Long-term treatment for 1-2 years with intranasal budesonide 256-400 microg daily in children with perennial rhinitis revealed no negative effects on growth or endogenous cortisol production. Local side-effects were mild and patient symptoms decreased.

SUMMARYThe effect of applying brain-orientated neonatal intensive care for term infants with severe neonatal asphyxia was studied. Such treatment included protective phenobarbitone administration together with assisted ventilation and other measures to counteract postasphyxial cerebral oedema and any abrupt changes in blood pressure and oxygenation. The mortality rate and incidence of long-term sequelae were reduced appreciably, resulting in a 0-1 year mortality rate of 14% (previously 50%) and an incidence of neurodevelopmental handicap at 18 months of 17 % (previously 50%). It is important in the management of infants with severe asphyxia at birth to avoid blood pressure fluctuations and to control neuronal epileptic activity by the use of barbiturates and early ventilator treatment.

The short-term outcome with survival rate, causes of death and neonatal complications in a 6-year material comprising 253 infants treated with intermittent positive pressure ventilation (IPPV) in the neonatal period has been analyzed in relation to different primary disorders necessitating IPPV treatment. The total survival rate was 53%. For the different diagnoses the survival rates were: hyaline membrane disease (HMD) 41%, apnoea repetens of immaturity 85%, severe birth asphyxia 46% and septicemia 59%. The total rate of pneumothorax during IPPV was 15% but occurred more often in the HMD group (28%). Trends in survival rates over the study period are discussed as are measurements for improvements.

SummaryPulmonary mechanics were studied with the constant pressure body plethysmograph method in 78 infants during the first year of life. Registrations of breathing frequency, tidal volume, minute volume, dynamic compliance, pulmonary functional resistance, and end-expiratory resistance were made at rest and during carbon dioxide-induced hyperventilation. Data from 70 infants demonstrated strong correlations (P < 0.001) between all pulmonary function parameters and length. Carbon dioxide-induced hyperventilation was achieved mainly by an increased tidal volume. Pulmonary functional resistance did not change with hyperventilation, indicating wider airways during forced ventilation.A special breathing pattern called "subclinical grunting" was found in 16 of 45 infants who were low birth weight but without clinical signs of hyaline membrane disease. The pattern was characterized by a high resistance during most of the prolonged expiration. It was identical to that previously described in cases of hyaline membrane diseases. All re-examined low-birth-weight infants with subclinical grunting developed a normal breathing pattern. SpeculationSublinical grunting found in preterm low-birth-weight infants might be a phenomenon of postnatal lung adaptation which can be registered by pulmonary mechanics examination.

The aim of this study was to evaluate the efficacy, safety and preference of pre-school children with regard to two different devices for treatment of bronchial asthma with terbutaline. Turbuhaler, a powder inhaler preloaded with pure terbutaline for inhalation, was compared with a pressurized metered dose inhaler, attached to a Nebuhaler. The study had an open, cross-over randomized design. Each treatment period consisted of 2 weeks. Diary cards were filled in every morning and evening by the parents regarding PEF, asthma symptoms, extra inhalations of terbutaline, and side effects. Twenty-one children (mean age 3.9 years) were included in the study. A highly significant (P less than 0.001) increase in peak expiratory flow (PEF) was obtained after inhalation with both devices. The PEF values in the mornings after inhalation of terbutaline with Turbuhaler were significantly higher (P = 0.046) than those with Nebuhaler. Further, the PEF baseline values in the evenings before inhalation were also significantly higher (P = 0.03) with Turbuhaler. No difference was found in asthma symptoms and extra medication between the two devices. Side effects were mild and few with both devices. The parents found Turbuhaler easier to handle and 19 of 21 preferred this device for future use.