Full-term Neonatal Respiratory Distress Syndrome Clinical Characteristics And Risk Factors Analysis

Background: Premature infant with neonatal respiratory distresssyndrome (RDS) is most likely to occur. However, the morbidity of full termRDS gradually increased in recent years and had increase trend year by year.Full term RDS has the characteristics including serious state of illness, fastprogress, long auxiliary mechanical ventilation and hospitalization time, andhigh fatality rate, arousing high emphasis of perinatal medicine and medicalworkers. The occurrence of RDS of premature infant is mainly related to thedeficiency of pulmonary surfactant (PS) caused by lung developmentimmaturity; while lung development of term infant is already mature, theoccurrence of RDS is related to PS secondary reduction and PS generationbarrier caused by multiple factors. As etiologic risk factors are different, clinicalmanifestation and therapeutic scheme also not the same, the systematic researchreport at present is incomplete. In addition, the severity of full term RDS stateof illness caused by different risk factors is different, thus the relevance is notclear. Bjective: the aim of research is to discuss the clinical characteristics ofneonatal respiratory distress syndrome, analyze its etiologic risk factors, furtherimprove the understanding on such disease, actively avoid the occurrence ofrisk factors, so as to improve medical quality, ameliorate prognosis, and achieveearly finding, early treatment, improve curative ratio and decrease mortalityrate. Method: taking26cases conforming to full term RDS diagnosis inneonatology department of our hospital (Chongqing Three Gorges CentralHospital) from Jan2011to Dec2012as observation group, randomly selecting26cases of premature infants hospitalized in hospital during the same periodwith combined RDS as control group, retrospective systemizing, analysis andconclusion on clinical data was conducted. Results: clinical characteristics:1.morbidity of term infant group was mostly12hours after birth, and averagedisease time was14±2.23hours after delivery; morbidity of premature infant group was mostly within several hours after birth, and average disease time was3.2±1.47hours after delivery.2. Auxiliary mechanical ventilation time of terminfant group was long, averagely98.7±27.32hours; while that of prematureinfant group was68.49±24.85hours.3. Hospitalization time of term infantgroup was long,17.38±4.95days on average; while that of premature infantgroup was14.08±2.91days.4. X ray chest radiography of two groups had noobvious difference, transparency of lungs decreased, ground glass opacity, airbronchogram; and white lung change can be seen in severe case.5. Grading asper chest topography, the more serious the grading, the proportion of applyingPS shall be higher.6. Term infant group had poor curative effect after applyingPS, and premature infant group had better effect after applying PS.7. Thecombined pulmonary arterial hypertension of term infant group had12cases(46.2%), hypoxic ischemic encephalopathy10cases (38.5%), patent ductusarteriosus7cases (26.9%), intracranial hemorrhage3cases (11.5%), meconiumaspiration pneumonia2cases (7.7%), cardiac damage5cases (19.2%),combined pneumorrhagia1case (3.8%), pulmonary air leaks8cases (30.8%),multiple organ failure1case (3.8%), and ventilator-associated pneumonia1case (3.8%).8. Term infant group had one case of death (3.8%), and prematureinfant group completely recovered. Risk factors of term infant group: in26cases,25cases were of caesarean section (96.2%, OR21.429), of which,selective caesarean section22cases (84.6%); male18cases (69.2%, OR1.65);there were16cases of birth asphyxia or perinatal period asphyxia (61.5%, OR8.8),4cases of aspiration pneumonia4cases (15.4%, OR4.545),2cases ofmother gestational diabetes mellitus (7.7%，OR2.083),3cases of prematurerupture of fetal membranes (11.5%, OR1.565). Conclusions:1. Full term RDSdisease time is relatively late, auxiliary mechanical ventilation time long,hospitalization time long, occurrence of complication and combination is high.2. Caesarean section especially selective Caesarean section, male, asphyxia,aspiration pneumonia, mother gestational diabetes mellitus, and premature rupture of fetal membranes are risk factors of full term neonatal respiratorydistress syndrome.3. Full term RDS had poor curative effect to PS, protopathyshould be actively cured and conducted with appropriate auxiliary mechanicalventilation.4. Full term RDS is the result of joint action of multiple factors,effective measures should be taken clinically to decrease its morbidity; prenatalmonitoring should be strengthened, and recovery process should bestandardized; caesarean section indications should be seriously mastered,especially non-medical caesarean section should be controlled; appropriatecaesarean section opportunity should be selected (gestational age＞39weeks);caesarean section mode should be changed, and it should be operated after theoccurrence of uterine contraction. Decreasing the occurrence of asphyxiaduring perinatal period, intrapartum, and postpartum can decrease the morbidityof full term RDS.5. Most of term infants had favorable prognosis on RDS.