Since 1984 we have cared for 11 neonates with severe respiratory distress whose clinical characteristics appear distinctive: 1) full-term by obstetric and Dubowitz criteria (median 39 wks, range 37-42; median BW 2950g, range 2610-4360), 2) diffuse alveolar disease radiographically, 3) requiring FiO2 1.0 and mechanical ventilation to maintain paO2 50, 4) absence of other conditions known to produce a similar clinical profile. No mothers were diabetic or Rh-sensitized. Blood cultures and latex agglutination bacterial antigen studies were negative in all. None had aspirated meconium. Two-dimensional echocardiography and simultaneous pre- and postductal ABGs showed no evidence of cyanotic congenital heart disease or extrapulmonary right-to-left mix. Among the 11, 5 had 5 minute Apgar scores ≤5, 8 had evidence of fetal distress, 5 had initial hematocirts <45, and 7 had hypotension or oliguria requiring pressors and/or volume support. Seven had multiple organ dysfunction. AH 11 survived but required prolonged mechanical ventilation and supplemental oxygen. Trials of hyperventilation (pH ≥7.55, paCO2 ≤25) in 8 and tolazoline in 4 failed to increase paO2 by >20 torr. Among 7 infants who underwent trials of increased PEEP to ≥6 cm H2O (range 6-10) without other concurrent changes in ventilator settings, 6 responded with prompt increases in paO2 >20 torr (median 68, range 22-136), despite resultant mean airway pressure (PAW) being lower than previously unsuccessful PAWs in 4 of 6. We suggest that ARDS is a distinctive clinical entity in neonates. A trial of PEEP ≥6 cm H2O should be considered in full-term infants with severe respiratory distress in whom other causes can be excluded.

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Faix, R., Viscardi, R., Dipietro, M. et al. ADULT RESPIRATORY DISTRESS SYNDROME (ARDS) IN NEONATES: A CLINICAL SYNDROME. Pediatr Res 21, 199 (1987).

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