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Children
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Neonatal Respiratory Distress Update
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Neonatal Respiratory Distress Update

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: closed (20 October 2021) | Viewed by 24598

Special Issue Editors

Prof. Rita Marie Ryan

E-Mail Website
Guest Editor
School of Medicine, Case Western Reserve University, UH Rainbow Babies and Children’s Hospital, Cleveland, OH 44106, USA
Interests: neonatal lung biology; hyperoxia; surfactant; natriuretic peptide system
Special Issues, Collections and Topics in MDPI journals
Dr. Thomas M. Raffay

E-Mail Website
Guest Editor
School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
Interests: the developing lung; nitrosylated compounds; bronchial airway hyperreactivity; oxygenation patterns
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Neonatal respiratory distress is a broad, but very common problem. We hope to highlight novel concepts regarding the pathophysiology of neonatal respiratory distress, including those involving classic respiratory distress syndrome (RDS)/surfactant deficiency, persistent pulmonary hypertension of the newborn (PPHN), pulmonary insufficiency of prematurity (factors related to the need for respiratory support due to small size, immaturity, control of breathing, etc.), and evolving early bronchopulmonary dysplasia (BPD) following RDS, as well as less common etiologies of neonatal respiratory distress such as acute lung injury/acute (adult) RDS (ARDS), congenital diaphragmatic hernia (CDH), tracheomalacia, and other anatomic problems. We are seeking both reviews, highlighting gaps in knowledge, as well as original research, including pilot studies and translational laboratory studies pertinent to the topic. We are especially interested in studies supporting or introducing novel therapies and their mechanisms of action, such as new modes of surfactant delivery, antenatal and perinatal steroids, anti-oxidants, and other early-stage pharmacotherapies, During the ever-changing time of the novel SARS-CoV-2 (COVID-19) pandemic, we would also welcome works pertaining to practice modifications and challenges in the delivery room management of RDS, non-invasive positive pressure, and intubation.

The goal of this Special Issue in Children is to highlight the scientific understanding of the factors that contribute to neonatal respiratory distress, as well as advances in therapeutic approaches across a variety of settings. Senior investigators are welcome to invite mentees and colleagues to co-author submissions under their supervision.  It is our intention that this Special Issue will appeal to both newborn medical providers and neonatal researchers from a variety of backgrounds, including nurses, advanced providers, therapists, pharmacists, physicians, and scientists.

Prof. Dr. Rita Marie Ryan
Dr. Thomas M. Raffay
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neonatal lung disease
  • prematurity
  • oxygenation
  • positive pressure
  • intubation
  • newborn resuscitation
  • congenital anomalies
  • hypoxic respiratory failure
  • surfactant

Published Papers (6 papers)

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Research

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10 pages, 941 KiB  
Article
Dexamethasone Alters Tracheal Aspirate T-Cell Cytokine Production in Ventilated Preterm Infants
by Siamak M. Yazdi, Ekta U. Patel, Colby D. Richardson, K. Thomas Hardy, John E. Baatz, Jennifer K. Mulligan and Rita M. Ryan
Children 2021, 8(10), 879; https://0-doi-org.brum.beds.ac.uk/10.3390/children8100879 - 02 Oct 2021
Cited by 3 | Viewed by 1665
Abstract
Postnatal corticosteroids improve respiratory status and facilitate respiratory support weaning in preterm infants with bronchopulmonary dysplasia (BPD). Older literature describes characteristic cytokine profiles in tracheal aspirates (TA) of BPD patients which are altered with corticosteroids. Corticosteroids also influence peripheral blood T-cell presence. However, [...] Read more.
Postnatal corticosteroids improve respiratory status and facilitate respiratory support weaning in preterm infants with bronchopulmonary dysplasia (BPD). Older literature describes characteristic cytokine profiles in tracheal aspirates (TA) of BPD patients which are altered with corticosteroids. Corticosteroids also influence peripheral blood T-cell presence. However, little is known regarding TA T-cell phenotype and cytokine production before or after exogenous corticosteroids. We hypothesized that postnatal dexamethasone alters the TA T-cell cytokine profiles of preterm infants. TA samples were collected from 14 infants born from 23 0/7 to 28 6/7 weeks who were mechanically ventilated for at least 14 days. Samples were collected up to 72 h before a ten-day dexamethasone course and again 1 to 3 calendar days after dexamethasone initiation. The primary outcome was change in T cell populations present in TA and their intracellular cytokine profile after dexamethasone treatment, ascertained via flow cytometry. Following dexamethasone treatment, there were significant decreases in respiratory severity score (RSS), percent CD4+IL-6+ cells, CD8+IL-6+ cells, CXCR3+IL-6+ cells, and CXCR3+IL-2+ cells and total intracellular IFN-γ in TA. RSS significantly correlated with TA percent CD4+IL-6+ cells. To our knowledge, this is the first study demonstrating that dexamethasone reduced T-cell IL-6 and this reduction was associated with improved RSS in pre-term infants with evolving BPD. Full article
(This article belongs to the Special Issue Neonatal Respiratory Distress Update)
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9 pages, 529 KiB  
Article
Early High-Dose Caffeine Improves Respiratory Outcomes in Preterm Infants
by Vineet Lamba, Oscar Winners and Prem Fort
Children 2021, 8(6), 501; https://0-doi-org.brum.beds.ac.uk/10.3390/children8060501 - 13 Jun 2021
Cited by 3 | Viewed by 2748
Abstract
The objective of the study is to determine if early high-dose caffeine (HD) therapy is associated with shorter duration of mechanical ventilation, bronchopulmonary dysplasia (BPD), or decreased need for mechanical ventilation. We conducted a single center, retrospective cohort study of 273 infants less [...] Read more.
The objective of the study is to determine if early high-dose caffeine (HD) therapy is associated with shorter duration of mechanical ventilation, bronchopulmonary dysplasia (BPD), or decreased need for mechanical ventilation. We conducted a single center, retrospective cohort study of 273 infants less than 32 weeks gestational age (GA). Infants receiving early HD (10 mg/kg/day maintenance) caffeine citrate started within 24 h of life were compared with those receiving LD (6 mg/kg/day) with variable timing of initiation using linear and logistic regression models. The infants in the early HD group had 91.4 (95% confidence interval (CI): −166.6, −16.1; p = 0.018) less hours of mechanical ventilation up to 36 weeks PMA or discharge as compared with the LD group. Moreover, infants in the HD group had 0.37 (95% CI: 0.14, 0.97; p = 0.042) times lower odds of developing moderate/severe BPD compared with the LD group. Infants receiving early HD caffeine had improved respiratory outcomes with no increase in measured comorbidities. Large prospective studies are needed to determine the long-term outcomes of using high-dose caffeine prophylaxis for preterm infants. Full article
(This article belongs to the Special Issue Neonatal Respiratory Distress Update)
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Review

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12 pages, 3794 KiB  
Review
Factors to Consider to Study Preductal Oxygen Saturation Targets in Neonatal Pulmonary Hypertension
by Heather Siefkes, Sherzana Sunderji, Jessica Vaughn, Deepika Sankaran, Payam Vali, Pranjali Vadlaputi, Sage Timberline, Avni Bhatt, Daniel Tancredi and Satyan Lakshminrusimha
Children 2022, 9(3), 396; https://0-doi-org.brum.beds.ac.uk/10.3390/children9030396 - 11 Mar 2022
Cited by 2 | Viewed by 5508
Abstract
There are potential benefits and risks to the infant with higher and lower oxygen saturation (SpO2) targets, and the ideal range for infants with pulmonary hypertension (PH) remains unknown. Targeting high SpO2 can promote pulmonary vasodilation but cause oxygen toxicity. [...] Read more.
There are potential benefits and risks to the infant with higher and lower oxygen saturation (SpO2) targets, and the ideal range for infants with pulmonary hypertension (PH) remains unknown. Targeting high SpO2 can promote pulmonary vasodilation but cause oxygen toxicity. Targeting lower SpO2 may increase pulmonary vascular resistance, especially in the presence of acidosis and hypothermia. We will conduct a randomized pilot trial to compare two ranges of target preductal SpO2 in late-preterm and term infants with hypoxic respiratory failure (HRF) and acute pulmonary hypertension (aPH) of the newborn. We will assess the reliability of a newly created HRF/PH score that could be used in larger trials. We will assess trial feasibility and obtain preliminary estimates of outcomes. Our primary hypothesis is that in neonates with PH and HRF, targeting preductal SpO2 of 95–99% (intervention) will result in lower pulmonary vascular resistance and pulmonary arterial pressures, and lower the need for pulmonary vasodilators (inhaled nitric oxide—iNO, milrinone and sildenafil) compared to targeting SpO2 at 91–95% (standard). We also speculate that a higher SpO2 target can potentially induce oxidative stress and decrease response to iNO (oxygenation and pulmonary vasodilation) for those patients that still require iNO in this range. We present considerations in planning this trial as well as some of the details of the protocol design (Clinicaltrials.gov (NCT04938167)). Full article
(This article belongs to the Special Issue Neonatal Respiratory Distress Update)
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12 pages, 1832 KiB  
Review
Lung Ultrasound in the Neonatal Intensive Care Unit: Does It Impact Clinical Care?
by J. Lauren Ruoss, Catalina Bazacliu, Nicole Cacho and Daniele De Luca
Children 2021, 8(12), 1098; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121098 - 29 Nov 2021
Cited by 6 | Viewed by 5900
Abstract
A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in [...] Read more.
A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in differentiating neonatal respiratory conditions, predicting morbidity, and guiding invasive interventions. Recent research has shown that a lung ultrasound can assist the clinician in accurately identifying and managing conditions such as respiratory distress syndrome, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In this review, we discuss basic lung ultrasound terminology, evidence for applications of neonatal lung ultrasound, and its use as a diagnostic and predictive tool for common neonatal respiratory pathologies. Full article
(This article belongs to the Special Issue Neonatal Respiratory Distress Update)
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23 pages, 1095 KiB  
Review
The Intertemporal Role of Respiratory Support in Improving Neonatal Outcomes: A Narrative Review
by Kosmas Sarafidis, William Chotas, Eleni Agakidou, Paraskevi Karagianni and Vasiliki Drossou
Children 2021, 8(10), 883; https://0-doi-org.brum.beds.ac.uk/10.3390/children8100883 - 02 Oct 2021
Cited by 3 | Viewed by 2513
Abstract
Defining improvements in healthcare can be challenging due to the need to assess multiple outcomes and measures. In neonates, although progress in respiratory support has been a key factor in improving survival, the same degree of improvement has not been documented in certain [...] Read more.
Defining improvements in healthcare can be challenging due to the need to assess multiple outcomes and measures. In neonates, although progress in respiratory support has been a key factor in improving survival, the same degree of improvement has not been documented in certain outcomes, such as bronchopulmonary dysplasia. By exploring the evolution of neonatal respiratory care over the last 60 years, this review highlights not only the scientific advances that occurred with the application of invasive mechanical ventilation but also the weakness of the existing knowledge. The contributing role of non-invasive ventilation and less-invasive surfactant administration methods as well as of certain pharmacological therapies is also discussed. Moreover, we analyze the cost–benefit of neonatal care-respiratory support and present future challenges and perspectives. Full article
(This article belongs to the Special Issue Neonatal Respiratory Distress Update)
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Other

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6 pages, 3988 KiB  
Case Report
Selective Bronchial Occlusion for Treatment of a Bronchopleural Fistula in an Extremely Preterm Infant
by Giacomo Simeone Amelio, Mariarosa Colnaghi, Silvia Gulden, Genny Raffaeli, Valeria Cortesi, Ilaria Amodeo, Giacomo Cavallaro, Fabio Mosca and Stefano Ghirardello
Children 2021, 8(12), 1208; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121208 - 20 Dec 2021
Cited by 1 | Viewed by 2691
Abstract
Neonatal pulmonary air leak commonly occurs as a complication of mechanical ventilation in infants with underlying hyaline membrane disease. They can commonly be managed conservatively or with the application of a chest drain, but some severe cases pose a significant challenge in finding [...] Read more.
Neonatal pulmonary air leak commonly occurs as a complication of mechanical ventilation in infants with underlying hyaline membrane disease. They can commonly be managed conservatively or with the application of a chest drain, but some severe cases pose a significant challenge in finding an alternative therapeutic solution. Selective bronchial occlusion represents an unconventional rescue therapy for treating bronchopleural fistula resistant to the standard therapy. A 27-week gestation preterm infant ventilated for respiratory distress syndrome developed tension right-sided pneumothorax. Conventional modalities of treatment were tried and were unsuccessful. Intermittent selective bronchial occlusion with a Fogarty’s catheter and high-frequency oscillatory ventilation resulted in considerable improvement in the infant’s clinical condition and radiographic findings. Full article
(This article belongs to the Special Issue Neonatal Respiratory Distress Update)
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