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Is DNase safe and effective in the treatment of refractory atelectasis among preterm neonates?
  1. Matthew McGovern,
  2. Neelam Gupta,
  3. Chinthika Piyasena
  1. Neonatal Unit, Guy’s and St Thomas’ NHS Foundation Trust, Evelina London Children's Hospital, London, UK
  1. Correspondence to Dr Matthew McGovern, Neonatal Unit, Guy’s and St Thomas’ NHS Foundation Trust, Evelina London Children's Hospital, London SE1 7EH, UK; Mattt111000{at}gmail.com

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Clinical bottom line

  • The short-term use of deoxyribonuclease (DNase) may improve clinical outcome in infants with atelectasis which is refractory to standard therapy (Grade C).

  • The short-term use of DNase appears to be safe in preterm infants with refractory atelectasis (Grade B).

  • A 3-day course of 1.25–2.5 mg nebulised DNase two times a day with a single rescue dose via direct endotracheal instillation was often employed (Grade C).

Scenario

You review a former 24+2 week gestation male infant on your ward round. This infant is now corrected to 30 weeks gestation and has been on invasive ventilatory support since birth. He has had recurrent ventilator-associated pneumonias, the most recent of which started 4 days ago. For the past 24 hours, he has had poor oxygenation despite escalating ventilation support, regular chest physiotherapy and appropriate antimicrobial therapy. An echocardiogram is normal. Chest X-ray shows bilateral airspace disease with an almost complete loss of volume on the left side which has been persistent since yesterday.

You recall a similar case where an infant was treated with endotracheal deoxyribonuclease (DNase) and appeared to improve, and you wonder about the safety and efficacy of DNase for this patient.

Structured clinical question

Is DNase therapy [intervention] safe and efficacious [outcome] in the treatment of refractory atelectasis [condition] in preterm neonates requiring respiratory support [patient group]?

Literature search

The literature search was undertaken in May 2021. In total, we identified nine relevant studies.

Secondary sources: The Cochrane database was searched for the term ‘DNase’ and yielded 0 relevant results. The Database of Abstracts of Reviews of Effects (DARE) was searched using the term ‘DNase’ and yielded 1 relevant retrospective case-control study.

Primary sources: MEDLINE was searched using PubMed. The following search string was used: (DNase[Title/Abstract]) AND (preterm[Title/Abstract] OR premature[Title/Abstract] OR neonat*[Title/Abstract]). Only studies published in English, and which had full text manuscripts available were included. A total of …

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Footnotes

  • Twitter @chinthikap

  • Contributors All authors contributed to the design of the manuscript. MMG performed the literature review and wrote the initial draft of the manuscript. NG performed the literature review and edited the article before submission. CP performed the literature review and edited the article before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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