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Pediatric Emergency Care:
doi: 10.1097/PEC.0000000000000089
Illustrative Cases

Surfactant for Acute Respiratory Distress Syndrome Caused by Near Drowning in a Newborn

Fettah, Nurdan MD; Dilli, Dilek MD; Beken, Serdar MD; Zenciroglu, Aysegul MD; Okumuş, Nurullah MD

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Abstract

Background: Near drowning is the term for survival after suffocation caused by submersion in water or another fluid. Pulmonary insufficiency may develop insidiously or suddenly because of near drowning.

Aim: We want to present a newborn case of acute respiratory distress syndrome caused by near drowning.

Case: A 26-day-old boy was brought to the emergency department because of severe respiratory distress. Two hours before admission, the baby suddenly slipped out his mother’s hands and fell in the bathtub full of water while bathing. After initial resuscitation, he was transferred to the neonatal intensive care unit for mechanical ventilation. PaO2/FIO2 ratio was 97, with SaO2 of 84%. Bilateral heterogeneous densities were seen on his chest x-ray film. The baby was considered to have acute respiratory distress syndrome. Antibiotics were given to prevent infection. Because conventional therapy failed to improve oxygenation, a single dose of surfactant was tested via an intubation cannula. Four hours later, poractant alfa (Curosurf) administered repeatedly at the same dosage because of hypoxemia (PaO2/FIO2 ratio, 124; SaO2, 88%). Oxygen saturation was increased to more than 90% in 24 hours, which was maintained for 3 days when we were able to wean him from mechanical ventilation. After 7 days, the x-ray film showed considerable clearing of shadows. He was discharged home on the 15th day after full recovery.

Conclusions: This case report describes a rapid and persistent improvement after 2 doses of surfactant in acute respiratory distress syndrome with severe oxygenation failure caused by near drowning in a newborn.

© 2014 Lippincott Williams & Wilkins, Inc.

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