Specific host/environmental factors can be used to identify which 33-35GA infants are at greatest risk of hospitalization for RSV infection and likely to benefit from palivizumab prophylaxis.

The use of ACV in pregnancy is not yet recommended for two main reasons : its safety has not been established and the,lack of studies on pharmacokinetics. In this paper, we have.reviewed data concerning nine pregnant women who was iven ACV in the perinatal period. Route of administration ani doses were as following : orally (0) 350 mg/8 hours (5), lntravenousl (IV) 5-10 mg/kg/8 hours ( 4 ) . Plasm? trough (T) and eak (P) fevels of ACV was deteroinated by radio~mmuno assay. At girth, plasma ACV levels were achieved in the mother and her offspring. P and T after IV were effective to inhiblt viral replication (17-41 pmol/l 1 22-1 36 umol/l) and hi her than in vitro ID 50 for Herpes'vi;adea'viruses (0.1-4 pmoY/l) ; whereas T and P ranged from 0.32 to 0, 59 pmol/l and from 1.79 to 3.78 pmol/l after 10 doses given orally. Furthermore steady state plasma level was not achieved even after 10 doses 0. The maternal foetal ratio of ACV level was approximately 1. No side effects were noted in newborns. Conclnsion : If this drug is felt,to be used in a pregnant.voman, IV administration seems to be advisable regarding it's efficacy. 0 administration requires more data about recommended dosage. Transplacental passa e of ACV occurs. Plasma ACV levels in the mother reflect probagly foetal ACV level. Fifteen very low birth weight I1tLBY1 children, nine appropriate for qeitati;i;al age in6A. aean birth weight 1302tIb4 g, gestational age 30t_1.5 neeksl, and six jrall for gestaticaa! aqe ISSR, aean birth neigih I:b3t117 g, qestatlonal age 35.35.5 weeks), xere studied at the age of 7-12 years, and coapared to trentysix age-, sex-, and height-latched healthy children, who were born at term (lean birth weight 3?2b+ib7 51. !lox of :Ce YLRY rhildren had developed chronic broncopullonary disease, The hab~tua! !ere1 of physical act~vity was not different in the YLBY and control Grcup. Pulronary function tests and progresirre exercise tests on treadlill were perforled. Forced v!tal caoacity, forced expiraiory ?oliiae at one second and forced expiratory flow between 251 and 751 of vital capaclty were in tb: norral range for all the subjects. No difference; were founo in aaxiwda oxyeen con'.um~tion (YO2 aaxl, anaerobic threshold IATI and #axiral heart rate between :he ASR !'lo2 lax - Lidoca~rcis either a convulsant or an anticonvulwnt drug, according to the plasmatic levels. W e used its anticonvulwnt effect in scizures of various etiology. Lidocairtinfusion (L.I.) was efficient in 19/29 full term (FT) and in 10/13 prcmaturc babies (PT) with seizures (confirmed by EEG) resisting to Phenobarbital and Diazepam therapy. L.1. was given at decreasing dosage (4 mg/kg/h, day 1; 3 mg/kg/h, day 2; 2 mg/kg/h,day 3; 1 mg/kg/h,day 4). After L.I. beginning : -seizures were controlled within 30 min. in 23 cases, aftcr 3 to 13 hours in 4 cases; -background EEG changed in some casts, immediatly or after a delay (up to 24 hours) into a very discontinuous pattern. In 2 cases L.I. alone did not control seizures, but an additional bolus (2 mg/Kg) was efficient ...

Unadjusted analyses revealed reduction in mortality (unadjusted odds ratio (UAOR): 0.83, 95% confidence interval (CI): 0.63, 0.98), severe retinopathy (UAOR: 0.68, 95% CI: 0.50 to 0.92), but increase in bronchopulmonary dysplasia (UAOR: 1.61, 95% CI: 1.39 to 1.86) and patent ductus arteriosus (UAOR: 1.22, 95% CI: 1.07 to 1.39). Adjusted analyses revealed increases in the later cohort for bronchopulmonary dysplasia (adjusted odds ratio (AOR): 1.88, 95% CI: 1.60 to 2.20) and severe neurological injury (AOR: 1.49, 95% CI: 1.22 to 1.80). However, the ascertainment methods for neurological findings and ductus arteriosus differed between the two time periods.Conclusion: Improvements in prenatal care has resulted in improvement in the quality of care, as reflected by reduced severity of illness and mortality. However, after adjustment of prenatal factors, no improvement in any of the outcomes was observed and on the contrary bronchopulmonary dysplasia increased. There is need for identification and application of postnatal strategies to improve outcomes of extreme preterm infants.

Early use of high-frequency oscillatory ventilation in very premature infants decreases exogenous surfactant requirements, does not improve the pulmonary outcome, and may be associated with an increased incidence of severe intraventricular hemorrhage.

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Pulmonary surfactant has a potential role in modulating inflammation in normal and injured lungs. In lung injury, monocytes become activated and participate in lung inflammation. We therefore, investigated the proinflammatory functions of stimulated human blood monocytes after an overnight preincubation period with modified natural porcine surfactant (Curosurf) (500-1000 micrograms/mL). Monocytes were stimulated either with phorbol myristate acetate (PMA), bacterial extract OM-85, lipopolysaccharide (LPS), or Ca2+ ionophore A23187. The present study shows that Curosurf significantly inhibits: 1) the production of superoxide anions stimulated with OM-85 (1 mg/mL, 30 min), but not with PMA (100 ng/mL, 30 min); 2) the release of cyclooxygenase metabolites prostaglandin E2 and thromboxane B2 stimulated with OM-85 (1 mg/mL, overnight); 3) the release of lipoxygenase metabolite leukotriene C4 stimulated with A23187 (10 microM, 10 min); 4) the release of the cytokine TNF-alpha stimulated overnight with either OM-85 (1 mg/mL) or LPS (10 micrograms/mL)) in a dose-dependent fashion. In addition, Curosurf decreases the spontaneous adherence of monocytes to plastic culture wells in a dose-dependent fashion. Experiments performed with staurosporine, an inhibitor of protein kinase C (PKC) indicate that, in contrast with PMA, the production of superoxide anions stimulated by OM-85 is not related to PKC activation. Consequently, we propose that the mechanism involved in the suppressive effects of Curosurf is PKC-independent. In summary, the present study provides experimental evidence that favors the anti-inflammatory role of modified natural porcine surfactant (Curosurf) in human monocytes in vitro.

ABSTRACT.Objective. To test the hypothesis that prophylactic treatment with the surfactant Curosurf (Chiesi Farmaceutici SPA, Parma, Italy) improves survival and respiratory problems more than rescue treatment.Design. Meta-analysis of three prophylaxis versus rescue treatment trials, conducted in four countries.Methods. A meta-analysis was performed with the original, individual data of mortality, severe respiratory distress syndrome, and chronic lung disease of 671 newborns as outcomes. The random-effects logistic model (accounting for the trial-within-country structure) was applied and adjusted for imbalances in covariates.Results. The probability of each outcome differed between the countries, but the actual treatment effect itself did not. The adjusted odds ratios (ORs) and confidence intervals (CIs) for prophylaxis versus rescue were as follows: mortality: OR, .47; 95% CI, .30 to .73; severe RDS: OR, .50; 95% CI, .33 to .74; and chronic lung disease of the newborn in the survivors at day 28 after birth: OR, .54; 95% CI, .34 to .86. Gender, birth weight, gestational age, and prenatal administration of glucocorticosteroids were significant confounding covariates.Conclusion. The analysis shows that for the porcine surfactant Curosurf, prophylactic administration of surfactant has significant advantages over rescue therapy. Pediatrics 1997;100(1). URL: http://www.pediatrics.org/ cgi/content/full/100/1/e4; mortality; respiratory distress syndrome; chronic lung disease of the newborn; surfactant, prophylaxis, meta-analysis.ABBREVIATIONS. OR, odds ratio; CI, confidence interval; RDS, respiratory distress syndrome; CLDN, chronic lung disease of the newborn; BPD, bronchopulmonary dysplasia; RRR, relative reduction of the risk ratio; BW, birth weight. M eta-analyses have shown that prophylactic and rescue treatment with surfactant reduce mortality rate, severity of acute respiratory problems, and the incidence of chronic lung disease in preterm newborns.