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DNase for Atelectasis
Rescue Use of DNase in Critical Lung Atelectasis and Mucus Retention in Premature Neonates. El Hassan NO and Huysman MW. Pediatrics 2001 (Aug); 108: 468-71.
Excessive or thick pulmonary secretions are a common clinical challenge in the neonatal population, and may cause life-threatening complications. The authors report 3 premature neonates who had critical pulmonary collapse secondary to mucus plugging. Different conventional methods to liquefy mucus and facilitate removal of secretions were exhausted to no avail. The rescue use of DNase was effective in re-establishing airway patency in each of these cases.
Comment. Nebulized recombinant human DNase hydrolyzes the extracellular DNA in sputum, transforming it from a viscous gel to a free-flowing liquid. It has commonly been used for this purpose in patients with cystic fibrosis, and no serious side effects have been noted. The dose used in the three premature babies reported in this study was 1 mg/m2 in the first case and 1.25 mg / dose (half of the pediatric dose) in the subsequent 2 cases. All 3 patients babies had a dramatic improvement in atelectasis, oxygen requirement and ventilator settings. Obviously, controlled clinical trials need to be done, but these preliminary results look promising.