Enteral DHA supplementation at a dose of 60 mg per kilogram per day did not result in a lower risk of physiological bronchopulmonary dysplasia than a control emulsion among preterm infants born before 29 weeks of gestation and may have resulted in a greater risk. (Funded by the Australian National Health and Medical Research Council and others; Australian New Zealand Clinical Trials Registry number, ACTRN12612000503820 .).

Using RA to initiate resuscitation was associated with an increased risk of death in infants <28 weeks' gestation. This study was not a prespecified analysis, and it was underpowered to address this post hoc hypothesis reliably. Additional data are needed.

Persistent pulmonary hypertension of the newborn (PPHN) is a complex syndrome with multiple causes, with an incidence of 0.43-6.8/1,000 live births and a mortality of 10-20%. Survivors have high morbidity in the forms of neurodevelopmental and audiological impairment, cognitive delays, hearing loss, and a high rate of rehospitalization. The optimal approach to the management of PPHN remains controversial. Inhaled nitric oxide (iNO) is currently regarded as the gold standard therapy, but with as many as 30% of cases failing to respond, has not proven to be the single magic bullet. Given the complex pathophysiology of the disease, any such magic bullet is unlikely. A number of recent studies have suggested a role for specific phosphodiesterase (PDE) inhibitors in the management of PPHN. Sildenafil, a specific PDE5 inhibitor, appears the most promising of such agents. We aim to review the current status and limitations of iNO and the potential of PDE inhibitors in the management of PPHN. The reasons why caution is warranted before specific PDE5 inhibitors like sildenafil are labelled as potential magic bullets for PPHN will be discussed. The need for randomized-controlled trials to determine the safety, efficacy, and long-term outcome following treatment with sildenafil in PPHN is emphasized.

Continuous positive airway pressure (CPAP) is often used to provide noninvasive respiratory support in infants with Respiratory distress syndrome. The recruitment of atelectatic lung and appropriate lung volume maintenance are vital to the success of CPAP treatment. The noisy pressure waveform of bubble CPAP superimposed on pressure fluctuations as a result of spontaneous breathing may promote airway opening events as a result of stochastic resonance. The magnitude and the frequency of the superimposed noise are critical to this process. We hypothesized that the applied bias flow and mechanical properties of the lung would influence the magnitude and the frequency content of the noise transmitted to the lung. The effect of varying bias flow (6 -10 L/min) and lung compliance (0.1-1. (2) highlighting the low incidence of chronic lung disease in preterm infants at the Columbia Presbyterian Medical Centre have focused attention on the specific respiratory care practices of that institution and particularly that of using bubble CPAP (3).During bubble CPAP, the expiratory limb of the CPAP circuits vents through an underwater seal. The resulting bubbles create pressure oscillations that are transmitted back to the airway opening. Lee et al. (4) observed that the chests of infants who received bubble CPAP via an endotracheal tube vibrated in a similar manner and frequency to infants who received high-frequency oscillatory ventilation and questioned whether these vibrations may contribute to gas exchange. When comparing bubble CPAP with ventilator-derived CPAP in intubated infants, they showed that infants were able to maintain blood gas parameters despite reducing both minute volume and respiratory rate while on bubble CPAP and hypothesized that bubble CPAP may reduce work of breathing compared with ventilator-derived CPAP and augment gas exchange through promotion of facilitated diffusion. This hypothesis has not been scientifically tested, and no alternative rationale to support a physiologic advantage of this form of CPAP over other methods has been published in the literature. Although consideration has been given to the potential of improved efficiency of gas mixing during bubble CPAP, a second possibility is that the superposition of noise on the underlying constant pressure may promote lung volume recruitment and hence also reduce intrinsic work of breathing. If so, then the

The diagnosis and treatment of ankyloglossia vary considerably around the world and between professions. Efforts to standardise management are required.