Document Detail


Surfactant-deficient respiratory distress after elective delivery at 'term'.
MedLine Citation:
PMID:  10591427     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Babies of 37-41 wk gestation are, by international convention, said to be born at 'term', but some still develop respiratory distress. It is not clear how mature a baby has to be to be free of risk of primary surfactant deficiency. An area-based retrospective study of all the 179,701 babies of 34 or more weeks' gestation born alive in a defined area of the north of England in 1988-92 identified 149 babies with features of respiratory distress typical of surfactant deficiency severe enough to be managed with ventilatory support and with no evidence of aspiration or intrapartum infection. Gestation was carefully cross-validated against antenatal information, including at least one ultrasound assessment in the first half of pregnancy. Thirty-six of these babies were born at or after 37 wk gestation. Only 4 of the 35 delivered at 37-38 wk went into spontaneous labour. Seven became ill enough to be candidates for ECMO and two died. A review of all neonatal deaths in the study area between 1981 and 1995 identified four similar deaths in 1981-87 and two in 1993-95. Babies who are not premature, using the internationally agreed definition, can show signs of potentially lethal pulmonary immaturity at birth, especially if subjected to pre-labour Caesarean delivery. Those born at 37-38 wk are 120 times more likely to receive ventilatory support for surfactant deficiency than those born at 39-41 wk. Elective delivery should only be undertaken before 39 wk gestation for good medical reasons.
Authors:
J Madar; S Richmond; E Hey
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta paediatrica (Oslo, Norway : 1992)     Volume:  88     ISSN:  0803-5253     ISO Abbreviation:  Acta Paediatr.     Publication Date:  1999 Nov 
Date Detail:
Created Date:  2000-01-06     Completed Date:  2000-01-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9205968     Medline TA:  Acta Paediatr     Country:  NORWAY    
Other Details:
Languages:  eng     Pagination:  1244-8     Citation Subset:  IM    
Affiliation:
Neonatal Unit, Derriford Hospital, Plymouth, UK. john.madar@phnt.swest.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Cesarean Section / statistics & numerical data*
Female
Gestational Age*
Great Britain / epidemiology
Humans
Infant Mortality*
Infant, Newborn
Labor Onset
Male
Pregnancy / physiology*
Pulmonary Surfactants / deficiency*
Respiration, Artificial / methods
Respiratory Distress Syndrome, Newborn / diagnosis,  epidemiology*,  therapy
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Chemical
Reg. No./Substance:
0/Pulmonary Surfactants
Comments/Corrections
Comment In:
Acta Paediatr. 1999 Nov;88(11):1180-1   [PMID:  10591416 ]

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