Læknaneminn - 01.04.2005, Blaðsíða 74

Verkefni 4. árs læknanema
Trends in Treatment of Respiratory Distress
Syndrome in Stockholm county during the
surfactant era - infants gestational ages
27-33 weeks.
Thorgerdur Gudmundsdottir1, Baldvín Jonsson, MD, PhD2, Miriam Katz-
Salamon PhD2,
'Faculty of Medicine, University of lceland. 2Department of Neonatology, Astrid
Lindgren's Children's Hospital, Karolinska Hospital, Stockholm, Sweden.
Background: Historically, respiratory distress syndrome (RDS)
is the major cause of increased mortality in premature infants.
The disease is due to developmental surfactant deficiency,
which results in increased surface tension in the lungs and poor
aeration. The symptoms of RDS are severe respiratory distress,
increased oxygen demand and characteristic radiographic find-
ings. Besides RDS the main morbidities in this population are
bronchopulmonary displasia (BPD), intra ventricular hemor-
rhage (IVH), retinopathy of prematurity (ROP) and air leaks (i.e.
pneumothorax, caused by barotrauma).
In the last 20 years the treatment for RDS has been mechan-
ical ventilation (MV) with some use of nasal continuous positive
airway pressure (nCPAP). In the beginning of 1990 a new treat-
ment strategy, surfactant instiliation began. This has improved
the prognosis tremendously for premature infants with RDS and
now the mortality rate and complications have been minimized.
There are clear regional differences in treatment strategies for
RDS with regards to the use of respiratory support and surfac-
tant instillation.
Study Objectives: The hypothesis is that MV is not necessary
for many infants with RDS, born in the 27th-33rd week of ges-
tation, and that the combined use of early nCPAP and surfac-
tant instillation reduces the need for MV with no increased risk
for sequele.
To investigate the trend in treatment for RDS in infants of ges-
tational ages >27 to <34 weeks born at the regional neonatal
intensive care unit (NICU), Karolinska Hospital (KS), in 1993-
2002.
To compare in a case-control fashion the effect on transfer to
the regional NICU after introducing INSURE (Intubation
Surfactant Extubation) i.e. surfactant therapy during a brief intu-
bation with immediate extubation to nCPAP in all infants with
RDS at one local referral unit (Huddinge Hospital).
Material and Methods: A chart review of all infants born in the
27th-33rd week of gestation and diagnosed with RDS during
the research period was performed. The study included infants
born at KS and one referral unit in Stockholm county. Data was
collected and stored in an Excel database from which statistical
analysis was made using the Stat Graphics statistical package.
Results: The patient population consisted of 289 infants born
in the 27th-33rd week of gestation with RDS. The mean gesta-
tional age was 29 weeks (+ 2,0) and mean birthweight 1394g (±
496,4). A total of 47% infants received prenatal steroids, 64%
were treated with mechanical ventilation and 36% with nCPAP
only. Surfactant instillation was given to 58% of infants. The total
mortality was 7%. The morbidity rates were, pneumothorax
20%, BPD 15%, IVH 8,7%, severe ROP 3,5%.
After initiation of the INSURE therapy (Intubation Surfactant
Extubation) the need for referral from one local unit to the
regional neonatal intensive care unit (NICU) for mechanical ven-
tilation decreased significantly from 64% to 20% during the
period 1998-2000.
Conclusions: The local treatment strategies at the regional unit
have not changed considerably during this 10 year period with
approximately 36% of RDS infants managed with nCPAP only.
This strategy results in considerably less use of ventilators than
in comparable regions in Europe and North America. The
INSURE method decreases the need for transfer for mechanical
ventilation without an increase in morbidity.
Áhrif fjölómettaðra fitusýra á frumuboða-
myndun kviðarholsátfrumna úr músum
Maxim Nebrig', Dagbjört H. Pétursdóttir2, Ingibjörg Harðardóttir2
'Læknadeild Hi, "Lítefna- og sameindalíffræðistofa, læknadeild HÍ
Inngangur: Ómega-3 fitusýrur í fæði hafa áhrif á ónæmiskerfið.
Talið er að áhrif þeirra á frumuboðamyndun komi þar við sögu.
Ómega-3 fitusýrur í fæði músa auka TNF-a myndun staðbund-
inna kviðarholsátfrumna þegar þær eru örvaðar ex vivo. Einnig
auka ómega-3 fitusýrur TNF-a myndun aðkominna kviðarhol-
sátfrumna úr rottum in vitro. Hins vegar minnka ómega-3
fitusýrur TNF-a myndun kviðarholsátfrumulínu in vitro. Ekki er
Ijóst hvort þetta ósamræmi í niðurstöðum rannsókna á áhrifum
ómega-3 fitusýra á TNF-a myndun átfrumna in vitro stafi af því
að annars vegar er notast við aðkomnar kviðarholsátfrumur og
hins vegar frumulínu. Tilgangur þessarar rannsóknar var að
kanna hvort ómega-3 fitusýrur in vitro hafi sömu áhrif á TNF-a
myndun staðbundinna kviðarholsátfrumna úr músum og
ómega-3 fitusýrur í fæði hafa á kviðarholsátfrumur örvaðar ex
vivo.
Efniviður og aðferðir: Kviðarholsfrumur voru teknar úr BalbC
músum og átfrumur einangraðar með snertieinangrun. Frum-
urnar voru ræktaðar án fitusýra eða með mismunandi fitusýrum
tengdum albúmíni í 24 klst. Frumurnar voru örvaðar með endót-
oxíni (LPS) og 24 klst. síðar voru þær spunnar niður og floti
safnað. TNF-a var mælt í floti með magnbundinni mótefnamæl-
ingu (ELISA).
Niðurstöður: Kviðarholsátfrumur sem ræktaðar voru með
arakídonsýru (AA 20:4 n-6) eða dókósahexaensýru DHA (22:6
n-3) mynduðu minna TNF-a en frumur sem voru ræktaðar án
fitusýra. Áhrif AA á TNF-a myndun sáust ekki þegar notaður var
lægsti styrkur fitusýrunnar (10 mM) heldur einungis þegar
notaðir voru hærri styrkir (25 og 50 mM). DHA hafði lítil áhrif á
72
LÆKNANEMINN
2005