William T. Bingham

One-year follow-up of 89 infants with birth weights of 500 to 749 grams and respiratory distress syndrome randomized to two rescue doses of synthetic surfactant or air placebo☆☆☆★

Abstract Double-blind neurodevelopmental and physical evaluations were conducted at 1-year adjusted age in 89 infants with birth weights of 500 to 749 gm who had respiratory distress syndrome in the neonatal period and were randomized to receive two rescue doses of a synthetic surfactant (Exosurf Neonatal, Burroughs Wellcome Co., Research Triangle Park, N.C.) or air placebo. The trial used a common protocol and was conducted at 13 hospitals; patients were entered in the trial between February 1988 and September 1990. Ninety-five percent of surviving infants were assessed. Growth and development in the two groups were equivalent. Mean Bayley Scales of Infant Development scores were comparable (mental development index, 79 ± 22 vs 87 ± 20; psychomotor development index, 73 ± 18 vs 81 ± 19 for air placebo and synthetic surfactant, respectively). The incidence of severe retinopathy of prematurity was significantly decreased in the surfactant group compared with the air placebo group (15% vs 34%; relative risk 0.428; 95% confidence interval 0.2 to 0.9). Overall, administration of surfactant appeared to increase the probability of a favorable outcome. Confirmation of the trends observed in this study would provide a strong rationale for the rescue use of synthetic surfactant in extremely low birth weight infants with respiratory distress syndrome even if overall mortality is not reduced. (J P EDIATR 1995;126:S53-60)

One-year outcome in 232 premature infants with birth weights of 750 to 1249 grams and respiratory distress syndrome randomized to rescue treatment with two doses of synthetic surfactant or air placebo

A randomized, double-blind, placebo-controlled trial was performed in 13 hospitals in Canada to assess whether two rescue doses of a synthetic surfactant (Exosurf Neonatal) would reduce mortality and morbidity rates in neonates with respiratory distress syndrome who weighed from 750 to 1249 gm. As part of the original trial design, double-blind follow-up evaluations were performed at 1-year adjusted age. A total of 118 patients who received air placebo and 114 patients who received synthetic surfactant were evaluated at 1 year. Growth and development in the two groups were equivalent. Scores on the Bayley Scales of Infant Development were within the normal range for both groups (mental development index, 90 +/- 22 vs 92 +/- 22; psychomotor development index, 81 +/- 19 vs 87 +/- 22 for the air placebo and synthetic surfactant groups, respectively). However, in both groups the proportion of infants with any impairment (air placebo group, 43 of 118 (36%); synthetic surfactant group, 41 of 114 (36%) and severe impairment (air placebo group, 29 of 118 (25%); synthetic surfactant group, 21 of 114 (18%)) was substantial. We conclude that two rescue doses of synthetic surfactant in infants with RDS who weighed 750 to 1249 gm had no detrimental effect on developmental outcome or late morbidity. No long-term benefits to 12-months corrected age were observed with the use of surfactant in this weight class. Larger studies or meta-analyses of existing trials will be required to determine if there are any late outcome advantages associated with rescue use of synthetic surfactant in infants weighing 700 to 1249 gm.

Serum Levels of C-reactive Protein in Neonatal Respiratory Distress Syndrome

Serum levels of C-reactive protein (CRP) were measured within 96 hours of birth in 55 neonates with respiratory distress syndrome (RDS), 19 neonates with no significant medical illness other than an unstable cardiovascular state, and 13 neonates with a variety of pulmonary and extra pulmonary problems either alone or in combination with RDS. The median serum CRP level in patients with RDS (2 μg/ml) was neither elevated nor different from CRP levels in infants with unstable cardiovascular systems (median CRP level, 2 μg/ml); however, neonates with other prob lems including pneumonia, aspiration, and extrapulmonary sepsis had significantly elevated serum CRP values (median 24 μg/ml). CRP levels are not elevated in neonatal RDS. Measurement of this acute phase reactant provides a rapid and reliable means of helping to distinguish infants with uncomplicated RDS from those with other serious pulmonary and extrapulmonary disease.

Neonatal Campylobacter Fetus Meningitis: A Report of an Unusual Case

Campylobacter fetus is a rare cause of meningitis in the pediatric age group and, in particular, among neonates. The clinical presentation of campylobacter meningitis in high-risk neonates is not well-described. A review of campylobacter meningitis by Lee et al1 in 1985 reported nine cases occurring in neonates, of which only one case was caused by C. fetus. In the ensuing six years only three more confirmed cases of neonatal meningitis caused by C. fetus have been reported.2,3 We here report another confirmed case of C. fetus meningitis in a neonate.

Nontraumatic Coma in Children and Adolescents: Diagnosis and Management

The causes of nontraumatic coma (NTC) vary by country, season and period of data collection. Infective diseases are among the major worldwide causes of NTC. Nonaccidental head injury must be in the differential diagnosis. Genetic and ethnic susceptibilities to causes of coma are being recognized. A systematic history and examination are essential for diagnosis, early recognition of herniation syndromes, and management. The management of NTC is discussed, with reference to clinical approach, treatment of seizures, and increased intracranial pressure. Public health measures, education, early diagnosis, and prompt appropriate treatment are the foundations needed to reduce incidence and improve outcome.

Complex transposition with interrupted right aortic arch and partial Di George syndrome: Successful palliation with combined medical and surgical therapy

SummaryA five-day-old infant with transposition of the great arteries, ventricular septal defect, and an interrupted right aortic arch underwent successful balloon septostomy, pulmonary artery banding, and aortic arch repair. The infant also had abnormal facies with severe refractory hypocalcemia and depressed T-lymphocyte number and function believed to represent a partial Di George syndrome. The hypocalcemia resolved following treatment with a vitamin-D analogue, T-cell number increased, and T-cell function improved, but both remained subnormal.

Coma in Childhood

Publisher Summary Coma is an important and common clinical problem in pediatric practice. The comatose state in children results from trauma or a wide variety of nontraumatic causes. It is clinically useful to classify causes into (1) those generally associated with structural changes in the brain and (2) those with predominant metabolic dysfunction. The metabolic causes of coma can be associated with structural changes in the brain. The assessment and management of a child in coma requires a multidisciplinary coordinated team approach with each member of the team being assigned a specific responsibility especially when coma is complicated by poor cardiorespiratory function, shock, or status epilepticus, and all of them must be rapidly addressed. Investigations have to be tailored to the individual case and the clinicians diagnostic considerations. Tests for infection (sepsis, meningitis, and encephalitis) include toxicology screen, neuroimaging, conventional electroencephalogram (EEG), continuous EEG monitoring, and serum biomarkers. Those who have suffered a metabolic or toxic encephalopathy have a good outcome provided the secondary effects of the cause are minimized and systemic complications avoided. Several advances have improved our understanding and management of coma in children. These include recognition of a number of inborn errors of metabolism, progress in the prevention, diagnosis, and treatment of infective diseases, prevention of head trauma, magnetic resonance imaging (MRI), and an emerging consensus on the management of raised intracranial pressure (ICP).