title: Comparing the efficacy of nebulizer recombinant human DNase and hypertonic saline as monotherapy and combined treatment in the treatment of persistent atelectasis in mechanically ventilated newborns.
abstract: BACKGROUND
  The purpose of the present study was to compare the cost-effectiveness and efficacy of nebulizer recombinant human DNase (rhDNase) and hypertonic saline (HS) as monotherapy and combined treatment in neonatal atelectasis.
  
  
  METHODS
  Eighty-seven newborns with persistent atelectasis who did not respond to traditional treatment were studied retrospectively. Group 1 did not receive nebulizer drugs; Group 2 received 7%HS; Group 3 received rhDNase; and Group 4 received both 7%HS and rhDNase. Subjects' chest X-ray scores, partial pressure of CO(2), respiratory rate, fraction of inspired oxygen (FiO(2)) peak inspiratory pressure, atelectasis healing rate, median duration of nebulizer treatment and costs were compared.
  
  
  RESULTS
  Percentages of improvement in atelectasis on Day 3 of treatment in Group 1, Group 2, Group 3 and Group 4 were 27, 70, 81 and 95%, respectively, while median duration of treatment was 8.1, 3.3, 2.9 and 2.4 days, respectively. Comparison of chest X-ray scores, partial pressure of CO(2), respiratory rate, FiO(2) and peak inspiratory pressure values before and 48 h after treatment did not yield a significant difference for the control group (P > 0.05), while a marked improvement was observed in other groups for all parameters (P < 0.05). The most distinct improvement was in Group 4, followed by Group 3.
  
  
  CONCLUSIONS
  Although both the combined treatment with HS and rhDNase and their monotherapies are effective in the treatment of persistent atelectasis in newborns receiving mechanical ventilation, their combined use produces higher efficacy. The efficacy of rhDNase is superior to monotherapy with HS. Use of these two treatments concomitantly reduces the cost. To the best of our knowledge, the present study is the first to use HS alone or in combination with rhDNase in newborn patients.
authors: Division of Neonatology, Selcuk University Meram Medical Faculty, Konya, Turkey.
authors: Hüseyin
authors: H
authors: Altunhan
authors: Ali
authors: A
authors: Annagür
authors: Sevgi
authors: S
authors: Pekcan
authors: Rahmi
authors: R
authors: Ors
authors: Hasan
authors: H
authors: Koç
mesh_terms: D003131:Combined Modality Therapy; D003850:Deoxyribonuclease I / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009330:Nebulizers and Vaporizers; D001261:Pulmonary Atelectasis / Q000188:drug therapy* / Q000628:therapy; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D012462:Saline Solution, Hypertonic; C085693:DNASE1 protein, human; D003850:Deoxyribonuclease I