Practice of intratracheal and inhaled recombinant human deoxyribonuclease (rhDNase) therapy in neonates with persistent atelectasis: A rescue treatment

Abstract

Objective: Atelectasis increases the risk of secondary pulmonary infections related with prolonged artificial ventilation. Therefore, it requires early and aggressive treatment in newborns cared in neonatal intensive care units (NICUs). Current treatment of atelectasis consists of certain conventional modalities. However, there is still no evidence-based, "gold standard" treatment. Use of recombinant human deoxyribonuclease (rhDNase) is a new concept in NICUs. In this study, we aimed to compare and evaluate the clinical and radiological changes in infants who received nebulized or intratracheal rhDNase for persistent atelectasis unresponsive to conventional treatment options. Material and Methods: This study was conducted in 23 newborns hospitalized at the NICU of Dr. Behcet Uz Children's Hospital. Twelve intubated patients received 1.25 mg rhDNase mixed with 1:1 0.9% saline intratracheally, whereas 11 non-intubated patients received the drug via a jet nebulizer. A second dose was administered 4 hours after the initial dose. Chest physiotherapy and tracheal aspiration was performed 1 hour after the second dose. The same protocol was repeated on the second day. Clinical and radiological responses were evaluated separately. Results: Positive radiological and clinical responses to rhDNase and recurrence of atelectasis in the whole study group were 78.3%, 56.3% and 16.7% respectively. Nebulized route was more successful than the intratracheal route. Response to rhDNase was better in cases with upper lung lobe involvement. Conclusion: Both nebulized and intratracheal rhDNase administrations are successful without any adverse reactions for the treatment of persistent atelectasis, especially in neonates with viscous secretions and pneumonia with upper lobe atelectasis. © 2013 by Türkiye Klinikleri.