RANDOMIZED CONTROLLED TRIAL OF RESTRICTIVE FLUID MANAGEMENT VERSUS BUDESONIDE INHALATION IN TRANSIENT TACHYPNEA OF THE NEWBORN INFANTS | ||
| Al-Azhar Journal of Pediatrics | ||
| Article 9, Volume 25, Issue 3, July 2022, Pages 2927-2949 PDF (252.78 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/azjp.2022.268940 | ||
| Abstract | ||
| Background: Transient tachypnea of the newborn (TTN) is considered as one of the most common respiratory disorders affecting 0.5% – 4% of all of the neonate full-term and post-term neonates, especially those who are delivered by cesarean section due to lack of the squeezing effect of the lungs by genital tract of mother. It is caused mainly due to lung edema, which is the result of delayed absorption of fluids of the lung alveoli in the fetus. Objective: To study the effect of Restrictive Fluid Management versus Early Budesnide Inhalation in outcome of Transient Tachypnea of the Newborn infants and on the Hospital course of neonates with (TTN). Patients and Methods: This comparative analytic study that was conducted at department of neonatology at Al-Azhar University Hospital and Sohag Teaching Hospital from 1st March 2021 to 1st January 2022 on 150 neonate aged between (34 to 37 weeks) subdivided into three groups: Group I (50 cases): infants in this group treated by ordinary management of TTN in the form of ordinary intra venous fluid , respiratory support if needed in form of t: continuous positive end-expiratory pressure (CPAP), high flow nasal CPAP (HFNCPAP), or conventional nasal cannula (NC), intravenous fluid, antibiotics, rayl feeding. Group II (50 cases): infants in this group treated by restriction of fluid therapy 50- 65 mL/kg and 65- 80 mL /kg for term and preterm neonates, respectively in addition to ordinary management of TTN. Group III (50 case): Infants in this group were randomized to have two doses, 12 h apart, of inhaled Budesonide 1000μg/dose within 6 h from delivery, in addition to ordinary management of TTN support if needed. All studied groups subjected to complete history, clinical and laboratory examination. Results: In the current study we found that there was significant improvement between the 3 groups as regard FIO2, Pao2 and paCO2 and Ph after treatment in fluid restriction group than other groups followed by ordinary treatment group then inhaled Budesonide group. There was insignificant differences between three groups as regard pretreatment RR, HR but as regard post treatment score there was significant improvement in group received restricted fluid than other groups followed by ordinary treatment group then inhaled budesonide group. The duration of hospitalization was shorter in fluid restriction group than other groups followed by ordinary treatment group then inhaled Budesonide group with significant differences. As regard need for MV or oxygen therapy there was insignificant differences between three groups. Conclusion: The present study demonstrated that the restrictive fluid management can decrease the hospitalization period, respiratory support period, and the respiratory distress score in the neonates with transient tachypnea, and was better than ordinary treatment and steroid inhalation in the form of Budosonide inhalation. Fluid restriction appears safe in late preterm and term neonates with uncomplicated TTN. Early inhaled budesonide steroid was associated with improvement in respiratory functions, decreasing the signs of respiratory distress and significantly reducing the TTN clinical manifestations. | ||
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