Surfactant replacement therapy for respiratory distress syndrome in preterm infants: United Kingdom national consensus

Our aim was to develop consensus recommendations from United Kingdom (UK) neonatal specialists on the use of surfactant for the management of respiratory distress syndrome RDS in preterm infants. RDS due to surfactant deficiency is common in preterm infants. Signs, including tachypnoea, recessions, and grunting, usually commence shortly after birth, and increase in severity during the first 12–48 h of postnatal life. Significant RDS may require mechanical ventilation (MV) or noninvasive ventilatory support (NIV), both of which have potential to cause lung injury via a number of mechanisms.1 The aim of RDS management is to provide appropriate respiratory support whilst minimising complications and, ultimately, bronchopulmonary dysplasia (BPD). Treatment with exogenous surfactant reduces requirement for positive pressure ventilation, mitigates risk of pulmonary air leak, and improves survival.1 International consensus guidelines on management of RDS have been published;1 however, recent developments in the field of less invasive surfactant administration prompt the need for a UK national consensus on surfactant use in preterm infants with, or at risk of, RDS

Atypical presentation of congenital pneumonia: Value of lung ultrasound

A term neonate was transferred from a Local Neonatal Unit to our surgical Neonatal Intensive Care Unit on Day 2 due to abdominal distension with radiological appearances suggestive of intestinal obstruction. He was born by Caesarean section with no risk factors for sepsis. He was intubated at birth for increased work of breathing and failed planned extubation on Day 1.&nbsp

Clinical Report Choanal Atresia: The Result of Maternal Thyrotoxicosis or Fetal Carbimazole?

We present the fourth published case of a child affected with choanal atresia following maternal treatment with carbimazole. The mother was receiving her highest dose of carbimazole at the crucial period for development of the choanae, between days 35 and 38.

Detection of exhaled carbon dioxide following intubation during resuscitation at delivery

ObjectivesEnd tidal carbon dioxide (ETCO2) monitoring can facilitate identification of successful intubation. The aims of this study were to determine the time to detect ETCO2following intubation during resuscitation of infants born prematurely and whether it differed according to maturity at birth or the Apgar scores (as a measure of the infant’s condition after birth).DesignAnalysis of recordings of respiratory function monitoring.SettingTwo tertiary perinatal centres.PatientsSixty-four infants, with median gestational age of 27 (range 23–34)weeks.InterventionsRespiratory function monitoring during resuscitation in the delivery suite.Main outcome measuresThe time following intubation for ETCO2levels to be initially detected and to reach 4 mm Hg and 15 mm Hg.ResultsThe median time for initial detection of ETCO2following intubation was 3.7 (range 0–44) s, which was significantly shorter than the median time for ETCO2to reach 4 mm Hg (5.3 (range 0–727) s) and to reach 15 mm Hg (8.1 (range 0–827) s) (both P&lt;0.001). There were significant correlations between the time for ETCO2to reach 4 mm Hg (r=−0.44, P&gt;0.001) and 15 mm Hg (r=−0.48, P&lt;0.001) and gestational age but not with the Apgar scores.ConclusionsThe time for ETCO2to be detected following intubation in the delivery suite is variable emphasising the importance of using clinical indicators to assess correct endotracheal tube position in addition to ETCO2monitoring. Capnography is likely to detect ETCO2faster than colorimetric devices.</jats:sec

Paxillus

Abstract is not availabl