The Experts below are selected from a list of 279 Experts worldwide ranked by ideXlab platform
Roger F Soll - One of the best experts on this subject based on the ideXlab platform.
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prophylactic protein free synthetic surfactant for preventing morbidity and mortality in preterm infants
Cochrane Database of Systematic Reviews, 2010Co-Authors: Roger F Soll, Eren OzekAbstract:BACKGROUND Respiratory distress syndrome (RDS) is caused by a deficiency or dysfunction of Pulmonary surfactant. A variety of surfactant products including protein free synthetic surfactant have been developed and tested in the prevention and treatment of RDS. OBJECTIVES To assess the effect of prophylactic administration of protein free synthetic surfactant (SS) on mortality, chronic lung disease and other morbidities associated with prematurity in preterm newborns at risk for developing RDS. Subgroup analysis were planned according to the degree of prematurity, surfactant product and dosage schedule. SEARCH STRATEGY Searches were made of the The Cochrane Library, MEDLINE, OVID, EMBASE, CINAHL from 1966 to 2009. In addition, previous reviews including cross references and abstracts from the Society for Pediatric Research were searched. No language restrictions were applied. SELECTION CRITERIA Randomized and quasi-randomized controlled trials that compared the effect of protein free SS administered to high risk preterm newborns at or shortly after birth in order to prevent RDS, mortality and complications of prematurity. DATA COLLECTION AND ANALYSIS Data regarding clinical outcomes was excerpted from the clinical trials by the reviewers. Data were analyzed according to the standards of the Cochrane Neonatal Review Group. MAIN RESULTS Studies of prophylactic administration of protein free SS note a variable improvement in the respiratory status and a decrease in respiratory distress syndrome in infants who receive prophylactic protein free SS. The meta-analysis supports a decrease in the risk of pneumothorax (typical relative risk 0.67, 95% CI 0.50, 0.90), Pulmonary Interstitial Emphysema (typical relative risk 0.68, 95% CI 0.50, 0.93), and neonatal mortality (typical relative risk 0.70, 95% CI 0.58, 0.85). No differences were seen in the risk of intraventricular hemorrhage, necrotizing enterocolitis, bronchoPulmonary dysplasia, retinopathy of prematurity and cerebral palsy. The meta-analysis supports an increase in the risk of patent ductus arteriosus associated with prophylactic SS administration (typical relative risk 1.11, 95% CI 1.00, 1.22), and an increase in the risk of Pulmonary hemorrhage (typical relative risk 3.28, 95% CI 1.50, 7.16). AUTHORS' CONCLUSIONS Prophylactic intratracheal administration of protein free synthetic surfactant to infants at risk of developing respiratory distress syndrome has been demonstrated to improve clinical outcome. Infants who receive prophylactic protein free SS have a decreased risk of pneumothorax, a decreased risk of Pulmonary Interstitial Emphysema, and a decreased risk of neonatal mortality. Infants who receive prophylactic protein free SS have an increased risk of developing patent ductus arteriosus and Pulmonary hemorrhage.
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animal derived surfactant extract for treatment of respiratory distress syndrome
Cochrane Database of Systematic Reviews, 2009Co-Authors: Nadine Seger, Roger F SollAbstract:Background Respiratory distress syndrome (RDS) is caused by a deficiency or dysfunction of Pulmonary surfactant. A wide variety of surfactant products have been formulated and studied in clinical trials. These include synthetic surfactants and animal derived surfactant extracts. Trials of surfactant replacement have either tried to prevent the development of respiratory distress in high-risk premature infants or treat established respiratory distress in premature infants. Objectives To assess the effect of administration of animal derived surfactant extract on mortality, chronic lung disease and other morbidities associated with prematurity in preterm infants with established respiratory distress syndrome. Subgroup analysis were planned according to the specific surfactant product, the degree of prematurity, and the severity of disease. Search methods Searches were made of the Oxford Database of Perinatal Trials, MEDLINE, EMBASE, and CINAHL from 1975 through December 2008. In addition, searches were made of previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants and journal hand searching in the English language. Selection criteria Randomized or quazi-randomized controlled trials that compared the effect of animal derived surfactant extract treatment administered to infants with established respiratory distress syndrome in order to prevent complications of prematurity and mortality. Data collection and analysis Data regarding clinical outcomes were excerpted from the reports of the clinical trials by the review authors. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group. Main results Thirteen randomized controlled trials were included in the analysis. The studies demonstrated an initial improvement in respiratory status (improved oxygenation and decreased need for ventilator support). The meta-analysis supports a significant decrease in the risk of any air leak (typical relative risk 0.47, 95% CI 0.39, 0.58; typical risk difference -0.16, 95% CI -0.21, -0.12), pneumothorax (typical relative risk 0.42, 95% CI 0.34, 0.52; typical risk difference -0.17, 95% CI -0.21, -0.13), and a significant decrease in the risk of Pulmonary Interstitial Emphysema (typical relative risk 0.45, 95% CI 0.37, 0.55; typical risk difference -0.20, 95% CI -0.25, -0.15). There is a significant decrease in the risk of neonatal mortality (typical relative risk 0.68, 95% CI 0.57, 0.82; typical risk difference -0.09, 95% CI -0.13, -0.05), a significant decrease in the risk of mortality prior to hospital discharge (typical relative risk 0.63, 95% CI 0.44, 0.90; typical risk difference -0.10, 95% CI -0.18, -0.03) and a significant decrease in the risk of bronchoPulmonary dysplasia (BPD) or death at 28 days of age (typical relative risk 0.83, 95% CI 0.77, 0.90; typical risk difference -0.11, 95 CI -0.16, -0.06). No differences are reported in the risk of patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, BPD or retinopathy of prematurity. Authors' conclusions Infants with established respiratory distress syndrome who receive animal derived surfactant extract treatment have a decreased risk of pneumothorax, a decreased risk of Pulmonary Interstitial Emphysema, a decreased risk of mortality, and a decreased risk of bronchoPulmonary dysplasia or death.
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prophylactic animal derived surfactant extract for preventing morbidity and mortality in preterm infants
Cochrane Database of Systematic Reviews, 1997Co-Authors: Roger F Soll, Eren OzekAbstract:BACKGROUND This section is under preparation and will be included in the next issue. OBJECTIVES To assess the effect of prophylactic intratracheal administration of natural surfactant extract in preterm newborns at risk for developing respiratory distress syndrome (RDS). SEARCH STRATEGY Searches were made of the Oxford Database of Perinatal Trials, Medline (MeSH terms: Pulmonary surfactant; limits: age groups; newborn infants), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants and journal hand searching in the English language. SELECTION CRITERIA Randomized controlled trials which compared the effect of prophylactic natural surfactant administration (surfactant obtained from human or bovine sources, either modified with additional phospholipids or not) administered to high risk preterm newborns at or shortly after birth in order to prevent respiratory distress syndrome, other complications of prematurity, and mortality. DATA COLLECTION AND ANALYSIS Data regarding clinical outcomes including incidence of pneumothorax, Pulmonary Interstitial Emphysema, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage (any grade and severe intraventricular hemorrhage), bronchoPulmonary dysplasia, mortality, bronchoPulmonary dysplasia or death, and retinopathy of prematurity were excerpted from the reports of the clinical trials by the reviewer. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group. MAIN RESULTS All of the included studies note an initial improvement in respiratory status and a decrease in the risk of respiratory distress syndrome in infants who receive prophylactic natural surfactant extract. The meta-analysis supports a decrease in the risk of pneumothorax (typical relative risk 0.35, 95% CI 0.26, 0.49; typical risk difference -0.15, 95% CI -0.20, -0.11), a decrease in the risk Pulmonary Interstitial Emphysema (typical relative risk 0.46, 95% CI 0.35, 0.60; typical risk difference -0.19, 95% CI -0.25, -0.13), a decrease in the risk of neonatal mortality (typical relative risk 0. 60, 95% CI 0.44, 0.83; typical risk difference -0.07, 95% CI -0.12, -0.03), and a decrease in the risk of bronchoPulmonary dysplasia or death (typical relative risk 0.84, 95% CI 0.75, 0.93; typical risk difference -0.10, 95% CI -0.16, -0.04. No differences are reported in the risk of intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis or retinopathy of prematurity. Few data are available on long-term followup of treated infants. REVIEWER'S CONCLUSIONS Prophylactic intratracheal administration of natural surfactant extract to infants judged to be at risk of developing respiratory distress syndrome (intubated infants <30 weeks gestation) has been demonstrated to improve clinical outcome. Infants who receive prophylactic natural surfactant extract have a decreased risk of pneumothorax, a decreased risk of Pulmonary Interstitial Emphysema, a decreased risk of mortality, and a decreased risk of bronchoPulmonary dysplasia or death.
Eric J Stern - One of the best experts on this subject based on the ideXlab platform.
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Pulmonary Interstitial Emphysema
Current Problems in Diagnostic Radiology, 2002Co-Authors: Nisa Thoongsuwan, Eric J SternAbstract:A 45-year-old man had a C4-C7 burst fracture while swimming. After he underwent laminectomy with C4-6 fusion, he had acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation. Because of clinical suspicion of a Pulmonary embolism, a computed tomography scan was obtained, and although it did not demonstrate a Pulmonary embolism, it did show the extent of his suspected barotrauma. In addition to a pneumothorax and pneumomediastinum, the black lines within the lung parenchyma indicated Pulmonary Interstitial Emphysema (arrows in Fig 1). Discussion
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Pulmonary Interstitial Emphysema ct findings
American Journal of Roentgenology, 1999Co-Authors: A C Kemper, Kenneth P Steinberg, Eric J SternAbstract:A 26-year-old man was exposed to trichiorosilane and tetrachlorosilane gases after an industrial explosion. These gases are converted to hydrochloric acid on contact with water, thus causing severe chemical bums to mucus membranes. The patient sustamed severe laiyngotracheobronchial injury, documented by bronchoscopy, and corneal bums. He rapidly developed the acute respiratory distress syndrome and required high levels of mechanical ventilatory support, with a 0.80-1.0 fraction of inspired 02, a positive end-expiratory pressure of 24 cm H20, and peak alveolar pressures in excess of 50 cm H70 to maintain adequate gas exchange. Severe barotrauma subsequently developed, including pneumothorax, pneumomediastinum, and severe subcutaneous Emphysema. A CT scan as part of an evaluation for nosocomial infection showed palmonary Interstitial Emphysema (PIE). Discussion PIE is recognized commonly in neonates but rarely in adults. It results from dissection of the Pulmonary interstitium by air from ruptured alveoli [I]. Multiple factors are responsible for the development of PIE, including the amount of time spent on ventilators with peak airway pressures greater than 30 cm H20, the clinical severity of the acute respiratory distress syndrome, and associated Pulmonary abnormalities [21. Virtually any phenomenon that increases intraPulmonary pressure or lung volume can result in PIE. Chest radiograph findings, which are subtle and often unrecognized, include multiple small and large parenchymal cysts, linear streaks of air extending to the mediastinum, perivascular halos from air collections, intraseptal air, and subpleural cysts [3, 4]. Our experience is that these findings are infrequent even in clinically suggestive cases, likely because of other superimposed radiographic abnormalities such as subcutaneous Emphysema and severe acute lung injury. Satoh et al. [5] reported that both perivascular and peribronchial Emphysema were CT findings of PIE. In our patient, we saw air within the interlobular septa (Fig. IA) and around the Pulmonary veins (Fig. IB). On most occasions, PIE is suspected clinically. The sequelae include decreased ventilation and perfusion due to an overall decrease in lung space. PIE is also a precursor for potentially life-threatening pneumothorax or pneumomediastinum [ 1]. PIE has been reported to be a transient phenomenon [5], although in our patient four serial CT scans showed no change in the appearance or distribution of PIE over 2 1 days.
Harriet J Paltiel - One of the best experts on this subject based on the ideXlab platform.
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ct findings and temporal course of persistent Pulmonary Interstitial Emphysema in neonates a multiinstitutional study
American Journal of Roentgenology, 2003Co-Authors: Lane F Donnelly, Javier Lucaya, Vanildo Ozelame, Donald P Frush, Peter J Strouse, Thomas E Sumner, Harriet J PaltielAbstract:OBJECTIVE. The purpose of this study was to evaluate the CT appearance, management, and temporal course of persistent Pulmonary Interstitial Emphysema in neonates.MATERIALS AND METHODS. Criteria for inclusion in the study group included neonates with a history of prematurity who required ventilation for lung disease, developement of hyperexpanded radiolucent lung lesions after typical radiographic findings of Pulmonary Interstitial Emphysema, and CT documentation of lung abnormalities. Radiographs and CT scans were reviewed for the anatomic distribution, appearance, and presence of classic lines or dots within a radiolucent mass. We compared the management (surgical vs nonsurgical) and the temporal course in nonsurgical cases for patients in the United States and patients outside the United States.RESULTS. From seven institutions, we identified 17 patients who had persistent Pulmonary Interstitial Emphysema with CT documentation. On CT, all lesions consisted of hyperexpanded cystic radiolucencies. Distrib...
Markus Waitz - One of the best experts on this subject based on the ideXlab platform.
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preeclampsia was a risk factor for Pulmonary Interstitial Emphysema in preterm infants born 32 weeks of gestational age
Acta Paediatrica, 2021Co-Authors: Judith Behnke, Klauspeter Zimmer, Markus Waitz, Anita Windhorst, Frank Oehmke, Lars D Berthold, Harald EhrhardtAbstract:Aim This study determined the prenatal and postnatal risk factors for Pulmonary Interstitial Emphysema (PIE) in preterm infants born at up to 32 weeks of gestational age (GA) and their contribution to severe complications. Methods We studied 179 preterm infants, who had undergone chest X-rays during the first five days of life at Justus Liebig University Giessen, Germany, between 2016 and 2017. Of these, 33 were retrospectively classified as PIE and 146 as non-PIE. The PIE cases were also matched with 33 non-PIE cases by GA and gender. Risk factors were identified by univariate analyses and multivariable logistic regression. Results Previously known risk factors for Pulmonary Interstitial Emphysema were confirmed, including GA and birthweight and the associations with adverse outcomes like intraventricular haemorrhage and mortality. We identified preeclampsia and haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome as additional risk factors for PIE (P = .027), and lung impairment was associated with respiratory distress syndrome (P = .001), higher maximum inspired oxygen (P = .014) and needing surfactant (P = .006). Conclusion Preeclampsia and HELLP syndrome were identified as possible additional risk factors for PIE in preterm infants. These conditions should be included in future studies, to identify preterm infants at risk of PIE straight after birth.
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early Pulmonary Interstitial Emphysema in preterm neonates respiratory management and case report in nonventilated very low birth weight twins
American Journal of Perinatology Reports, 2018Co-Authors: Judith Gronbach, Harald Ehrhardt, Klauspeter Zimmer, Markus WaitzAbstract:Early Pulmonary Interstitial Emphysema in extreme preterm neonates is closely linked with respiratory distress syndrome and exposure to mechanical ventilation. In severe cases, maintaining adequate gas exchange aiming to avoid further lung damage and other neonatal morbidities associated with systemic/Pulmonary hypoperfusion, prolonged hypoxia, and respiratory acidosis can be challenging and requires in-depth knowledge into the pathophysiology of the disease. Herein, we report on very low birth weight twins who developed early Pulmonary Interstitial Emphysema during noninvasive respiratory support. We further review the current evidence from the literature, specifically addressing on possible preventive measures and the respiratory management options of this acute Pulmonary disease in high-risk neonates.
Elizabeth J Perlman - One of the best experts on this subject based on the ideXlab platform.
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localized persistent Pulmonary Interstitial Emphysema ct findings with radiographic pathologic correlation
American Journal of Roentgenology, 1997Co-Authors: Amal A Jabra, Elliot K Fishman, Bahig M Shehata, Elizabeth J PerlmanAbstract:Amal A. Jabra1, Elliot K. Fishman1, Bahig M. Shehata2, Elizabeth J. Perlman3 L ocalized persistent Pulmonary Interstitial Emphysema ( LPPIE) is an uncommon acquired form of Interstitial Emphysema of infancy with a propensity for localized progressive accumulation ofair in the interstitium. This accumulation resuIts in cystic air spaces that are typically associated with mediastinal shift and progressive respiratory distress. The plain radiographic findings of LPPIE are well described l 1-3]. The CT findings, however, to our knowledge have not been reported and are the subject of this report. We believe the CT findings are characteristic and should help in differentiating this lesion from other cystic lesions. The CT findings are correlated with plain radiography and pathologic analysis.
