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.

During severe RDS, inflammation may contribute to increased lipid peroxidation leading to increased local CO production in the lung, indicated by increased ETCOc. Early ETCOc determinations may be helpful to exclude occurrence of chronic lung disease.

Objective To determine the proportional reduction per day in the number of fetal and donor red blood Design Aretrospective study of 302 transfusions in 101 fetuses.Setting The Department of Obstetrics and Gynaecology of the University Medical Centre Leiden, The Netherlands. MethodsWe measured the haematocrit in fetal samples both before and after repeated intravascular intrauterine transfusion in fetuses with alloimmune disease. The percentage of fetal erythrocytes was determined in Kleihauer-Betke stained smears. The decline of fetal, donor and mixed red blood cells was calculated by dividing the proportional decrease of the haematocrit values by the number of days between transfusions, also after correction for changes in fetoplacental volumes. Results (given as mean [SD]) are derived from the proportional changes of haematocrit per day. ResultsThe interval between the first and second transfusion (15.5 days [SD 5.21) was shorter than between subsequent transhsions (means ranging from 21.4 to 21.9 days; P 5 0.0001). The decline per day of mixed, and of donor red blood cells, calculated without corrections for volume changes did not differ from those corrected for volume changes resulting from the transfusion and from fetal growth (correction factor 1.1 [SD 0.41). Since the coefficient of variance is smaller for the uncorrected decline values, this type of calculation is preferable for clinical purposes. The disappearance of fetal erythrocytes after the first transfusion (6*l%/day [SD 2-91) was faster than that of mixed fetal and donor red blood cells (3,2%/day [SD 1.21; P < 0.0001) and of donor cells alone (1.4%/day [SD 1.61; P < 0.0001). The decline of the mixed red blood cell population became the same as that of the donor cells (2.2%/day [SD 0.81) after the second transfusion. This decline of donor cells was higher than after the first transfusion (1.4%/day [SD 1 *6]; P < 0.05). After the first transfusion the fetal erythrocytes disappeared faster after transplacental puncture of the umbilical cord (6*6%/day [SD 2.81) than after transamniotic punctures (5*4%/day [SD 2.71; P = 0.05). The mixed red blood cell also decreased faster (3.5%/day [SD 1.31 versus 2*8%/day [SD 0.91; P < 0.01). ConclusionThe fast disappearance of fetal erythrocytes, especially after transplacental punctures, shows that the interval between the first and second transfusion needs to be shorter than that for intervals between subsequent transfusions. The number of donor erythrocytes declines by approximately 2% per day.cells from the fetal circulation after intrauterine intravascular transfusions.

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A low blood pressure is common in preterm infants with respiratory distress syndrome (RDS). A diminished vascular resistance appears to be an important cause. The endogenous production of nitric oxide (NO), a mediator of vascular smooth muscle relaxation, has been shown to be higher in infants with RDS than in those without. Infants with persistent pulmonary hypertension showed decreased endogenous NO levels as compared with controls. Severe RDS in preterm infants may be accompanied by persistent pulmonary hypertension. To elucidate the role of NO in RDS and low blood pressure, we determined the endogenous NO production in infants with and without RDS by measuring urinary nitrite and nitrate excretions and plasma cGMP levels. In consecutively admitted preterm infants (gestational age <32 weeks), urine samples for measurement of NO₂ and NO₃ and plasma samples for the determination of the cGMP concentrations were serially collected during the 1st week of life. Arterial blood pressure, therapy to support blood pressure, and additional relevant clinical data were registered simultaneously. 27 infants with and 39 without RDS were included. The urinary NO_x levels increased in all patients and were not different between both groups. The plasma cGMP concentrations were higher in the RDS group on days 2, 3, 4, and 7 (p < 0.05). The severity of RDS was positively correlated with plasma cGMP (r = 0.50, p = 0.0001). Although the arterial blood pressure did not differ between the groups, more blood pressure support was needed in the RDS infants during the first 4 days (p < 0.05). A positive correlation was found between blood pressure support and plasma cGMP (r = 0.34, p < 0.0001). The endogenous NO production was not different in infants with and without RDS. Increased plasma cGMP levels in the RDS infants were associated with the severity of RDS and the intensity of antihypotensive treatment. The origin of cGMP in infants with RDS requires further research.