SCENARIO You review a former 24+2week 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.
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