Document Detail


Respiratory distress syndrome in New Zealand: evidence from the OSIRIS trial of exogenous surfactant (Exosurf).
MedLine Citation:
PMID:  8208494     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To assess the impact, mortality, morbidity and economic costs, of respiratory distress syndrome severe enough to warrant ventilation in one year in New Zealand. METHODS: Review of data from all five New Zealand regional neonatal intensive care units' participation in the international OSIRIS trial of exogenous surfactant (Exosurf) treatment for respiratory distress syndrome (involving 6700 infants in 21 countries), and extrapolation of these data to a full year. RESULTS: There were 265 New Zealand infants entered in the OSIRIS trial; the mean birthweight was 1335 g and mean gestation 29 weeks; 61% of infants were less than 30 weeks gestation. Forty-seven infants (17.7%) died prior to discharge from hospital, 40 deaths being attributed to prematurity or respiratory distress syndrome. One hundred and two infants (38.5% of the cohort; 45% of surviving infants) were oxygen dependent and 36 infants (13.6%) were dead at 28 days of age. Thirty-four infants (12.8% of the cohort; 15% of surviving infants) were oxygen dependent and 40 infants (15%) were dead at the expected date of delivery. Infants were intubated for a mean 12.5 days, with surviving infants of less than 27 weeks gestation intubated for a disproportionately long period of time. Seventy-two infants (29% of the 246 infants examined) had an abnormality detected by cranial ultrasound scan at 1 or 6 weeks of age and in 23 (9%) this was a major abnormality. Of surviving infants 16 (7.5% of 213 examined) had a major abnormality on cranial ultrasound scan. Amongst infants at high risk for respiratory distress syndrome (gestation less than 30 weeks) 53% received antenatal steroids, compared with 22% in the OSIRIS trial overall. In a full year the cost of caring for infants with respiratory distress syndrome sufficiently severe enough to warrant ventilation is estimated to be NZ$12.5 million. The average cost of caring for a surviving infant was roughly NZ$52,500 and a nonsurviving infant was NZ$24,500. CONCLUSIONS: In a full year (total births 60,000) approximately 350 New Zealand infants may require ventilation for respiratory distress syndrome. Increasing the percentage of infants who receive antenatal steroids is likely to be extremely cost effective. In the era of antenatal steroids and exogenous surfactant, 85% of infants with respiratory distress syndrome requiring ventilation survive to discharge home and over 90% of survivors are likely to be healthy normal adults.
Authors:
R Wach; B Darlow; D Bourchier; R Broadbent; D Knight; R Selby
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study    
Journal Detail:
Title:  The New Zealand medical journal     Volume:  107     ISSN:  0028-8446     ISO Abbreviation:  N. Z. Med. J.     Publication Date:  1994 Jun 
Date Detail:
Created Date:  1994-07-13     Completed Date:  1994-07-13     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0401067     Medline TA:  N Z Med J     Country:  NEW ZEALAND    
Other Details:
Languages:  eng     Pagination:  234-7     Citation Subset:  IM    
Affiliation:
Department of Paediatrics, Christchurch Hospital.
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MeSH Terms
Descriptor/Qualifier:
Birth Weight
Cerebral Hemorrhage / complications,  ultrasonography
Cohort Studies
Cost of Illness
Drug Combinations
Fatty Alcohols / administration & dosage,  therapeutic use*
Female
Hospital Mortality
Humans
Infant, Newborn
Infant, Premature
Male
New Zealand / epidemiology
Oxygen Inhalation Therapy
Phosphorylcholine*
Polyethylene Glycols / administration & dosage,  therapeutic use*
Prenatal Care
Pulmonary Surfactants / administration & dosage,  therapeutic use*
Respiratory Distress Syndrome, Newborn / economics,  mortality,  prevention & control,  therapy*
Steroids / administration & dosage
Survival Rate
Chemical
Reg. No./Substance:
0/Drug Combinations; 0/Fatty Alcohols; 0/Polyethylene Glycols; 0/Pulmonary Surfactants; 0/Steroids; 107-73-3/Phosphorylcholine; 99732-49-7/Exosurf

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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