[Acute respiratory distress syndrome in infants at term and near term about 23 cases].

AIM

to precise the incidence of acute respiratory distress syndrome in infants at term and near term and the clinical characteristics of this disease not yet well recognised.

METHODS

Retrospective study of the medical records of infants admitted in the paediatric intensive care unit for ARDS along a period of 4 years. Diagnosis of ARDS was based on the following criterias: (1) Gestational age > or =35 weeks of gestation; (2) Severe and immediate respiratory distress requiring mechanical ventilation with PEEP > or =4 cmH2O and FiO2 > or = 0.5 during at least 6 hours; (3) Dependence on oxygen > or =48 hours ; (4) Diffuse alveolar damage in the chest radiograph; (5) PaO2 < or =60 mmHg under FiO2 > or = 0.5.

RESULTS

During the period of the study, 23 infants (gestational age = 36 +/- 1.1 weeks of gestation; birth weight = 2756 +/- 453 gr) were included in the study. Their mean age at admission was 16.5 +/- 14.6 hours. The majority of infants (91.3%) were born by caesarean section before the onset of labour in 78.3% cases. All infants had a severe acute hypoxemic respiratory failure (D(A -a)O2 = 468 +/- 165; OI = 19 +/- 8.4). Five infants (21.7 %) improved their oxygenation parameters under conventional mechanical ventilation (CMV) (p < 0.001; p = 0.002 et p = 0.003 respectively for D(A - a)O2, OI and PaO2/FiO2). Eighteen infants (78.2%) required high frequency oscillatory ventilation (HFOV)with a rapid and persistant improvement of oxygenation parameters. Five patients (21.7%) developed pulmonary air leak. One infant died.

CONCLUSION

ARDS represents 6.8% of etiology of respiratory distress in infants at term and near term. Caesarean section before the onset of labour seems to be a triggering factor. The outcome seems to be favourable (rate of survival = 95.7%) if the management is suitable.