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- Title
NEONATAL DISTRESS RESPIRATORY SYNDROME IN PREMATURE TWIN PREGNANCY UNDER PERINATAL DEXAMETHASONE TREATMENT.
- Authors
Navarro, Carla Forne; Sánchez-Monge, Sofia Larrea; Gonzalez, Maria Victoria; Gómez, Natalia Fornells; Simon, Márta
- Abstract
Introduction: Neonatal Respiratory Distress Syndrome (NRDS), or Surfactant Deficiency Disorder, is a lung condition in infants caused by inadequate synthesis and secretion of pulmonary surfactant. Therefore there is an increased surface tension in the alveoli causing them to collapse. It is more prevalent among preterm infants, with incidence and severity decreasing with gestational age. Risk factors include prematurity, maternal diabetes mellitus, cesarean delivery, male sex, and multiple pregnancy. Signs include tachycardia, tachypnea, grunting, nasal flaring and use of accessory muscles appearing shortly after birth. Complications of NRDS include air leakage, hemorrhage, and bronchopulmonary dysplasia. Fetal lung maturity tests evaluate the risks perinatally, but the diagnosis relies on clinical features, thoracic X-ray, and blood gas analysis. Treatment involves surfactant administration and supportive measures. Prophylactic beta- or dexamethasone treatment 48 hours before birth or between 24-34 weeks of pregnancy is suggested. Case Report: A 39-year-old gravid woman with pre-existing hypertension and type II diabetes gives birth via C-section to fraternal twins (Y and X) at 28th weeks of gestational age with very low birth weight. Y--> male BW = 1000gr APGAR 8/1' 8/5' diagnosed with NRDS Medium form. X--> female BW = 1050gr APGAR 7/1' 8/5' diagnosed with NRDS Severe form with early bilateral air leak complication. At the delivery room, deobstruction of upper airways, tactile stimulation, and respiratory support by NCPAP was performed. Once in the NICU, they were both diagnosed with NRDS and surfactant administration was performed by LISA technique. Patient Y responded well to non-invasive ventilation (NIV), while Patient X required intubation and mechanical ventilation (SIMV) due to severe NRDS. A pneumothorax was suspected in Patient X post-intubation, confirmed by thoracic radiography, necessitating drainage tubes. After 12 days, these tubes were removed. Currently, Patient Y is still on NIV and Patient X with SIMV, both are well controlled and will continue to be ventilated until there is an improvement of BG and respiratory performance. Discussions : Multidisciplinary collaboration and research on prophylactic measures is pivotal. Proper gestational follow-up and efforts to prevent prematurity are crucial to reduce NRDS incidence and severity. Recognition and control of predisposing factors, such as glycemic control in diabetic gravidae, is also essential. Conclusions: NRDS is time-dependent because it is directly proportional to the degree of respiratory system maturation. Antenatal corticoprophylaxis increases surfactant production and has evident benefits regarding the decreased incidence and severity of NRDS. Nevertheless, individual response influence early complications and later outcomes.
- Subjects
ROMANIA; RISK assessment; PREMATURE infants; MULTIPLE pregnancy; GESTATIONAL diabetes; CONFERENCES &; conventions; RESPIRATORY distress syndrome; DEXAMETHASONE; DISEASE complications
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p274
- ISSN
2668-7755
- Publication type
Article