 

Robinson MJ, Campbell F, Powell P, Sims D, Thornton C. Antibody response to accelerated Hib immunisation in preterm infants receiving dexamethasone for chronic lung disease. Arch Dis Child Fetal Neonatal Ed 1999 80(1) F69-71. 

Banks BA, Macones G, Cnaan A, Merrill JD, Ballard PL, Ballard RA. North American TRH Study Group. Multiple courses of antenatal corticosteroids are associated with early severe lung disease in preterm neonates. J Perinatol 2002 22(2) 101-7. 

There are also several examples of natural surfactants and foams in the human body. The understanding of the pulmonary surfactant system, although discovered in 1929, has only been applied clinically since about 1990 for the treatment of respiratory distress syndrome. Surfactant replacement therapy may also be used in treating other forms of lung disease, such as meconium aspiration syndrome, neonatal pneumonia and congenital diaphragmatic hernia [881]. Lung surfactant, composed of phospholipids and proteins [882,883], is necessary to maintain a low surface tension at the alveolar air-liquid interface. When there is a deficiency of surfac-... 

In a randomized trial in 248 neonates older than 34 weeks of gestation, 126 of whom received nitric oxide, treatment with nitric oxide afforded no protection against neurodevelopmental abnormalities (12). The only benefits conferred by inhaled nitric oxide treatment in 42 preterm neonates was a reduction in the incidence of chronic lung disease along with improvement in oxygenation (13) and significant reductions in oxygenation index, duration of ventilation, and stay in neonatal ICU (14). 

In an acute experiment, infusion of fat emulsion (Intrahpid) for 60 minutes (mean dose 0.07-0.16 g/kg/ hour) in neonates with lung disease was found to lead consistently to a 10% fall in transcutaneous PO2 (transcutaneous oxygen tension). There was no change in PCO2. This is evidence that Intralipid contributes to the hjrpoxia of respiratory distress in neonates it should be used with caution in this group, and not at all in infants with pulmonary disease (14). 

Zar HI, Weinberg EG, Binns HI, GaUie F, Mann MD. Lung deposition of aerosol—a comparison of different spacers. Arch Dis Child 2000 82(6) 495—498. Wilkie RA, Bryan MH. Effect of bronchodUators on airway resistance in ventilator-dependent neonates with chronic lung disease. J Pediatr 1987 111 278-282. Lee H, Amon S, Silverman M. BronchodUator aerosol administered by metered dose inhaler and spacer in subacute neonatal respiratory distress syndrome. Arch Dis Child 1994 70 F218-F222. 

Fig. 1.4a,b. Duodenal atresia, a Plain radiograph obtained 6 h after birth shows absence of air in the gastrointestinal tract of this neonate with severe lung disease, b Radiograph made after inflation ofthe stomach through a nasogastric tube demonstrates complete duodenal obstruction ( double bubble sign)... 

Canakis AM, Cutz E, Manson D, et al. Pulmonary interstitial glycogenosis a new variant of neonatal interstitial lung disease. Am J Respir Crit Care Med 2002 165(11) 1557-1565. 

Dexamethasone has been used to diminish the inflammatory injury which contributes to the chronic lung disease in oxygen- and ventilator-depen-dent neonates with bronchopulmonary dysplasia (BPD) (22,23). The use of corticosteroids in high doses would seem to create an additional risk for infection in these vulnerable children. There does not appear to be any definite increase in risk for the development of nosocomial LRI in dexamethasone-treated neonates (22-25). 

Jones R, Wincott E, Elbourne D, Grant A. Controlled trial of dexamethasone in neonatal chronic lung disease a 3-year follow-up. Pediatrics 1995 96 897-906. 

We are unaware of deposition studies in healthy neonates or infants, probably owing to concerns over the use of radiotracers in this popnlation (33). There are some deposition studies, related to therapeutic drug dehveiy, in spontaneously breathing or ventilated infants with lung diseases (216-218). Also, filter and animal lung models have been used to assess deposition in infants (219-222). One of the limitations of these studies is that deposition is often related to the amount of radioactivity delivered into the nebulizer unit and not to what is actually inhaled. Hence, there is a clear necessity for improved deposition studies to better imderstand health risks from environmental air pollutions or to improve inhalation therapy in neonates and infants. 

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