Use of recombinant human DNase in a premature infant with recurrent atelectasis

Abstract

Key wordsatelectasis, premature neonate, rhDNase.Presence of mucus-plugging and abundance of thickened pulmonary secretions in the neonatal period are risk factors for pulmonary infections and prolonged artificial ventilation. The viscoelastic properties of airway secretions was known to be largely due to the presence of highly polymerized DNA. 1 Recombinant human DNase (rhDNase) degrades highly viscosic DNA and was shown to be efficient in patients with cystic fibrosis (CF). 2,3 The use of rhDNase for the treatment of atelectasis in patients in the neonatal intensive care unit is a new concept, intended to liquefy the mucus when conventional therapies fail. 4 We present our experience with rhDNase use in a premature infant with recurrent atelectasis. CaseA female infant of 29 weeks, 1 day gestation and a birth weight of 1040 g was delivered to a 30-year-old mother by cesarean section, because of intrauterine growth retardation, non-reactive non-stress test and breech presentation. Six days before delivery, the mother had spontaneous rupture of membranes and received erythromycin. The mother was a hepatitis B surface antigen (HBsAg) carrier and there was no consanguinity between the parents. The Apgar scores were 5, 7 and 9 at 1, 5 and 10 m. The placenta and the umbilical cord were normal in appearance, no pathological examination was performed. The patient's general condition was moderate-togood after birth: skin color was pink, activity was good, body temperature was 36.1 ° C, heart rate was 132/minute, respiratory rate was 48/minute, and blood pressure was 50/22 mmHg. In the complete blood count (CBC) the following were found: hemoglobin 16.3 g/dL, hematocrit 48.4%, white blood cell count 7.000/ µ l, mean corpuscular volume (MCV) 107.9 fl, red cell distribution width (RDW) 14.7, platelets 205.000/ µ l. C-reactive protein (CRP) was <0.01 mg/dL. Blood sugars were found to be 89 and 106 mg/dL at 2 and 6 h after birth, respectively. Oxygen saturation measured with pulse oxymetry was found to be 94%. No microorganisms were cultured in blood or urine samples taken on the patient's first day of life. No infiltration was found on chest X-ray and her cranial ultrosonographic examination was normal. The patient was given both hepatitis B immunoglobulin and hepatitis B vaccine. She was started on ampicillin and netilmycin because of the mother's history of preterm rupture of the membranes. The chest X-rays of the patient were not compliant with respiratory distress syndrome (RDS). On the third day of life, the infant had been apneic and had an increase in her oxygen requirement with pneumonic infiltration visible on chest X-ray. The patient was not hypothermic nor was she hyperthermic. There was no electrolyte imbalance or acidosis in her biochemistry and blood gas examination. She was not anemic. She was not RDS but there was an infiltration on chest X-ray. To treat apnea, first nasal continuous positive airway pressure (CPAP) (day 3), then nasal synchronized intermittent mandatory ventilation (SIMV) (day 4) was applied...

Perspectives for treatment with dornase-alfa in paediatric respiratory medicine

“…В последние годы появились публикации об эф фективном использовании препарата при ателекта зах, в т. ч. у недоношенных детей [29][30][31]. Обструк ция дыхательных путей слизистыми пробками часто встречается у пациентов неонатальных реанимаци онных отделений.…”

“…При неэффективности стандарт ной терапии бронхоскопическое удаление мукозных пробок не всегда возможно у недоношенных детей грудного возраста в связи с малым размером их рес пираторной системы. S. Kupeli et al [29,30] использовали ДА для улучшения выве дения мокроты и очищения просвета дыхательных путей в связи с неэффективностью стандартной те рапии и невозможностью бронхоскопии из за мало го размера тела пациента. Препарат вводился в виде ингаляций.…”

Pharmacotherapy of impaired mucociliary clearance in non‐CF pediatric lung disease. A review of the literature

“…70 In contrast, others found no clinical or radiological improvement after rhDNase treatment in mechanically ventilated children with an atelectasis. 71 Kupeli et al 72 reported even new atelectatic areas after rhDNase treatment in one premature infant with recurrent atelectasis, perhaps due to profuse secretions that could not be expectorated efficiently. Hendriks et al 69 reported that 3 out of 30 children showed temporary clinical deterioration with desaturations due to increased airways obstruction immediately after endotracheal administration of rhDNase.…”

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

“…Its efficacy has also been shown in respiratory syncytial virus (RSV) bronchiolitis, asthma and bronchiectasis 1,2,9,10,16 . There are studies which report successful results in the treatment of atelectasis in newborns, particularly in premature ones 7,17–19 . However, the cost of treatment with rhDNase is very high.…”