MINISTRY OF EDUCATION AND TRAINING MINISTRY OF NATIONAL DEFENCE
VIETNAM MILITARY MEDICAL UNIVERSITY
NGUYEN THANH NAM
STUDY ON CAUSES, RISK FACTORS AND
TREATMENT OUTCOME OF
RESPIRATORY DISTRESS NEWBORNS IN
PEDIATRICS DEPATMENT BACH MAI
HOSPITAL
Specialized : INTERNAL MEDICINE Code : 972 01 07
SUMMARY OF DOCTORAL THESIS
THE STUY ARE COMPLETED AT
VIETNAM MILITARY MEDICAL UNIVERSITY
Scientific Supervisor:
1. Assoc. Prof. Nguyen Tien Dung
2. Prof. Dong Khac Hung
Reviewer 1: ……………………………….
Reviewer 2: ……………………………….
Reviewer 3: ……………………………….
The Thesis will be presented at the Military Medical
Academy
At the time : /
/2018
Can find the thesis at:
1. The National Library
1
ABBREVIATIONS
Birth weight BW 1
Continuous positive airway pressure CPAP 2
High flow nasal oxygen HFNO 3
Oxygenation index OI 4
Patent ductus arteriosus PDA 5
Respiratory distress RD 6
7 SIMV Synchronized intermittent mandatory ventilation
8 VI Ventilation index
THE THESIS BACKGROUND
1. Introduction
Respiratory distress is common disease in neonatal period, and the
newborn admit to the neonatal intensive care unit on the increase.
Term newborn respiratory distress rate is also up to 7%. There are
some causes: hyaline membrane disease, meconium aspiration
syndrome, pneumonia, preterm, congenital heart disease, transient
tachypnoea of newborn, asphyxia... There are many risk factors of
respiratory distress: previous history of pregnancy, mother had
internal disease, diabetes in pregnancy, heart disease in pregnancy,
cesarean delivery without labour, risk factor from fetal: threatening
premature, fetus asphyxia…
There are many risk factos that affect treatment of respiratory
distress and ventilator treatment. Evaluation the common causes of
respiratory distress, risk factors, predictors index in treatment,
ventilator treatment are still being studied in clinical practice.
Cooperation in neonatal resuscitation immediaterly after birth is
very important to decrease morbidity for newborn..The report in
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2016, the rate of newborn needed respiratory support was still 410%
in term and nearterm and needed to rescue 0.10.3% to live out.
We study with two objectives:
Identify some common causes and risk factors of respiratory
distress newborn in Pediatricsdepartment Bach Mai Hospital.
Initially evaluate the results of respiratory distress treatment in
newborn in Pediatricsdepartment Bach Mai Hospital.
2. The need of the subject
Respiratory distress is common disease in newborn and the
incidence is not reduced. There are many causes and risk factors of
disease.. Knowing these factors will provide intervention to reduce
complications after birth for newborn, especially respiratory distress.
The routine cooperation resuscitation after birth was not contribution
widely so the goal doing neonatal resuscitation program is very
necessary in the country. Observing some influence factors,
prognostic outcome factors that help the treatment process
reasonable, timely and necessary.
3. The new contributions of the thesis are as follow Describe some common causes of respiratory distress newborn
and risk factors of respiratory distress in Pediatrics department
Bach Mai Hospital.
Initially evaluated the treatment results of respiratory distress
newborns in Pediatrics department Bach Mai Hospital and some
factors affecting the outcome of respiratory distress treatment.
4. The composition of the thesis
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The Thesis has 128 pages: Introduction 2 pages; Overview
30 pages; Objects and methods 26 pages; Results 30 pages;
Discussion 36 pages; Conclusion 02 pages; Request 01 pages. 150
references: 32 Vietnamese references and 118 English references.
CHAPTER 1: OVERVIEW
1.1. RESPIRATORY DISTRESS NEWBORN DIAGNOSIS 1.1.1. Characteristics of respiratory distress newborn
Respiratory distress is a disorder of respiratory functional, the
gas exchange process is disturbanced, insufficient oxygen leads to
hypoxia and is not excreted carbon dioxide causing hypercarbia.
Respiratory distress is common syndrome, the leading cause of
death in newborn, requiring immediately emergency and doing right
management. 1.1.2. Causes of respiratory distress newborn Upper airway obstruction: choanal atresia; tracheoesophageal
fistula; tracheal stenosis ...
Lower airway disease: congenital (pulmonary ageneisis and
hypoplasia, congenital lobar emphysema) or acquired (meconium
aspiration syndrome; hyaline membrane disease; transient
tachypnoea of newborn; pulmonary hemorrhage; pneumonia)
Congenital heart disease: transposition of great arteries,
pulmonary hypertension, patent ductus arteriosus.
Neurological disorder, metabolic abnormal: intraventricular
hemorrhage; hypoglycemia.
Others: congenital diaphragmatic hernia; anemia ...
4
1.1.3. Common risk factors of respiratory distress newborn
Risk factors might either be from the mother or from the fetus.
Birth trauma is also factors that cause the newborn not to breathe
after birth (brain injury, cerebral hemorrhage, brain edema). It can
also caused by prolapsed umbilical cord, premature separation of
placenta, hypertonic uterine contractions interrupting the perfusion
respiratory center was inhibited and
for the placenta or due to anesthesia when caesarean section affect respiratory depression (cid:0) consequenced hypoxia.
Risk factors of respiratory distress can be identified early in the
fetus: prenatal history of preterm had respiratory distress, maternal
diabetes, multiple pregnancy, caesarean section …, early detection
will have plan follow up to reduce risk of respiratory distress after
birth.
Mother’s disease before pregnancy can affect respiratory
distress for baby after birth: intenal diseases (hypertension, diabetes,
lupus, renal disease, heart disease, thyroid disease …); In pregnancy:
maternal diabetes, disorders of amniotic fluid, maternal hypertension,
not take care of during pregnancy…); In labour: eclampsia,
preeclampsia, HELLP syndrome, fetal distress, caesarean without
labour …
Fetal problems can increase respiratory distress: fetal distress,
preterm, intrauterine growth restriction …
1.1.4. RESPIRATORY DISTRESS DIAGNOSIS
1.1.4.1. Clinical symptoms
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Based on one or more symptoms: Tachypnea (>60/min) or
bradypnea (<30/min); intercostals, subcostal retraction, seesaw
chest movement; nasal flaring; grunting or apnea; cyanosis in air. Evaluate the newborn adaptation after birth by Apgar score at 1
minute, 5 minute:: If Apgar score: ≤ 3: severe asphyxia; 4 6:
mild asphyxia and ≥ 7: normal.
Laboratory symptoms
1.1.4.2. Blood gas monitor: Sa02 < 90%, Pa02 < 60mmHg, PaC02 >
50mmHg and/or pH < 7.2 .
1.2. RESPIRATORY DISTRESS TREATMENT
1.2.1. Specific treatment Respiratory distress management: oxygen therapy, ventilation support CPAP, nSIMV, HFNO, invasive mechanical ventilation.
Manage blood gas and electrolyte disorders Prevention and treatment of infections Ensure nutrition Keeping the body temperature stable, especially avoid
hypothermia.
1.2.2. Invasive mechanical ventilation Indication Apnea, breathe disorder; Did not breathing after birth, asphyxia,
or must be intubated immediately.
Failure when ventilated with CPAP, nSIMV, HFNO: prolonged
apnea; severe hypoxia : Sp02 < 85% or Pa02 < 50 mmHg; severe
increase C02 : PaC02 > 60 mmHg and pH < 7.2.
CHAPTER 2: OBJECTS AND METHODS
2.1. STUDY OBJECTS
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2.1.1.Selection criteria
Newborns 0 28 days have criteria:
Born in Obstetric department – Bach Mai hospital Treated in Neonatal unit – Pediatric department – Bach Mai
hospital:
+ Respiratory distress group: diagnosed respiratory distress: based
on clinical symptoms: dyspnea, respiratory distress and/or
laboratory symptoms.
+ Group have other diseases and don’t have clinical of respiratory
distress.
+ Respiratory distress treated invasive mechanical ventilation:
Symptoms respiratory distress; hypoxia: Pa02 < 50mmHg when
oxygen therapy Fi02 > 60%; hypercapnia C02: PaC02 > 60mmHg
and/or pH < 7.2; Although treaded with CPAP, HFNO, nSIMV
but the baby not improve; very extreme premature < 28 weeks.
The baby had be resuscitation and intubated transfered from
delivery room to neonatal room.
2.1.2. Exclusion criteria
Newborns who do not complete the treatment or want to
transfer to another hospital with some reasons.
2.2. STUDY METHODS 2.2.1.Research design For object 1: Descriptive research methods, determining the rate
and causes of respiratory distress and the casecontrol study:
identification of risk factors.
For object 2: Continuous followup the outcome of respiratory
distress therapy.
7
(cid:0)
p
p
)
2
(cid:0)
)2/
1(
2.2.2. Sample size Sample selection formula: (cid:0) (cid:0)
Zn
2
1( d Calculation: n = 1.96 ×1.96 × 0.3 × 0.7 / 0.052 = 323.
Calculate the theoretical sample size = 126 newborns
The newborns who need treat with mechanical ventilation were
30% of respiratory distress newborns. According to the theoretical
sample size, there were 30 respiratory distress newborns need
invasive mechanical ventilation.
2.2.3. Research Method
2.2.3.1. Clinical, laboratory evaluate method Each newborn had a research document with research data: Clincal evaluate:
+Geography, sexual, gestational age, birth weight.
+Apgar score at 1 minute and 5 minute.
+Resuscitation high risk fetus, methods of birth.
+Condition of hospitalization: temperature, clinical signs of
respiratory distress, respiratory support.
+Duration of and timing of mechanical ventilation
+Timing of feeding by digestive tract
+Treatment: antibiotics, inotropic agents drugs, surfactant.
Laboratory evaluate
+Laboratory: Troponin T, glucose
+Blood gas: pH, Pa02, PaC02
+Relevant indicators and mechanical ventilation: OI, VI
+Evaluation functions: echocardiography, cranial ultrasound
2.2.3.2. Determining the cause of respiratory distress, risk
factors
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Assessments of respiratory distress Patient was diagnosed respiratory distress through clinical
symptoms, laboratory symptoms and function tests (Xray, blood
cultures, ultrasound …) to determine the cause of respiratory distress.
Risk factors assessment
Sexual, gestational age, birth weight and respiratory distress
Role of resuscitation in delivery room
Methods of birth, asphyxia and risk of respiratory distress
Mother disease, age of mother, job risk of respiratory distress
Hypothemia and risk of respiratory distress
2.2.3.3. Treatment evaluation method Treatment results in the number of patients died Common causes of death Evaluate the information and signs when hospitalization
+Gestational age, birth weight
+Role of resuscitation in delivery room, asphyxia and result
+Hypothemia and result
+Duration of mechanical ventilation, timing of mechanical
ventilation and result.
+Evaluate Troponin T ; Blood gas (pH, Pa02, PaC02); OI
(oxygenation index) and VI (ventilation index).
+Evaluate echocardiography, cranial ultrasound, used antibiotics,
inotropic agent drugs, surfactant and result.
+Timing of feeding by digestive tract and result.
2.3. DATA COLLECTION AND HANDLING
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Information collected through medical document research. The data is encrypted and processed by SPSS 20.0 software
CHAPTER 3: RESULTS
There were 417 patients, in which respiratory distress is 139
patients (68 patients had to invasive ventilator) in the study from
January 2013 to December 2015. The rate of respiratory distress in
study is 33.3%. 3.1. CLINICAL CHARACTERISTICS OF CASES GROUP
The group of respiratory distress the ratio boy:girl is 1.36. The
mean gestational age (GA) of cases group was 34.02 ± 4.27 weeks (<
37 weeks was 70.5%), lower than controls group was 38.13 ± 2.09 (p
<0.001). The mean birth weight (BW) of the respiratory distress
group was 2,056.9g ± 939.3g (<2,500g was 65.5%) was lower than
the controls group was 2,893.3g ± 608.6g (p <0.001).
The rate of patients needed respiratory support (oxygen, bag
with mask) was 67.6%, the highest was oxygen therapy 46.8%.
Dyspnea is 80.6% (tarchypnea, grunting, intubated).
3.2. CAUSES, RISKS OF RESPIRATORY DISTRESS
3.2.1. Causes of respiratory distress Table 3.2: Causes of respiratory distress (n=139)
Causes of RD (139 patients) n Ratio (%)
Hyaline membrane disease 15 10.8%
Asphyxia 22 15.8%
Transient tachypnoea of newborn 14 10.1%
Pneumonia 3 2.2%
PDA 22 15.8%
Pulmonary hypertension 5 3.6%
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Others congenital heart disease 1 0.7%
Sepsis 4 2.9%
Intraventricular hemorrhage 1 0.7%
Hypoglycemia 7 5%
Others 45 32.2%
Apsphyxia, PDA have high rates in respiratory diseases. There is
10.8% that diagnose hyaline membrane disease. 3.2.2.Risk factors of respiratory distress Birth weight <2,500g and premature < 37 weeks had risk of RD
were 5.324 times and 7.527 times, respectively (p<0.001).
High risk fetus had increase risk of RD with OR=4.101(95%CI,
2.6656.31).
Caesarean without labour had risk of RD was 76.06 (95% CI,
29.37212.819) times compare with Caesarean after labour
(p<0.001).
In pregnant period, mother had been internal disease (pneumonia,
nephritis, Lupus, encephalitis ...) had risk of RD were 3.486 (95%
CI, 1.5387.903) times, p=0.002.
Table 3.12: Relative some maternal diseases in labour and respiratory distress newborrn (n=417)
Study’s group RD NonRD OR (139 ) (278 ) p (95%CI) n (%) n (%)
Yes (25) 13 (9.4) 12 (4.3) 0.041
Maternal disease Cardiovascular disease 2.287 (1.0155.155) No 126 (90.6) 266 (95.7)
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(392)
Yes (29) 20 (14.4) 9 (3.2)
<0.001 5.023 (2.22211.357) 119 (85.6) 269 (96.8) No (388) Eclampsia, preeclampsia, HELLP syndrome
Pregnance had disease in labour (cardiovascular disease; eclampsia,
preeclampsia, HELLP syndrome), risk of RD was higher (p<0.05).
Risk of RD is 2.287 times and 5.023 times.
Table 3.14: Hypothermia and risk of respiratory distress(n=415)
Study’s group RD Non RD OR (139) (276) p 95%CI n (%) n (%) Temperature
55 (39.6) 21 (7.6) 7,951 (4,54213,919) <0.001 < 360C (76) (cid:0) 360C (339) 84 (60.4) 255 (92.4)
The risk of RD in newborrn with hypothermia at admission is 7.951
(95%CI;4.54213.919) times (p<0.001).
Table 3.15: Multivariate logistic analysis some risk
factors:premature (<37 weeks); birth weight < 2,500g; mother's job,
caesarean without labour; internal disease in pregnant period;
cardiovascular disease in labour; eclampsia, preeclampsia, HELLP
2; p * OR correction; 95%CIOR; p **
Factors
syndrome;hypothermia and risk of respiratory distress OR; 95%CIOR; c 7.527(4.76811.883) ; 4.859(1.729 13.654) ; 0.003 Premature < 37 weeks (Yes/No)
83.445 ; <0.001 5.324(3.4298.267); 0.901(0.3262.487); 0.84 Birth weight <2,500g (Yes/No) 59.703; <0.001
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1.295(0.4893.427); 0.603
4.101(2.6656.31); 43.434; < 0.001 76.06(29.37212.819); 73.688(24.359222.917);
<0.001
0.729(0.1563.419); 0.689 149.215; < 0.001 3.486(1.5387.903); 9.927; 0.002
1.194(0.2515.679); 0.823 2.287(1.0155.155); 4.17; 0.041
0.611(0.1143.282); 0.565 5.023(2.22211.357); 17.807; <0.001
1.199(0.383.786); 0.757
1.883(0.6675.316); 0.232 High risk fetus (Yes/No) Caesarean without labour (Yes/No) Disease in pregnant period (Yes/No) Cardiovascular disease in labour (Yes/No) Eclampsia, preeclampsia, HELLP (Yes/No) Mother worked hard (Yes/No) Hypothermia <360 (Yes/No) 3.875(2.1896.859); 23.701; <0.001 7.951(4.54213.919); 63.119; <0.001
* Single variable analysis/ ** Multivariate analysis Multivariate logistic analysis: premature < 37 weeks, caesarean
without labour predict risk of RD newborn with p=0.003 and <0.001,
respectively. OR is 4.859(1.729 13.654) và 73.688(24.359
222.917), respectively. 3.3. TREATMENT RESULTS AND FACTORS AFFECTING 3.3.1. Treatment result of respiratory distress
+ Death + Survivordischarge
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Chart 3.4: Treatment result of respiratory distress (n=139)
The ratio of survivordischarge (successful) was 84.9%, there
were 21 patients died (15.1%). The common causes of death were
hyaline membrane disease, followed by birth asphyxia, others cause
were heart disease (PDA, Pulmonary hypertension), sepsis.
68 patients treated invasive mechanical ventilator. The common
causes were asphyxia (29.4%), hyaline membrane disease (20.6%).
Death ratio was 31%. 3.3.2. Factors affecting the result of respiratory distress Severe asphyxia at 5 minutes afer birth, risk of death is
7.467(95%CI, 2.13226.149) times, p=0.003.
Pediatricians who participated resuscitation have survivors were
higher but not statistically significant
Hypothermia has increase risk of death 3.756 times, p=0.006. BW < 1,500g has risk of dead 8.426 (95%CI, 2.97923.83) times,
p<0.001.
Table 3.21: Relative premature < 32 weeks and result
Result Death Survivor OR (21) (118) p 95% CI Gestational age n (%) n (%)
< 32 weeks (39) 16 (76.2) 23 (19.5) 13,217 < 0,001 (4,38839,813) ‡ 32 weeks (100) 5 (23.8) 95 (80.5)
Gestational age < 32 weeks increased risk of death when
treated RD 13.217(4.38839.813) times compare with Gestational age
> 32 weeks (p<0.001).
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Table 3.23: Multivariate logistic analysis some risk
factors:premature (<32 weeks); birth weight <
1,500g;hypothermia,severe asphyxia at 5 minutes;ventilator support
(ventilator with maskintubated) and results
2; p * OR correction; 95%CIOR; p **
Factors
Severe asphyxia at OR; 95%CIOR; c 7.467 (2.13226.149); 2.11 (0.4759.365); 0.326
5 minutes (Yes/No) Ventilator support 12.467; 0.003 6.111 (2.26516.489); 2.978 (0.9159.691); 0.07
(Yes/No) Premature < 32 14.883; < 0.001 13.217 (4.38839.813); 7.856 (1.28847.909) ; 0.025
weeks (Yes/No) BW < 1,500g 28.392; < 0.001 8.426 (2.97923.83); 1.172 (0.1897.28); 0.326
(Yes/No) Hypothermia <360 19.926; < 0.001 3.756 (1.40510.04); 1.024 (0.2883.648); 0.97 (Yes/No) 7.597; 0.006
* Single variable analysis/ ** Multivariate analysis The mortality risk increased 7.856 (95% CI; 1.28847.909) in
respiratory distress newborns that was premature < 32 weeks
(p=0.025). 3.3.3.Factors affecting the result of invasive ventilator support Troponin T > 0.089 ng/ml predicts risk of have to treat with
invasive ventilator support.
Abnormal cranial ultrasound when treated with mechanical
ventilator predicts risk of death 14.4 times.
Patients didn’t have feeding by the gastrointestinal tract within the
first 24 hours after admission, the risk of death increased
16.875(95%CI, 3.21188.683) times, p < 0.001
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Values of VI, OI and mechanical ventilation result Evaluate the value of VI in the 2nd time by the ROC curve and the
risk of death, results: Area under curve 0.725; p = 0.008. Cut off
point VI = 33.093 with a sensitivity 76.5%, a specificity 66.7%
predict risk of mortality when treated mechanical ventilation.
Evaluate the value of OI in the 3rd time by the ROC curve and the
risk of death, we had results: Area under curve 0.865; p < 0.001. Cut
off point OI = 6.72 with a sensitivity 83.3%, a specificity 84.4%
predict risk of mortality when treated mechanical ventilation.
OI value
Chart 3.10. Change in OI value during mechanical ventilation
The OI value of the respiratory distress group treated with
ventilated patients that was survivor was reduced and lower than the
death group with p=0.009; <0.001; <0.001 and 0.003, respectively.
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CHAPTER 4: DISCUSSION
4.1. CLINICAL CHARACTERISTICS OF CASES GROUP
Study 417 newborns, the prevalence of RD is 33.3%. The
result is the same as report of Nguyen Thi Xuan Huong (2010) the
rate of asphyxia, hyaline membrane disease, premature was 33.1%.
Mathai S.C.S. reported that had 3040% patients with RD
hospitalization. 139 patients in study, the ratio of boy/girl was 1.36.
This result is similar other authors studies. The prevalence of
respiratory rate disorder (tachypnea, grunting, apnea need ventilator
with mask) 80.6% similar other authors when evaluate respiratory
distress newborns.
4.2. CAUSES, RISKS OF RESPIRATORY DISTRESS
4.2.1. Causes of respiratory distress Respiratory diseases : Our study, asphyxia was highest 15.8%,
followed by hyaline membrane disease 10.8% (table 3.2),
transient tachypnoea of newborn 10.1%. This results different with Mamta Bajad (2016) and Arit Parkash (2015) were the 1 st
hyaline membrane disease and next asphyxia. Thus, asphyxia and
hyaline membrane disease still the common cause of respiratory
distress from respiratory disease and also require the coordination of neonatal resuscitation to reduce morbidity.
Heart disease: there was 15.8% diagnosed PDA (table 3.2). Dice
(2007) reported that the rate of PDA in newborns was 510% of congenital heart diseases. Pumonary hypertension was the 2nd
cause of heart disease 3.6% (table 3.2). Our results was lower than
Robin H. Steinhorn’s (2010) had about 10% secondary pulmonary
hypertension complication in respiratory distress newborns and
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severe pulmonary hypertension was about 0.2% in term newborns.
This is also one of the severe disease that may primarily or
secondary by asphyxia, sepsis, others congenital heart disease …. Others disease: sepsis, intraventricular hemorrhage, hypoglycemia
(table 3.2) had in our study. Hany Aly (2004) and Reuter (2014)
said that the less others cause of respiratory distress was septic,
metabolic disorder, neurological disease similar our study.
4.2.2. Risk factors of respiratory distress
4.2.2.1. Premature, low birth weight, high risk fetus Gestation age (GA): In our result GA<37 weeks was 70.5%.
Reuter (2014) said that newborns<34 weeks had higher
respiratory distress rate. The mean GA in cases group was 34.02 – 4.27 weeks really lower than controls group was 38.13 – 2.09
(p<0.001). Premature < 37 weeks has risk factor of death 7.527
times. Prematuare also independent factor when used multivariate
logistic analysis, risk factor of RD is OR=4.859(95%CI, 1.729
13.654), p=0.003. This is the predictive risk of respiratory distress
newborns.
Birth weight: In 417 newborns has 139 respiratory distress
939.3g really lower than controls group was 2,893.3 (cid:0)
(BW<2,500g was 65.5%). The mean BW in cases group was 2,056.9 (cid:0) 608.6g (p < 0.001). Risk of newborns < 2,500g had be respiratory
distress was 5.324 times compare with controls group. Our results
are similar other authors. So that, low birth weight is risk factor of
respiratory distress newborn, we need well control during
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pregnancy period, chronic disease, maternal disease, disease in
labour…
High risk fetus: risk of RD is 4.101 (95%CI, 2.6656.31) times
compare with non high risk fetus. Reuter S. and partner (2014)
detail risk factors of RD (transient tachypnoea of newborn,
pneumonia, hyaline membrane disease, meconium aspiration
syndrome) were: gestational diabetes, mother use drug or
anesthesia, mother had infected streptococcus group B,
premature .... Liu J. and partner (2014) studied in China about
RD in term babies showed that risk factors of RD: severe
asphyxia, smaller than gestation age, infection motherfetal,
abnormal sugar absorption during pregnancy and low birth
weight.
4.2.2.2. Methods of birth and risk of respiratory distress
Analysis the risk of respiratory distress (RD), we had result:
Caesarean without labour was an independent prognostic factor
affects RD newborns (p<0.001), and OR=73.688(95%CI, 24.359
222.917) with multivariate logistic analysis. Similar conclusion, Liu
(2014) studied 205 RD newborns had 34.6% was caesarean without
labour higher than controls group only had 20.5%. 4.2.2.3. Mother disease and risk of respiratory distress
Mother disease in labour: cardiovascular disease, pregnancy
toxicity preeclampsia HELLP syndrome are associated with risk
of respiratory distress newborns with p = 0.041; <0.001, respectively
(table 3.15). Risk of respiratory distress is 2.287; 5.023 times,
respectively. Susana Machado (2012), Aisha Lateef and Michelle
Petri (2012), Panagiotis Pateinakis (2014) said that mothers had
Lupus disease, acute kidney damage during pregnancy were suffer
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from pregnacy complication such as preeclampsia, HELLP
syndrome, hypertension and affect to premature, asphyxia .... 4.2.2.4. Hypothermia and risk of respiratory distress
Rate of hypothermia (<360C) in respiratory distress group was
higher than nonrespiratory distress group (36.9% and 7.6%,
respectively) (p <0.001). Risk of respiratory distress increased 8
times when the newborn had hypothermia (Table 3.15). Nayeri
(2005) found that the complications of hypothermia were respiratory
distress within 6h after birth. Hypothermia should be monitored
during resuscitation and in the following hours.
4.3. TREATMENT RESULTS AND FACTORS AFFECTING 4.3.1. Treatment result of respiratory distress
139 respiratory distress newborns in study, 68 of whom
received invasive mechanical ventilation. The mortality rate of
respiratory distress was 15.1% (Figure 3.4). The Wadi (2012) study
in Iraq on 167 newborns showed a mortality rate of 9% for
respiratory distress, which was lower than our study, but in Wadi's
study only the term newborn. Compared two recent reports of
respiratory distress in India, Swarnkar (2015) and Bajad (2016), the
mortality of their respiratory distress were 22.86% and 22.33%,
respectively, higher than our study. Thus, respiratory distress is still
high mortality. Therefore, determining causes, risk factors,
resuscitation coordination after birth, reasonable treatment will
improve the results.
Invasive mechanical ventilation result mortality were 21/68
patients (31%). Reported by Vu Thi Thu Nga (2017) at the National
20
Hospital of Paediatrics, the mortality rate when treated with
mechanical ventilation was 34.8% similar our results. 4.3.2.Factors affecting the result of respiratory distress 4.3.2.1. Relative preterm, low birth weight, asphyxia and
result
The babies were more lower gestation age (GA), the mortality
was more increase when treated RD, GA < 32 weeks has risk of
death OR=13.217(95%CI, 4.38839.813) (table 3.21). VuThi Thu
Nga said that the babies 28 < 32 weeks had treated with mechanical
ventilation mortality rate 41.4% and increased 74.6% if gestation age
< 28 weeks. Nguyen Thi Xuan Huong reported the ratio of premature
dead was 46.29%. We analysis multivariate logistic factors: severe
asphyxia, ventilator with maskintubated, premature < 32 weeks, low
birth weight < 1,500g and hypothermia the result shown that only
premature < 32 weeks was risk factor of death with
OR=7.856(95%CI,1.28847.909), p =0.025 (table 3.23).
The mortality increased 8.426 (95%CI,2.97923.83) times
when the birth weight was < 1,500g (p<0.001). Tang Chi Thuong
from Nhi dong 1 hospital (2010) reported that patients < 1,000g the
mortality was 31.8% in the same group, group had BW 1,0001,499g
the mortality was 11.3% in this group. That prevalence was lower
than us. The prevalence of our study is similar with Vu Thi Thu Nga
(2017) in ventilator group: BW < 1,000g the mortality upto 84.9%,
BW 1,0001,499g the mortality was 38.5%.
The baby still was in severe asphyxia when evaluated Apgar
score at 5 minute, the risk of death is OR=7.467(95%CI,2.132
26.149). Antonucci R. (2014) showed the role of evaluation Apgar
score associated brain damage after hypoxia in preterm, mother had
21
to anesthesia, infection, and said that asphyxia before birth caused
nerve damage or high mortality. Oliveira T.G. and partner (2012)
said that the lower BW, the lower Apgar score were higher mortality. 4.3.2.2. Ventilation Index (VI), oxygenation Index (OI)
and ventilator treatment results
In the 2nd time (T2), the prognostic value of VI by the ROC
curve resulted: VI> 33.093 increased mortality risk with sensitivity 76.5%, specificity 66.7% (p = 0.008). Thus, when VI ≥ 34 in the 2nd
time taken blood gas predict increased risk of death when mechanical
ventilation treatment.
In the 3rd time (T3), the prognostic value of OI by the ROC
6,72 increased mortality risk with sensitivity
curve resulted: OI (cid:0) 83.3%, specificity 84.4% (p<0.001).
When follow up the value of OI in treatment: survivor group
had OI value decrease during the treatment, dead group had OI value
increase (chart 3.10).
Subhedar N.V. and partner (2000) evaluated 155 RD preterm
babies said that OI value of dead group higher than survivor group
was 38.8 (22.0–98.9) and 10.0 (5.6–19.1), respectively, p<0.001 and
recommendation used OI value for prognosis outcome. Trivedi
(2009) published the results of study on mortality risk factors when
treatment in neonatal intensive care unit in India with 50 ventilated
newborns: OI> 10 predicted increase mortality rate when mechanical
ventilation treatment. This study showed that the ventilation
treatment mortality with VI > 30 (63.3%) higher than group with VI £ 30 (41%), but the difference was not clear because of p>0.05.
Our study suggested using OI, VI to predict patient status
when ventilator treatment combine with clinical evaluate.
22
4.3.2.3. Brain damage and ventilator treatment results
Ancora (2007) showed the relationship between cranial
ultrasound abnormalities and treatment outcomes in CMV infants
infection. Our results are similar with the author. Cranial ultrasound
abnormal had risk of mortality was 14.4 times when treated
mechanical ventilator.
4.3.2.4. Feeding by the gastrointestinal tract and results
Our study results: 68 ventilator patients were not feeding
within 24 hours after hospitalization, the rate of dead increased with
OR=16.875(95%CI,3.21188.683) (p<0.001). Lee P.L. and partner
(2017) recommended early feeding reducing the risk of ventilator
acquired pneumonia in low birth weight newborns, which is similar
our results.
CONCLUSION Study 417 patients included 139 respiratory distress newborns treated
in neonatal unitPediatric departmentBach mai hospital from
01/2013 to 12/2015 showed that: 1. Causes, some risk factors of respiratory distress 1.1. Causes of respiratory distress The ratio of RD in our study was 33.3% Causes of respiratory distress newborns are: respiratory diseases:
hyaline membrane disease (10.8%), asphyxia (15.8%), transient
tachypnoea of newborn (10.1%), pneumonia (2.2%); heart
diseases: patent ductus arteriosus (15.8%), pulmonary
hypertension (3.6%); others: hypoglycemia, cerebral hemorrhage,
sepsis…
1.2. Risk factors of respiratory distress
23
Premature < 37 weeks, risk of RD is 4.859(1.729 13.654) times Caesarean section without labour, risk of RD is higher 74 times
than Caesarean section with labour.
High risk fetus has risk of RD increased 4.101(2.6656.31) times. Mother has internal disease during pregnant, risk of RD increased
is 3.486(1.5387.903) times.
In labour, mother has cardiovascular disease, preeclampsia
eclampsiaHELLP syndorme risk of RD increased with p=0.041
and p<0.001, respectively.
Hypothermia <360C risk of RD is increased 8 times. 2. Treatment results and factors affecting 2.1. Treatment result of respiratory distress The mortality rate of respiratory distress was 15.1%. Common causes of ventilator treatment were: asphyxia (29.4%),
hyaline membrane disease (20.6%) and patent ductus arteriosus
16.2%.
Common cause of death: hyaline membrane disease (42.9%),
asphyxia (23.8%).
2.2. Factors affecting the result of respiratory distress Severe asphyxia, Apgar score < 4 risk of death is increased 7.467
times.
Pediatricians who done resuscitation risk in delivery room
improved the rate of survivordischarge but no significant
difference.
Preterm < 32 weeks, risk of death increased 7.856 (1.28847.909)
times.
Hypothermia is risk of treatment failure upto 3.756(1.40510.04)
times compare with nonhypothermia.
24
6.72, ventilator (VI) (cid:0) 33.1 predict risk
Oxidation Index (OI) (cid:0) of treatment failure.
Cranial ultrasound abnormalities were risk of mortality. Enteral feeding within 24 hours after admission improves
treatment outcomes.
COMMENTS
Studies to find causes of respiratory distress due to congenital
diseases, must be surgical intervention.
Conduct other studies to assess the risk of each maternal disease
to determine which disease most affected risk of respiratory
distress newborns.
Continuing deployment effectively neonatal resuscitation
program.
There should be information about advantages, disadvantages,
complications when caesarean section without lobour delivered to
the public
LIST OF JOURNAL ARTICLES
THE RESULTS OF THESIS
ễ
ị
ả Nguy n Thành Nam, Cao Th Bích H o,
1.
ư
ồ
ế
ễ
ắ
(2016).
Đ ng Kh c H ng, Nguy n Ti n Dũng
ế ố
ơ ử
ở ẻ ơ
Nguyên nhân và y u t
nguy c t
vong
tr s sinh
ặ
ầ
ấ
ở
ẻ Vietnam
ị b suy hô h p n ng c n th máy ngay sau đ .
Medical Journal, 449(1): 7478.
Nguyen Thanh Nam, Cao Thi Bich Hao,
2.
Pham Van Đem, et al. (2017). Causes, risk factors and
outcomes in neonates with respiratory failure. Journal
of Military Pharmacomedicine, 42 (9/2017): 662668.
