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Children
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Diagnosis and Management of Newborn Respiratory Distress Syndrome
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Diagnosis and Management of Newborn Respiratory Distress Syndrome

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

Deadline for manuscript submissions: 1 July 2025 | Viewed by 7037

Special Issue Editor

Dr. Luca Pierri

E-Mail Website
Guest Editor
AORN Santobono-Pausilipon, Neonatal Intensive Care Unit, Naples, Italy
Interests: neonatology; respiratory distress syndrome; lung ultrasound; surfactant; PPHN; prematurity; BPD; NEC; neonatal surgery; CDH

Special Issue Information

Dear Colleagues,

The neonatal survival of preterm babies is still improving thanks to modern technologies and newly targeted therapy approaches to pulmonary immaturity and surfactant deficiency. Respiratory Distress Syndrome (RDS) prevention starts during pregnancy, considering all the possible interventions aiming to prolong the gestation of preterm fetuses, and continues after birth. The evidence-based lung-protective strategies include the initiation of non-invasive respiratory support from birth, the judicious use of oxygen, early surfactant administration, caffeine therapy, cardiovascular assessment, and the avoidance of mechanical ventilation where possible. Lung ultrasound has replaced conventional radiology in the diagnosis of RDS, allowing neonatologists to act quickly and avoid unnecessary radiation exposure to the baby. The modern approach to RDS should be personalized, taking a physiopathology and critical care perspective, which can only be built by developing cross-disciplinary awareness in order to avoid chronic lung disease.

Dr. Luca Pierri
Guest Editor

Manuscript Submission Information

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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

  • surfactant
  • non-invasive ventilation
  • lung ultrasound
  • chronic lung disease
  • delivery room

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Published Papers (6 papers)

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Research

11 pages, 2568 KiB  
Article
Thrombospondin-1 Airway Expression and Thrombospondin-1 Gene Variants Are Associated with Bronchopulmonary Dysplasia in Extremely Low-Birth-Weight Infants: A Pilot Study
by Parvathy Krishnan, Hannah Sampath, Van Trinh and Lance Parton
Children 2025, 12(4), 424; https://doi.org/10.3390/children12040424 - 28 Mar 2025
Viewed by 234
Abstract
Background: Thrombospondin-1 (TSP-1) is an extracellular glycoprotein that mediates the differentiation of pulmonary endothelial cells and specialized stem cells into alveolar epithelial lineage-specific cells during the repair phase after lung injury. Since bronchopulmonary dysplasia (BPD) involves the inhibition of lung development with altered [...] Read more.
Background: Thrombospondin-1 (TSP-1) is an extracellular glycoprotein that mediates the differentiation of pulmonary endothelial cells and specialized stem cells into alveolar epithelial lineage-specific cells during the repair phase after lung injury. Since bronchopulmonary dysplasia (BPD) involves the inhibition of lung development with altered lung structure and vasculature, differential expression of the THBS-1 gene may impact lung development and pulmonary endothelial cell repair and have an important role in BPD. Methods: This prospective single-center cohort study included ELBW infants with and without BPD. DNA from buccal swabs underwent RT-PCR with TaqMan probes, and TSP-1 protein was measured in tracheal aspirates. Statistical analyses used Chi-square tests, Fisher’s exact tests, Wilcoxon Rank Sum tests, and t-tests (p < 0.05). Results: ELBW infants with BPD had significantly lower gestational ages and birth weights compared to those without BPD [25 (24,26) and 27 (25,28) weeks; median (IQR); p = 0.008] and [712 (155) and 820 (153) grams; mean (SD); p = 0.002], respectively. There were significant differences in the haplotype distributions of THBS1 variants rs2664139/rs1478604 (p = 0.006) and THBS1 variants rs1478605/rs1478604 (p = 0.008) between no-BPD and BPD groups. There were also significant differences in airway TSP-1 protein levels between moderate and severe BPD patients [(p = 0.02) (no BPD: 527 (114–1755); moderate BPD: 312 (262–641); and severe BPD 211: (117–352) ng/dL; median (IQR)]. Conclusions: Although no individual variants differed, two THBS1 haplotypes and early TSP-1 airway expression varied by BPD severity, suggesting a role for TSP-1 in lung development and BPD pathogenesis in ELBW infants. Full article
(This article belongs to the Special Issue Diagnosis and Management of Newborn Respiratory Distress Syndrome)
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11 pages, 1277 KiB  
Article
Laryngeal Mask Airway Method for Minimally Invasive Surfactant Therapy in Neonates with Pneumothorax Complicating Respiratory Distress Syndrome
by Joaquim M. B. Pinheiro, Marilyn Fisher, Kate A. Tauber and Chad Pezzano
Children 2025, 12(2), 134; https://doi.org/10.3390/children12020134 - 26 Jan 2025
Viewed by 720
Abstract
Background/Objectives: Pneumothorax is a common complication of neonatal respiratory distress syndrome, which is decreased by surfactant therapy. Rescue administration of surfactant in neonates with severe RDS complicated by pneumothorax requires management of the pneumothorax to optimize surfactant distribution while avoiding positive pressure ventilation [...] Read more.
Background/Objectives: Pneumothorax is a common complication of neonatal respiratory distress syndrome, which is decreased by surfactant therapy. Rescue administration of surfactant in neonates with severe RDS complicated by pneumothorax requires management of the pneumothorax to optimize surfactant distribution while avoiding positive pressure ventilation to minimize iatrogenic exacerbation of the air leak. Methods: We retrospectively reviewed our center’s experience with neonates who had clinically significant pneumothorax complicating RDS, in whom we used a novel technique to administer surfactant through a laryngeal mask/supraglottic airway device without applying positive pressure ventilation. Results: In 13 of the 20 neonates in our cohort, subsequent invasive ventilation and chest tube insertion were avoided. There were no major complications or unfavorable outcomes. We describe our experience with this method and suggest an approach to individualize the management of neonates with pneumothorax preceding surfactant therapy. Conclusions: In our setting, laryngeal mask airway devices are now the preferred method to deliver surfactant in neonates with RDS and pre-existing pneumothorax. We believe this approach is readily applicable in most neonatal care settings. Full article
(This article belongs to the Special Issue Diagnosis and Management of Newborn Respiratory Distress Syndrome)
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11 pages, 750 KiB  
Article
Non-Invasive Ventilation with Neurally Adjusted Ventilatory Assist (NAVA) Improves Extubation Outcomes in Extremely Low-Birth-Weight Infants
by Kevin Louie, Shaili Amatya, Gad Alpan and Lance A. Parton
Children 2024, 11(10), 1184; https://doi.org/10.3390/children11101184 - 28 Sep 2024
Viewed by 1256
Abstract
Objective: This study investigates the effectiveness of extubation from conventional mechanical ventilation using an endotracheal tube (MVET) compared to synchronized non-invasive positive-pressure ventilation (sNIPPV) using neurally adjusted ventilatory assist (NAVA) and conventional non-invasive positive-pressure ventilation (NIPPV) in extremely low-birth-weight (ELBW) infants. Methods: An [...] Read more.
Objective: This study investigates the effectiveness of extubation from conventional mechanical ventilation using an endotracheal tube (MVET) compared to synchronized non-invasive positive-pressure ventilation (sNIPPV) using neurally adjusted ventilatory assist (NAVA) and conventional non-invasive positive-pressure ventilation (NIPPV) in extremely low-birth-weight (ELBW) infants. Methods: An institutional review board (IRB) approved this study (#12175) to conduct a single-center randomized control trial including 60 ELBW infants assigned in a one-to-one computer-generated scheme to either sNIPPV using NAVA or NIPPV. The primary outcome involved the need for reintubation, and the secondary outcome involved the assessment of moderate/severe BPD, defined as an oxygen requirement at 36 weeks, as in #NCT03613987 (clinicaltrials.gov). Results: There were 60 ELBW infants enrolled and randomized. The overall gestational age was 26 (1.5) weeks, and the birth weight was 773 (157) g [mean (SD)]. There were no statistically significant differences between the NAVA and NIPPV patient characteristics. There was a 41% extubation failure rate in the NIPPV group and 35% in the NAVA group (p = NS). The NAVA group had less moderate and severe BPD (p = 0.03), a shorter oxygen therapy duration (p = 0.002), a decreased length of stay (p = 0.03), and less need for home oxygen (0, 43%; p = 0.0004). Conclusions: This study found similar extubation failure rates among ELBW infants as in prior studies. However, the NAVA group had lower rates of moderate/severe BPD and need for oxygen at discharge, as well as shorter oxygen therapy duration and length of stay. The use of NAVA may be a reasonable alternative mode of non-invasive ventilation in the ELBW population. Full article
(This article belongs to the Special Issue Diagnosis and Management of Newborn Respiratory Distress Syndrome)
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11 pages, 667 KiB  
Article
Risk Factors and Outcomes Associated with Pneumothorax in Very Preterm Infants
by Cristina Nogueroles Blanco, Ana Herranz-Barbero, Mar Velilla-Aparicio, Carla Balcells-Esponera, Marta Teresa-Palacio, Miguel Alsina Casanova, Cristina Carrasco Carrasco, Cristina Borràs-Novell, José Manuel Rodríguez-Miguélez, Ma Dolors Salvia-Roigés and Victoria Aldecoa-Bilbao
Children 2024, 11(10), 1179; https://doi.org/10.3390/children11101179 - 27 Sep 2024
Viewed by 1271
Abstract
Background/Objectives: Pneumothorax can be a major complication of neonatal lung diseases. We aim to delineate trends and describe the main outcomes related to pneumothorax in very preterm infants (VPI). Methods: Preterm infants < 32 weeks of gestation admitted in two-level III neonatal intensive [...] Read more.
Background/Objectives: Pneumothorax can be a major complication of neonatal lung diseases. We aim to delineate trends and describe the main outcomes related to pneumothorax in very preterm infants (VPI). Methods: Preterm infants < 32 weeks of gestation admitted in two-level III neonatal intensive care units (1995–2019) were included. Risk factors and outcomes were assessed by logistic regression and adjusted for gestational age (GA). Results: In total, 4271 VPI with a mean GA of 28.7 ± 2.3 weeks were evaluated. Pneumothorax was diagnosed in 174 patients (4.1%, 95% Confidence Interval (CI) 3.5–4.7) with its incidence inversely proportional to GA: 9.9% in 23–25 w and 2.1% in 30–31 w (p < 0.001), but stable over the years 1995–1999 (5.2%) and 2015–2019 (4.2%) (p = 0.309). Patients with pneumothorax exhibited higher rates of severe intraventricular hemorrhage (IVH) (Odds Ratio (OR) = 2.0 (95%CI 1.3–3.1), p = 0.003), bronchopulmonary dysplasia (OR = 2.7 (95%CI 1.7–4.4), p < 0.001), and death (OR = 8.5 (95%CI 6.2–11.6), p < 0.001). Independent risk factors for pneumothorax were GA, prolonged premature rupture of membranes, and intubation in the delivery room. The composite outcome of death or severe IVH was higher in patients with pneumothorax with an adjusted OR = 6.7 (95%CI 4.7–9.6), p < 0.001. Although VPI mortality has significantly decreased over the years (20.3% 1995–1999 and 11.7% 2015–2019, p < 0.001), we found no significant difference in pneumothorax-related deaths. Conclusion: Pneumothorax remains a serious threat to VPI, leading to a higher incidence of morbidity, and mortality attributable to this complication has not decreased. Preventive strategies and early recognition are essential for improving disability-free survival in VPI. Full article
(This article belongs to the Special Issue Diagnosis and Management of Newborn Respiratory Distress Syndrome)
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17 pages, 300 KiB  
Article
Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units—The Results of a Recent Survey
by Maria Livia Ognean, Anca Bivoleanu, Manuela Cucerea, Radu Galiș, Ioana Roșca, Monica Surdu, Silvia-Maria Stoicescu and Rangasamy Ramanathan
Children 2024, 11(7), 836; https://doi.org/10.3390/children11070836 - 9 Jul 2024
Cited by 1 | Viewed by 1714
Abstract
Background: Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). Objectives: We aimed [...] Read more.
Background: Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). Objectives: We aimed to identify the usage extent and clinical application of nHFOV in Romania. Methods: A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU’s size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. Results: A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10–17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%); heated, humidified high-flow nasal cannula (HHHFNC) (61.9%); and nHFOV (11/21 units; 52.4%). A total of 5/11 units reported frequent nHFOV use (in two or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). Face/nasal masks and short binasal prongs are the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV. Only three of the NICUs had a written protocol for nHFOV use. Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. Conclusions: Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV. Full article
(This article belongs to the Special Issue Diagnosis and Management of Newborn Respiratory Distress Syndrome)
9 pages, 506 KiB  
Article
Intubation at Birth Is Associated with Death after Pulmonary Hemorrhage in Very Low Birth Weight Infants
by Yong-Ping Sun, Hou-Bing Qin, Yun Feng, Yun-Su Zou, Yun Liu, Rui Cheng and Yang Yang
Children 2024, 11(6), 621; https://doi.org/10.3390/children11060621 - 22 May 2024
Viewed by 1220
Abstract
Objective: This retrospective cohort study was performed to clarify the association between intubation in the delivery room and the mortality after pulmonary hemorrhage in very low birth weight infants (VLBWIs) during hospitalization. Methods: The study participants were screened from the VLBWIs admitted to [...] Read more.
Objective: This retrospective cohort study was performed to clarify the association between intubation in the delivery room and the mortality after pulmonary hemorrhage in very low birth weight infants (VLBWIs) during hospitalization. Methods: The study participants were screened from the VLBWIs admitted to the neonatal intensive care unit (NICU) of the Children’s Hospital Affiliated to Nanjing Medical University from 31 July 2019 to 31 July 2022. The newborns who ultimately were included were those infants who survived until pulmonary hemorrhage was diagnosed. These subjects were divided into the intubation-at-birth group (n = 29) and the non-intubation-at-birth group (n = 35), retrospectively. Results: Univariate analysis found that the intubation group had a higher mortality and shorter hospital stay than the non-intubation group (p < 0.05) (for mortality: 25/29 (86.21%) in intubation group versus 14/35 (40.00%) in non-intubation group). By multivariate analysis, the result further showed that intubation in the delivery room was related to shorter survival time and higher risk of death (adjusted hazard ratio: 2.341, 95% confidence interval: 1.094–5.009). Conclusions: Intubation at birth suggested a higher mortality in the VLBWIs when pulmonary hemorrhage occurred in the NICU. Full article
(This article belongs to the Special Issue Diagnosis and Management of Newborn Respiratory Distress Syndrome)
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