title: Adjunctive therapies for treatment of severe respiratory failure in newborns.
abstract: BACKGROUND
  Severe respiratory failure of the newborn requires adjunctive therapies as application of surfactant, inhalation of nitric oxide (iNO), high frequency oscillatory ventilation (HFOV), or extracorporeal membrane oxygenation (ECMO). We designed this study to analyze the the usage and effectiveness of adjunctive therapies and the mortality of severe respiratory failure.
  
  
  METHODS
  The survey in Germany was done in collaboration with the "Erhebungseinheit für seltene pädiatrische Erkrankungen" (ESPED). 397 patients within 2 years were included into the study. Effectiveness of each adjunctive therapy was judged by the treating physician.
  
  
  RESULTS
  The most frequent diagnosis was respiratory distress syndrome (RDS) with 36.8%, followed by pneumonia sepsis (16.4%), meconium aspiration syndrome (MAS) and congenital diaphragmatic hernia (CDH). Surfactant was applied in 77.3% of all cases with a reported effectiveness of 71.6%. More than 40% of all patients were treated with iNO, which led to an improvement in every second case. HFOV was used in every third case with a response rate of about 60%. ECMO was performed on one in 7 patients and was successful with a survival rate of nearly 80%. The overall mortality was 10.3%. 29 patients in total died without ECMO. 10 of them might actually have been contraindicated, but 19 cases with a potential benefit from ECMO were not transferred for ECMO.
  
  
  CONCLUSIONS
  Our study-data suggests that more newborns suffering from respiratory failure should be transferred to centers offering ECMO.
authors.affiliation: Department of Neonatology, Universitätsmedizin Mannheim, Mannheim, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Patry
authors.affiliation: Department of Neonatology, Universitätsmedizin Mannheim, Mannheim, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Hien
authors.affiliation: Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Demirakca
authors.affiliation: Department of Neonatology, Universitätsmedizin Mannheim, Mannheim, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Reinhard
authors.affiliation: Department of Neonatology, Universitätsmedizin Mannheim, Mannheim, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Majorek
authors.affiliation: Department of Neonatology, Universitätsmedizin Mannheim, Mannheim, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Brade
authors.affiliation: Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schaible
mesh_terms: D000280:Administration, Inhalation; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants; D009569:Nitric Oxide