Necrotizing pneumonia is a severe complication of pneumonia, characterized by local destruction of lung tissue with development of multiple small cavities (abscesses) and may be associated with empyema. Empyema is an unusual complication in neonates with limited data reported. We present a healthy term neonate with late-onset sepsis caused by Methicillin-resistant
Staphylococcus aureus
(MRSA) bacteremia due to severe necrotizing pneumonia associated with advanced stage empyema. To the best of our knowledge this is the youngest reported patient with multifocal lung abscesses associated with stage 2 empyema treated successfully without surgical intervention.
Administration of liquid surfactant through an endotracheal tube for the treatment of respiratory distress syndrome has been the standard of care for decades. A skilled health care provider is needed to perform this procedure. In lower-income and middle-income countries (LMICs), healthcare resources are often limited, leading to increased mortality of premature infants, many of whom would benefit from surfactant administration. Therefore, having a simplified procedure for delivery of surfactant without the need for advanced skills could be life-saving, potentially diminish gaps in care, and help ensure more equitable global neonatal survival rates. Modifications to the standard approach of surfactant administration have been put into practice and these include: INtubation-SURfactant-Extubation (INSURE), thin catheter surfactant administration (TCA), aerosolized surfactant, and surfactant administration through laryngeal or supraglottic airways (SALSA). Although there is a need for larger studies to evaluate the comparative effectiveness of these newer methods, these methods are being embraced by the global community and being implemented in various settings throughout the world. Because the SALSA technique does not require laryngoscopy, a provider skilled in laryngoscopy is not required for the procedure. Therefore, because of the ease of use and safety profile, the SALSA technique should be strongly considered as a viable method of delivering surfactant in LMICs.
Background
The largest randomized control trial of aerosolized surfactant (AERO-02 trial) demonstrated a reduction in intubation by 50%.
Objective
To determine the response after aerosolized calfactant treatment.
Methods
We conducted a post-hoc analysis of moderate to late preterm neonates in the AERO-02 trial. Trends in hourly fraction of oxygen (FiO2), mean airway pressure (MAP) and respiratory severity score (RSS) were compared between the aerosolized surfactant (AS) and usual care (UC) groups.
Results
Forty-eight percent of subjects in the UC group required intubation compared to 24% in the AS group. FiO2, MAP and RSS were lower in the UC group. FiO2 decrease was seen after the first aerosolized calfactant dose.
Conclusion
FiO2, MAP and RSS were lower in the UC group. This is likely due to early and higher rate of liquid surfactant administration in the UC group. Decrease in FiO2 was noted in the AS group after the first aerosolization.
BackgroundThe largest randomized control trial of aerosolized surfactant (AERO-02 trial) demonstrated a reduction in intubation by 50%.
ObjectiveTo determine the response after aerosolized calfactant treatment.
MethodsWe conducted a post-hoc analysis of moderate to late preterm neonates in the AERO-02 trial. Trends in hourly fraction of oxygen (FiO2), mean airway pressure (MAP) and respiratory severity score (RSS) were compared between the aerosolized surfactant (AS) and usual care (UC) groups.
ResultsForty-eight percent of subjects in the UC group required intubation compared to 24% in the AS group.FiO2, MAP and RSS were lower in the UC group. FiO2 decrease was seen after the rst aerosolized calfactant dose.
Background
Preterm infants often develop CPAP failure. These infants miss the advantages of early rescue surfactant therapy. In this study, we evaluate the utility of Respiratory Severity Score (RSS) during the first three hours of life (HOL) as a predictor for CPAP failure.
Methods
We conducted a post-hoc analysis of patients who received usual care in the AERO-02 clinical trial. Univariate and multivariable logistic regression were used to assess whether the RSS summary measures were associated with the odds of surfactant administration.
Results
Study involved 146 infants. Sixty-four infants (45%) received surfactant within the first 72 hours. Administration of surfactant was associated with the mean RSS (p < 0.01) and the linear trend (p < 0.01).
Conclusion
We demonstrated that RSS during the first three HOL can predict CPAP failure and need for surfactant administration. Optimal RSS cutoffs for early rescue surfactant therapy need to be determined in large cohort studies.
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