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Gastric shake test and pharyngeal lecithin/sphingomyelin ratios in new born infants
Insights
The gastric shake test and pharyngeal lecithin/sphingomyelin ratio help identify respiratory distress syndrome in newborns. Discrepancies may occur in infants born via emergency cesarean section due to maternal complications.
Area of Science:
- Neonatal Medicine
- Pulmonary Medicine
- Biochemistry
Background:
- Respiratory distress syndrome (RDS) is a significant cause of morbidity and mortality in newborn infants, particularly those who are premature or of low birth weight.
- Accurate and timely diagnosis of RDS is crucial for appropriate management and improved outcomes.
- Existing diagnostic methods have limitations in certain clinical scenarios.
Purpose of the Study:
- To evaluate the utility of the gastric shake test and pharyngeal lecithin/sphingomyelin (L/S) ratio in differentiating idiopathic respiratory distress syndrome (IRDS) from other causes of respiratory difficulties in neonates.
- To investigate potential discrepancies between these laboratory tests and the clinical presentation of IRDS.
Main Methods:
- Gastric aspirates were collected for the shake test to assess surfactant presence.
- Pharyngeal swabs were used to determine the lecithin/sphingomyelin (L/S) ratio, a marker of fetal lung maturity.
- These tests were performed on newborn infants presenting with respiratory difficulties, including low birth weight infants.
Main Results:
- Both the gastric shake test and pharyngeal L/S ratio were generally effective in distinguishing IRDS from other respiratory conditions.
- However, in six infants diagnosed with IRDS, the pharyngeal L/S ratio suggested lung maturity.
- Furthermore, three of these six infants showed evidence of surfactant via the gastric shake test, indicating a discrepancy between lab results and clinical diagnosis.
Conclusions:
- While useful, the gastric shake test and pharyngeal L/S ratio may yield results inconsistent with clinical findings in some IRDS cases.
- Emergency lower segment cesarean sections due to maternal complications may be associated with these discrepancies, possibly due to altered fetal physiological responses.
- Further investigation is warranted to understand and reconcile these observed discrepancies in surfactant assessment for neonates.
Abstract:
Gastric shake test and pharyngeal lecithin/sphingomyelin ratios were measured in newborn infants with respiratory difficulties, and in low birth weight infants in the immediate neonatal period. Both tests were useful in distinguishing infants with idioathic respiratory distress syndrome from those with respiratory difficulty due to other causes. However, in six infants with idiopathic respiratory distress syndrome, the pharyngeal lecithin/sphingomyelin ratio indicated mature lungs, and in three of these, the gastric shake test showed the presence of surfactant. Five of these six infants had been delivered by emergency lower segment caesarean section because of maternal complications, which might account for the discrepancy between the laboratory results and the clinical condition of the patient.