All issues > Volume 38(6); 1995

Original Article

J Korean Pediatr Soc. 1995;38(6):760-770. Published online June 15, 1995.

Diagnostic Value of Stable Microbubble Rating test and Efficacy of Surfactant Replacement Therapy in Neonates with Respiratory Distres syndroems

Jeong Hee JH Kim¹, Eun Ae EA Park¹, Kyung Hee KH Kim¹

¹Department of Pdeiatrics, Ewha Womans University Hospital, Seoul, Korea

Abstract

Purpose
: Stable microbubble rating test(SMR) plays an important role in the clinical course and the prognosis of respiratory distress syndrome(RDS) patients, because SMR can be easily performed and it can predict quickly the neonatal RDS. After the success of the pulmonary surfactant replacement therapy in RDS infants by Fujiwara and co-workers in 1980, many supporting studies were presented and the pulmonary surfactant replacement has been widely used RDS infants in Korea. Thus the author conduct this study in order to find the diagnostic value of SMR, the efficacy of reconstituted bovine surfactant replacement therapy in RDS.
Methods
: 1) SMR was performed to 142 neonates(gestational periods; 22-40 weeks) and its sensitivity, sepcificity, and the correlation between various factors and SMR were studied. 2) For evaluation of the effect of surfactant replacement therapy, 34 RDS infants were enrolled in this study. The infants in the treatment group(n=17) received intratracheal reconstituted bovine surfactant(Surfecten ￠c, wherease the infants in the control group (n=17) received only conventional ventillator therapy without surfactant, FiO2, a/A PO2, MAP, chest X-ray, and the complications were assessed in both groups.
Results
: 1) SMR showed a significant correlation with RDS, gestational age, birth weight.1 & 5minute Apgar score(p<0.05), had no correlation with meconium statining, premature rupture of membrane, and maternal toxemia. 2) Among the 142 neonates, 27 case developed RDS. Of the 27 infants with RDS, 14 cases showed weak, 12 cases showed medium and 1 case showed strong response. Of the 115 infants with non-RDS, 3 cases of weak, 21 cases of medium and 91 cases of strong response were observed. Therefore, sensitivity and specificity of SMR were 96.3%, 79.1%, respectively. 3) The surfactant replacement was performed at average 4.41¡¾2.47 hr after birth and dose of surfactant was 101.19¡¾17.46mg/kg/ 4) a/A PO2 ratio was significantly increased and FIO2 was significantly decreased in the surfactant treatment group(p<0.05) and MAP was reduced rapidly in the surfactant treatment group compared to the control group. 5) The chest radiograph score before tratment showed no significant differences between the surfactent treatment group and control group. But after surfactant replacement, significant improvement in the chest radiograph scores was noted in the surfactant treatment group. 6) The requirement of FiO2 > 0.4 assisted ventilation, and supplemental oxygen was decreased in surfactant treatment group. 7) The were no differences between the surfactant treatment group and control group with respect to the frequency of pneumothorax, intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, and the mortality.
Conclusion
: The stable microbubble rating test is useful in identifying or predicting the infants who are likely to develop respiratory distress syndrome. And surfactant replacement resulted in good efficacy for the treatment of RDS.

Keywords :Neonates with Respiratory Distress Syndrome, Stable Microbubble Rating test, Surfactant replacement therapy