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Our results suggest that prematurely born infants may have a genetic predisposition to RSV LRTIs and subsequent respiratory morbidity which is independent of premorbid lung function.

. Purpose:   To determine the feasibility and efficacy of morphine sedation/analgesia in the laser treatment of retinopathy of prematurity (ROP). Methods:  A retrospective study was carried out on all infants who underwent laser treatment for ROP over a 7 year period. Morphine infusion commenced 6 hrs prior to treatment at a rate of 10 µg/kg/hr. This rate increased to 20 µg/kg/hr at the start of laser treatment. Subsequent infusion rate was titrated according to tolerance of the laser and cardio and respiratory system changes and evidence of infant distress (truncal and limb movements) up to a maximum rate of 40 µg/kg/hr. Following treatment, morphine was weaned over 6 hrs. Infant ventilation status was recorded prior to and during morphine infusion and during laser treatment. The incidences of adverse cardiac or respiratory events occurring during laser treatment were determined. Results:  One hundred and nine infants treated from 1998 to 2005 were involved in the study. One hundred and thirty‐six treatments were performed and mean gestational age at the time of treatment was 36 weeks. In 130 treatments, respiratory status remained stable and was not adversely affected. Infants were mechanically ventilated because of morphine‐induced apnoea during three treatments, because of poor laser tolerance during two treatments and because of post‐procedure apnoea in one case. In 65 treatments, minor alterations in oxygen saturation (< 90%), bradycardia or tachycardia occurred. Conclusion:  This study demonstrates that morphine analgesia can be used as an alternative to general anaesthesia.

These results suggest viral LRTIs, regardless of whether hospitalisation is required, adversely affect prematurely born infants' airway resistance at follow up.

Addition of low VT levels to patient-triggered modes increases the WOB during weaning. This can be avoided by using a VT level of 6 mL/kg. ABSTRACTOBJECTIVES. The objectives of this study were to determine the impact of different volume-targeted levels on the work of breathing and to investigate whether a level that reduced the work of breathing below that experienced during ventilatory support without volume targeting could be determined.METHODS. The transdiaphragmatic pressure-time product, as an estimate of the work of breathing, was measured for 20 infants (median gestational age: 28 weeks) who were being weaned from respiratory support by using patient-triggered ventilation (either assist-control ventilation or synchronous intermittent mandatory ventilation). The transdiaphragmatic pressure-time product was measured first without volume targeting (baseline) and then at volume-targeted levels of 4, 5, and 6 mL/kg, delivered in random order. After each volume-targeted level, the infants were returned to baseline. Each step was maintained for 20 minutes.RESULTS. The mean transdiaphragmatic pressure-time product was higher with volume targeting at 4 mL/kg in comparison with baseline, regardless of the patient-triggered mode. The transdiaphragmatic pressure-time product was higher at a volume-targeted level of 4 mL/kg in comparison with 5 mL/kg and at 5 mL/kg in comparison with 6 mL/kg. The mean work of breathing was below that at baseline only at a volume-targeted level of 6 mL/kg. CONCLUSIONS. Low volume-targeted levels increase the work of breathing during volume-targeted ventilation. Our results suggest that, during weaning, a volumetargeted level of 6 mL/kg, rather than a lower level, could be used to avoid an increase in the work of breathing. Pediatrics 2009;123:e679-e684 D URING VOLUME-TARGETED VENTILATION (VTV), a nearly constant tidal volume is delivered. This minimizes excessive tidal volume delivery, reducing volutrauma and the likelihood of hypocarbia. In one study, use of VTV was associated with avoidance of severe hypocarbia or hypercarbia in Ͼ90% of the first 48 hours for infants at Ͻ33 weeks of gestation. 1 VTV may be useful in situations in which there are changes in lung function, such as when infants are recovering from respiratory distress and being weaned from a ventilator. During VTV, compared with pressure-limited ventilation, blood gas values were maintained at lower airway pressures. 2 Those results suggested that infants make a greater contribution to minute ventilation during VTV than during pressure-limited ventilation and hence their work of breathing (WOB) may be higher with VTV, which may affect weaning and extubation adversely. 3 It seems likely, however, that higher volume-targeted (VT) levels would reduce the WOB and, with a sufficiently large targeted volume, the WOB would be lower during ventilatory support with versus without volume targeting. These hypotheses have not been tested, however, and a variety of VT levels have been used in VTV studies. 4-8 The aims of this study w...

Objective To determine if fetal lung volumes (FLVs), determined by three-dimensional rotational ultrasound and virtual organ computer-aided analysis software (vocal), correlated with neonatal respiratory outcomes in surviving infants who had a high risk [fetuses with congenital diaphragmatic hernia (CDH)], lower risk [fetuses with anterior wall defects (AWDs)] and no risk (controls) of abnormal antenatal lung growth.Design Prospective observational study.Setting Tertiary fetal medicine and neonatal intensive care units.Population Sixty fetuses (25 with CDH, 25 with AWDs and ten controls).Methods FLVs were measured and expressed as the percentage of the observed compared with the expected for gestational age.Main outcome measures Neonatal respiratory outcome was determined by the duration of supplemental oxygen, mechanical ventilation and dependencies, and assessment of lung volume using a gas dilution technique to measure functional residual capacity (FRC).Results The infants with CDH had lower FLV results than both the infants with AWDs (P = 0.05) and the controls (P < 0.05). The infants with CDH had longer durations of mechanical ventilation (P < 0.001) and supplementary oxygen (P < 0.001) dependence, compared with infants with AWDs. The infants with CDH had a lower median FRC than both the infants with AWDs (P < 0.001) and the controls (P < 0.001). FLV results correlated significantly with the durations of dependency on ventilation (r = )0.744, P < 0.01) and oxygen (r = )0.788, P < 0.001), and with FRC results (r = 0.429, P = 0.001).Conclusions These results suggest that FLVs obtained using three-dimensional rotational ultrasound might be useful in predicting neonatal respiratory outcome in surviving infants who had varying risks of abnormal lung growth. Larger and more comprehensive studies are needed to clarify the role that lung volume measurements have in assessing lung function and growth.

In a prospective study of 1019 infant and mother pairs, 268 infants suffered with 'infantile colic'. Significantly more of these were breast fed, supporting the proposed theory of a colic-producing factor in breast milk. Social class and maternal education were not related to the incidence of colic. Seventy-two percent of our infants with colic suffered from classical evening colic. The symptoms did not disappear from all the infants by 3 months - over 38% continued to have symptoms after 3 1/2 months of age. Treatment is limited, but merbentyl helped to relieve symptoms to a varying degree in over 60% of the infants who tried it. The family relationships are often strained during this period and this appears to persist when at one year of age significantly more of these infants were described as demanding, miserable and bad-tempered by their mothers.