The authors conducted a randomized trial of second-line anticonvulsant treatments for neonates. The response to treatment was assessed using continuous video-EEG because the clinical diagnosis of seizure in neonates is known to be unreliable. Of 27 neonates with EEG-confirmed seizures, 5 were excluded because of protocol violations, and 11 responded to phenobarbitone in a dose of 40 mg/kg as first line. Three of five neonates treated with lignocaine responded. Six neonates were treated with benzodiazepines as second line: None responded, and their neurodevelopmental outcome was poor.

Background: A study was undertaken to determine the impact of respiratory syncytial virus (RSV) infection, both in hospital and the community, on healthcare utilisation and respiratory morbidity in prematurely born infants and to identify risk factors for symptomatic RSV infection. Methods: A hospital and community follow up study was undertaken of 126 infants born before 32 weeks of gestational age. Healthcare utilisation (hospital admissions and general practitioner attendances) in the first year, respiratory morbidity at follow up (wheeze and cough documented by parent completed diary cards), and RSV positive lower respiratory tract infections (LRTIs) were documented. Nasopharyngeal aspirates were obtained for immunofluorescence and culture for RSV whenever the infants had an LRTI, either in the community or in hospital. Results: Forty two infants had an RSV positive LRTI (RSV group), 50 had an RSV negative LRTI (RSV negative LRTI group), and 32 infants had no LRTI (no LRTI group). Compared with the RSV negative LRTI and the no LRTI groups, the RSV group required more admissions (p = 0.392, p,0.001) and days in hospital (p = 0.049, p = 0.006) and had more cough (p = 0.05, p = 0.038) and wheeze (p = 0.003, p = 0.003) at follow up. Significant risk factors for symptomatic RSV LRTI were number of siblings (p = 0.035) and maternal smoking in pregnancy (p = 0.005), for cough were number of siblings (p = 0.002) and RSV LRTI (p = 0.02), and for wheeze was RSV LRTI (p = 0.019). Conclusion: RSV infection, even if hospital admission is not required, is associated with increased subsequent respiratory morbidity in prematurely born infants.

Aims-To assess the eVects of smoking during pregnancy on lung mechanics and lung volumes in the immediate neonatal period, before infants are exposed to passive smoking. Methods-Lung function tests were carried out within 72 hours of delivery in infants born to 100 non-smoking and 189 smoking mothers. Lung growth was assessed by plethysmography and lung mechanics using the single breath occlusion technique and oesophageal balloon/ pneumotachography.Antenatal maternal serum cotinine values were obtained from 133 mothers. Results-Smoking was associated with a significant reduction in birthweight (mean 256 g, 95% CI 0.164 to 0.392), and length (mean 1.26 cm, 95% CI 0.48 to 2.00). Lung volume was not reduced when related to weight. Smoking was associated with a highly significant reduction in static compliance (C rs) . This eVect remained significant after relating C rs to weight and lung volume. Regression analyses showed that the C rs association was limited to the boys. Smoking was associated with a small but significant reduction in respiratory system conductance (G rs ) (single breath occlusion technique) and total pulmonary conductance (G p ). These associations were limited to girls. Conclusions-Smoking in pregnancy reduces static compliance in boys and conductance in girls. There was no evidence that maternal smoking adversely aVected fetal lung growth. (Arch Dis Child Fetal Neonatal Ed 1999;80:F8-F14)

RSV and hMPV LRTIs in prematurely born infants are associated with abnormal lung function at follow-up.

This study demonstrates that oral salbutamol is beneficial in the treatment of acute episodes of wheezing in infancy. A combination of oral salbutamol and oral prednisolone appeared to have no additional benefit over treatment with oral salbutamol alone.

In our study population, PDA closure was gestation dependant, with a cumulative closure rate of 65%. A similar proportion of infants closed their PDA following the first and second courses regardless of gestation. These data suggest that a second course of ibuprofen may be effective in closing a PDA in even the most preterm infant.

Background-Previous studies suggest that recurrent episodes of coughing and wheezing occur in up to 75% of infants after acute viral bronchiolitis. Aim-To assess the eYcacy of budesonide given by means of a metered dose inhaler, spacer, and face mask in reducing the incidence of coughing and wheezing episodes up to 12 months after acute viral bronchiolitis. Methods-Children under the age of 12 months admitted to hospital with acute viral bronchiolitis were randomised to receive either budesonide or placebo (200 µg or one puV twice daily) for the next eight weeks. Parents kept a diary card record of all episodes of coughing and wheezing over the next 12 months. Results-Full follow up data were collected for 49 infants. There were no significant diVerences between the two study groups for the number of infants with symptom episodes up to six months after hospital discharge. At 12 months, 21 infants in the budesonide group had symptom episodes compared with 12 of 24 in the placebo group. The median number of symptom episodes was 2 (range, 0-13) in those who received budesonide and 1 (range, 0-11) in those who received placebo. Because there is no pharmacological explanation for these results, they are likely to be caused by a type 1 error, possibly exacerbated by there being more boys in the treatment group. Conclusion-Routine administration of budesonide by means of a metered dose inhaler, spacer, and face mask system immediately after acute viral bronchiolitis cannot be recommended. (Arch Dis Child 1999;80:343-347)

The expired tidal volume, inflation pressures and times during the first five inflations during resuscitation were variable. The expired tidal volumes were significantly greater if the infant inspired during the inflation.