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for the Hemodynamic EPIPAGE 2 Study Group IMPORTANCE There is currently no consensus for the screening and treatment of patent ductus arteriosus (PDA) in extremely preterm infants. Less pharmacological closure and more supportive management have been observed without evidence to support these changes.OBJECTIVE To evaluate the association between early screening echocardiography for PDA and in-hospital mortality. DESIGN, SETTING, AND PARTICIPANTSComparison of screened and not screened preterm infants enrolled in the EPIPAGE 2 national prospective population-based cohort study that included all preterm infants born at less than 29 weeks of gestation and hospitalized in 68 neonatal intensive care units in France from April through December 2011. Two main analyses were performed to adjust for potential selection bias, one using propensity score matching and one using neonatal unit preference for early screening echocardiography as an instrumental variable.EXPOSURES Early screening echocardiography before day 3 of life. MAIN OUTCOMES AND MEASURESThe primary outcome was death between day 3 and discharge. The secondary outcomes were major neonatal morbidities (pulmonary hemorrhage, severe bronchopulmonary dysplasia, severe cerebral lesions, and necrotizing enterocolitis).RESULTS Among the 1513 preterm infants with data available to determine exposure, 847 were screened for PDA and 666 were not; 605 infants from each group could be paired. Exposed infants were treated for PDA more frequently during their hospitalization than nonexposed infants (55.1% vs 43.1%; odds ratio [OR], 1.62 [95% CI, 1.31 to 2.00]; absolute risk reduction [ARR] in events per 100 infants, −12.0 [95% CI, −17.3 to −6.7). Exposed infants had a lower hospital death rate (14.2% vs 18.5% ; OR, 0.73 [95% CI, 0.54 to 0.98]; ARR, 4.3 [95% CI, 0.3 to 8.3]) and a lower rate of pulmonary hemorrhage (5.6% vs 8.9%; OR, 0.60 [95% CI, 0.38 to 0.95]; ARR, 3.3 [95% CI, 0.4 to 6.3]). No differences in rates of necrotizing enterocolitis, severe bronchopulmonary dysplasia, or severe cerebral lesions were observed. In the overall cohort, instrumental variable analysis yielded an adjusted OR for in-hospital mortality of 0.62 [95% CI, 0.37 to 1.04]. CONCLUSIONS AND RELEVANCEIn this national population-based cohort of extremely preterm infants, screening echocardiography before day 3 of life was associated with lower in-hospital mortality and likelihood of pulmonary hemorrhage but not with differences in necrotizing enterocolitis, severe bronchopulmonary dysplasia, or severe cerebral lesions. However, results of the instrumental variable analysis leave some ambiguity in the interpretation, and longer-term evaluation is needed to provide clarity.

Over the last three decades, knowledge about fundamental and clinical aspects of the ductus arteriosus has substantially improved, leading to considerable progress in the management of various cardiac diseases involving the ductus. The identification of the mechanisms regulating ductal patency led to design pharmacological drugs to achieve medical closure of PDA in premature infants, or inversely to maintain patency in neonates with duct-dependent congenital heart diseases. Concurrently, widespread availability of echocardiography has improved the detection of congenital PDA, resulting in earlier treatment. Closure of PDA, by either surgery or transcatheter techniques, can now be achieved safely, resulting in a decrease in the incidence of severe complications of PDA.

Aim: To study baroreflex maturation by measuring, longitudinally, baroreflex sensitivity in preterm (gestational age 24-37 weeks) and full term infants. Methods: Baroreflex sensitivity was quantified once a week, one to seven times, by a totally non-invasive method. Results: Baroreflex sensitivity at birth was lower in the preterm infant and increased with gestational age. It also increased with postnatal age, but the values for the preterm infants at term still tended to be lower than the values for full term babies. Conclusion: Baroreflex control of heart rate is present in the premature infant, but is underdeveloped and increases with postnatal age. Ex utero maturation seems to be delayed compared with in utero maturation assessed by full term values. These results may reflect sympathovagal imbalance in preterm infants and could identify a population more vulnerable to stress.T he short term regulation of arterial blood pressure by the autonomic nervous system involves the arterial baroreflex. This reflex minimises any variation in blood pressure by responses of both heart rate and arterial vascular tone. For example, an increase in blood pressure will be buffered by a decrease in both heart rate and peripheral vascular resistance. These responses of heart rate and vascular resistance, produced by the efferent limb of the baroreflex, are mediated by the parasympathetic and sympathetic system respectively. As both systems are involved, studies on the baroreflex give information on sympathovagal balance.Our knowledge about ontogeny of the baroreflex relies almost exclusively on animal studies, performed mainly in the lamb. Shinebourne et al 1 have shown the presence of functional arterial baroreflex responses in sheep very early during fetal and postnatal life. Furthermore, these authors and others 2 have shown that the arterial baroreflex is impaired in the fetus and newborn and increases later. Others have found, however, that the sensitivity of baroreflex control of the heart rate does not change throughout gestation 3 or is higher during fetal life than postnatally. 4 Few studies in humans have investigated the development of the baroreflex, possibly because the classical methods of investigation were not applicable to newborns for ethical reasons.The classical methods of investigating baroreflex sensitivity (BRS) are based on analysis of changes in blood pressure and heart rate experimentally induced in a controlled fashion by various manoeuvres. In these methods, the change in blood pressure is produced by either pharmacological or mechanical means. The pharmacological methods consist of giving vasoactive drugs, such as phenylephrine and nitroprusside, whereas the mechanical methods consist of carotid baroreceptor deactivation or stimulation by body tilting or use of a neck chamber device. However, these methods have major limitations. Firstly, they are not very physiological and thus cannot be easily repeated many times over a short period. As a consequence, they cannot be used to provide information on ...

Balloon pulmonary valvotomy is not always feasible in newborns, but it is relatively safe and effective and should be considered a valid alternative to operation.

In this large multicentre study, the long-term outcome of congenital or childhood non-immune, isolated AV block was favourable, regardless of the patient's age at the time of diagnosis. No patient died or developed DCM, and pacemaker-related complications were few.