SUMMARY The incidence of necrotising enterocolitis (NEC) in very low birthweight infants (VLBW. 1500 g) was reduced by the delayed onset of enteral feeding. Eight (18 %) out of 44 VLBW infants who were in hospital during the first year of the study developed NEC. During the next 12 months 85 similar infants were initially fed by parenteral nutrition only,. and then from age 14-21 days with infant formula. During the second year only 3 (3 %) patients developed NEC. There were no other relevant changes in management. Throughout the entire study, the onset of NEC in each infant in whom it occurred was after the start of enteral feeding. We recommend avoiding enteral feeding in VLBW infants during the period that they are particularly vulnerablenamely the first 2 or 3 weeks of life.Necrotising enterocolitis (NEC) is a serious problem in very low birthweight infants (VLBW. 1500 g), and it was therefore of considerable interest when Barlow and colleagues' 2 showed that experimental NEC was prevented in a rat by feeding expressed breast milk (EBM). This finding was soon adopted and extrapolated to human newborn infants,3 and neonatal units renewed their interest in human milk banks. New criteria for collecting and using milk were suggested,45 but after a year of daily struggle to ensure fresh supplies of EBM for our VLBW patients, we were still encountering a considerable number of cases of NEC. A decision to change our feeding policy was made in accordance with the growing evidence for the role of enteral feeding in the pathogenesis of NEC.-8 We present our experience during 2 consecutive years of early EBM feeding and delayed formula feeding in VLBW infants. Subjects and methodsDuring two consecutive years, from May 1977 to April 1979, 342 newborn infants were in hospital in the newborn intensive care unit of this hospital.One hundred and twenty-nine (37 3 %) were VLBW infants (. 1500 g). During the second year, the number of admissions and the number of VLBW infants were almost double those of the first year (Table 1).
The present report concerns a young woman previously diagnosed as having childhood asthma who presented with a secondary spontaneous pneumothorax during the third trimester of pregnancy; at term a caesarean section was recommended for safety reasons. Post partum a severe fixed ventilatory defect unresponsive to inhaled bronchodilator and a short oral course of steroids ruled out asthma. Diffuse bronchiectasis was found on her chest CT scan, although this was not evident clinically. Known aetiologies for diffuse bronchiectasis (cystic fibrosis, anti-α1 antitrypsin deficiency, rheumatic diseases, mycobacterial infections, childhood infections and immune deficiencies) were ruled out. Therefore it is believed her bronchiectasis was idiopathic or congenital. No recommendations from recent guidelines on how to manage labour in a woman after a spontaneous pneumothorax could be found. However, a literature search revealed that pregnant women usually experience primary pneumothorax and may continue in natural labour; however, it is unknown how best to manage a woman with secondary spontaneous pneumothorax.
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