digoxin and Respiratory-Distress-Syndrome--Newborn

Lendrum 1955 suggested that pulmonary edema secondary to congestive heart failure may contribute to neonatal respiratory distress syndrome (RDS). Based on this hypothesis, investigators began to use digitalis glycosides to improve myocardial contractility and decrease congestive heart failure. The first use of digitalis glycosides in infants with RDS was reported by Stahlman 1959. Stahlman reported a reduction in mortality in an uncontrolled trial of digitalis in infants with RDS.. To assess the effect of digoxin on mortality in premature infants at risk for or with RDS.. Searches were made of the Oxford Database of Perinatal Trials, Medline (MeSH terms: digoxin; limits: age groups, newborn infants; publication type, clinical trial), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, and journal handsearching in the English language.When updated in December 2008, the search was expanded to include Medline, CINHAL, and Embase (MeSH terms and text words: digoxin or digitalis; limits: age group, all infants; publication type: clinical trial).. Randomized and quazi-randomized controlled trials of digoxin in either the prevention or treatment of RDS are included in this overview.. Data regarding clinical outcomes were excerpted from the trial reports by one review author (RS) and checked by the second review author (EO). Data were analyzed according to the standards of the Cochrane Neonatal Review Group.. Two randomized controlled trials have studied the effects of digoxin in the prevention and treatment of RDS. No improvement in respiratory status or mortality was noted. Meta-analysis of the effect of digoxin given to infants at risk of or with RDS on mortality does not suggest any benefit of digoxin treatment (typical relative risk 1.27 95% CI 0.78 to 2.07; typical risk difference 0.06, 95% CI -0.06 to 0.17).. Although hemodynamic disturbances play a role in the overall pathogenesis of respiratory distress syndrome, the specific contribution of early congestive heart failure (unrelated to hemodynamically significant patent ductus arteriosus) does not appear to be a significant factor in RDS. Treatment with digoxin has no proven value in infants solely affected with RDS.

Topics: Cardiotonic Agents; Digoxin; Humans; Infant, Newborn; Infant, Premature; Randomized Controlled Trials as Topic; Respiratory Distress Syndrome, Newborn

This section is under preparation and will be included in the next issue.. To assess the effect of digoxin on clinical outcome in infants at risk of, or with, respiratory distress syndrome (RDS).. Searches were made of the Oxford Database of Perinatal Trials, Medline (MeSH terms: digoxin; limits: age groups, newborn infants; publication type, clinical trial), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, and journal handsearching in the English language.. Randomized controlled trials of digoxin in either the prevention or treatment of respiratory distress syndrome are included in this overview.. Data regarding clinical outcomes were excerpted from the trial reports by the reviewer. Data were analyzed according to the standards of the Cochrane Neonatal Review Group.. Two randomized controlled trials have studied the effects of digoxin in the prevention and treatment of respiratory distress syndrome. No improvement in respiratory status or mortality was noted. Meta-analysis of the effect of digoxin given to infants at risk of or with RDS on mortality does not suggest any benefit of digoxin treatment (typical relative risk 1.27 95% CI 0.78, 2.07; typical risk difference 0.06, 95% CI -0.06, 0.17).. Although hemodynamic disturbances play a role in the overall pathogenesis of respiratory distress syndrome, the specific contribution of early congestive heart failure (unrelated to hemodynamically significant patent ductus arteriosus) does not appear to be a significant factor in RDS. Treatment with digoxin has no proven value in infants solely affected with respiratory distress syndrome.

Topics: Cardiotonic Agents; Digoxin; Humans; Infant, Newborn; Respiratory Distress Syndrome, Newborn

Recently there has been a significant reappraisal of the role of PDA in the context of neonatal cardiopulmonary disease. This article reviews surgical intervention, pharmacologic treatment, and assessment of ductal patency in the neonate.

Topics: Alprostadil; Blood Circulation; Clinical Trials as Topic; Digoxin; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Defects, Congenital; Heart Function Tests; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Ligation; Persistent Fetal Circulation Syndrome; Prostaglandin Antagonists; Random Allocation; Respiratory Distress Syndrome, Newborn

Recently there has been a significant reappraisal of the role of PDA in the context of neonatal cardiopulmonary disease. This article reviews surgical intervention, pharmacologic treatment, and assessment of ductal patency in the neonate.

Topics: Alprostadil; Blood Circulation; Clinical Trials as Topic; Digoxin; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Defects, Congenital; Heart Function Tests; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Ligation; Persistent Fetal Circulation Syndrome; Prostaglandin Antagonists; Random Allocation; Respiratory Distress Syndrome, Newborn

In infants with respiratory distress syndrome (RDS) hypoxemia inhibits closure of the patent ductus arteriosus (PDA), resulting in increased pulmonary blood flow with subsequent increased hypoxemia. In an attempt to interrupt this cycle 42 consecutive premature infants with RDS and PDA, weighing between 550 and 2,000 gm (average, 1,383 gm) and with an average gestational age of 31 weeks, were arbitrarily treated either medically (13 patients) or by interruption of the PDA (20 patients). Eleven patients who were initially treated medically could not be weaned from the respirator and later underwent operation. There were no operative or anesthetic deaths; late survival was 65% (20 patients). The last 31 patients were randomly divided into operative and nonoperative groups. Preliminary results revealed no significant differences in late survival between the two groups. Since the operative risk is minimal, further investigative efforts are indicated to settle this issue.

Topics: Digoxin; Ductus Arteriosus, Patent; Humans; Hypoxia; Infant, Newborn; Radiography, Thoracic; Respiratory Distress Syndrome, Newborn

Topics: Blood Proteins; Cardenolides; Digoxin; Female; Fetal Organ Maturity; Humans; Infant, Newborn; Lung; Pregnancy; Pregnancy Complications; Respiratory Distress Syndrome, Newborn; Saponins

A retrospective study is made on the results of the treatment of 38 preterm infants with symptomatic PDA; they represented an incidence of 4% of all the admissions to our Unit from June 1978 to March 1980. 30 of the 38 infants (79%) had PDA associated with RDS. Conservative medical treatment failed in 42% of the patients, requiring the administration of indomethacin for pharmacologic closure of their PDA. The different responses to the drug in each of the established groups are commented, being the group with a birth weight less than 1,500 g who presented the highest percentage of re-openings (62.5%) and of therapeutic failures (50%). An early closure of the PDA can contribute to decrease the morbidity and mortality of these infants, specially those with lower birth weight.

Topics: Digoxin; Ductus Arteriosus, Patent; Female; Furosemide; Humans; Indomethacin; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Male; Respiratory Distress Syndrome, Newborn; Retrospective Studies

Topics: Digoxin; Humans; Infant, Newborn; Infant, Premature, Diseases; Jaundice, Neonatal; Kinetics; Respiratory Distress Syndrome, Newborn; Time Factors

A prospective 2 1/2 year study of 50 infants with combined respiratory distress syndrome (RDS) and patent ductus arteriosus (PDA) was undertaken to determine whether echocardiographic measurements combined with clinical assessment could be used to select those infants who needed cardiac treatment. From a pilot study, criteria were adopted to use digoxin in the treatment of infants with evidence of congestive cardiac failure and/or a left atrial dimension 1.5 times normal size, and to ligate the PDA in those with unremitting congestive cardiac failure and a left atrial dimension persistently twice normal. Left atrial, left ventricular, and aortic dimensions, left atrial to aortic ratio, and mean Vcf were echocardiographically determined. Forty-six per cent of the 50 infants with PDA required digoxin administration, and 18 per cent of the total group was operated. The long-term mortality for the total group was 12 per cent (6 of 50) and mortality was 33 per cent (3 of 9) for the operated group. Results showed that absolute left atrial dimension, particularly if recorded in two dimensions, most accurately predicted those infants who would develop congestive cardiac failure or failure that would become medically unmanageable.

Topics: Aorta; Birth Weight; Digoxin; Ductus Arteriosus, Patent; Echocardiography; Heart Atria; Heart Failure; Heart Ventricles; Humans; Infant, Newborn; Prospective Studies; Respiratory Distress Syndrome, Newborn

Topics: Acute Disease; Biological Transport, Active; Digoxin; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Magnesium; Male; Phenytoin; Poisoning; Potassium; Respiratory Distress Syndrome, Newborn; Sodium; Vomiting

Topics: Angiocardiography; Cardiac Catheterization; Coronary Circulation; Coronary Disease; Coronary Vessels; Cyanosis; Digoxin; Electrocardiography; Heart Failure; Heart Ventricles; Humans; Infant, Newborn; Infant, Newborn, Diseases; Oxygen Inhalation Therapy; Pulmonary Circulation; Respiratory Distress Syndrome, Newborn

Topics: Asphyxia Neonatorum; Body Weight; Digoxin; Ductus Arteriosus, Patent; Female; Gestational Age; Heart Failure; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Male; Organomercury Compounds; Respiratory Distress Syndrome, Newborn; Sex Factors

The possibility that cardiac failure may be an important contributory or additive factor has led to the sporadic use of digitalis in the treatment of the respiratory distress syndrome in newborn infants. To assess the value of such medication a double-blind controlled study was conducted on 196 newborn infants, using digoxin and a placebo. As a result of the findings in this study the routine use of digoxin for the prevention of the respiratory distress syndrome is not recommended. The toxic effects of digitalis are outlined.

Topics: Asphyxia Neonatorum; Digoxin; Double-Blind Method; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Placebos; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Toxicology