Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns

Ribeiro, Manoel Antonio da Silva; Fiori, Humberto Holmer; Luz, Jorge Hecker; Garcia, Pedro Celiny Ramos; Fiori, Renato Machado

doi:10.1016/j.jped.2018.04.008

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Original articles • J. Pediatr. (Rio J.) 95 (4) • Jul-Aug 2019 • https://doi.org/10.1016/j.jped.2018.04.008 copy

Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns^☆ ☆ Please cite this article as: Ribeiro MA, Fiori HH, Luz JH, Garcia PC, Fiori RM. Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns. J Pediatr (Rio J). 2019;95:489 -94. , ^☆☆ ☆☆ Study linked to Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome.

Method:

This study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours.

Results:

The sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n = 21) and control group (n = 43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group = 12 (8 -22) stable microbubbles/mm²; control group = 100 (48 -230) microbubbles/mm² (p < 0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval = 0.85 -0.95; p < 0.001). Considering a cut-off point of 25 microbubbles/mm², the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively.

Conclusion:

The study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.

KEYWORDS
Hyaline membrane disease; Pulmonary surfactant; Infant; Diagnostic tests

	RDS group (n = 21)	Control group (n = 43)	p
Gestational age ,^a a Mean ± standard deviation. weeks	28 ± 2	31 ± 2	0.001
Birth weight ,^a a Mean ± standard deviation. g	1.147 ± 513	1.620 ± 448	0.001
Male, n (%)	11 (52.4)	22 (51.2)	1.00
1-min Apgar score ^b b Median (minimum -maximum).	7 (6 -7)	8 (7 -8)	0.05
5-min Apgar score ^b b Median (minimum -maximum).	8 (7 -9)	9 (8 -9)	0.05
Use of surfactant, n (%)	18 (85.7)	1 (2.3)	0.001
Respiratory support, n (%)	21 (100)	26 (60.4)	0.001
CPAP	9 (45.0)	24 (55.8)
Mechanical ventilation	3 (15.0)	1 (2.3)
CPAP + mechanical ventilation	9 (45.0)	1 (2.3)
Duration of flow therapy with FiO₂>0.40 ,^b b Median (minimum -maximum). h	3 (0 -11)	0 (0 -0)	0.001
Maximum FiO₂ ,^b b Median (minimum -maximum). ^, ^c c Maximum FiO2 required for a period longer than 1 h within the first 28 days, not considering transient increases in oxygen supply. %	50 (40 -60)	21 (21 -21)	0.001

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[1] * Corresponding author. E-mail:manoel.ribeiro@pucrs.br (M.A. Ribeiro).