April 2008

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• And much, much more

Disappointing Results from iNO Follow Up
Investigators who followed up on infants enrolled in the INNOVO trial to gauge the effects of inhaled nitric oxide (iNO) in preterm infants with severe respiratory failure find no long-term benefits from the treatment. The study involved 55 infants in the iNO arm and 53 controls. At the initial one year follow up, 59% of the infants had died and 84% of the survivors exhibited signs of impairment. This trial followed 38 of the 43 survivors up to age 4-5. Sixty-two percent of infants in the iNO group had died or were severely disabled versus 70% in the control group. No differences were seen in levels of impairment or disability between the two groups, and costs were similar as well. The authors conclude, “For this group of babies with severe respiratory failure there was no evidence of difference in the longer-term outcome between those babies allocated to iNO and those who were allocated to no iNO. The challenge is to identify those premature babies who are able to respond to nitric oxide with clinically important health improvements.” The study was published in the March 28 Epub edition of the Archives of Disease in Childhood: Fetal and Neonatal Edition. READ ABSTRACT

Need for Oxygen Determines Bronchiolitis Length of Stay
British researchers publishing in the March issue of Pediatrics find oxygen supplementation is the main determinant of hospital length of stay for infants with bronchiolitis. The study was conducted among 102 patients, 77 of whom were positive for the respiratory syncytial virus. Eighty-two percent presented with feeding problems, and while the majority of infants did not need oxygen supplementation at admission, the treatment was required by 70% by 6 hours. Feeding problems resolved for 98% of the infants by 96 hours, with oxygen supplementation resolving with an average lag of 66 hours. Infants requiring longer hospitalization due to oxygen supplementation, however, did not experience a deterioration requiring PICU support. READ ABSTRACT

Percutaneous Ventilation?
Noting percutaneous transfer of oxygen and carbon dioxide is possible in the newborn human, Australian investigators conducted a study involving 4 preterm lambs to see if the technique would impact their lung function. After delivery using a modified EXIT procedure, catheterized lambs were immersed in warm, oxygenated FC-77 perfluorocarbon (PFC) liquid and monitored for up to 60 minutes. All lambs were warmed adequately and initially seemed to have centrally intact circulation. However, little or no respiratory effort was seen, there was no appreciable lung expansion, and all the lambs had severe respiratory acidosis. These findings lead the authors to conclude, “For adequate gas exchange to occur it will require a ‘breathing’ animal with expanded alveoli . . . Given some lung gas exchange with less injurious liquid ventilation (spontaneous or mechanical) we hypothesize that the combination of skin and lung gas exchange will provide sufficient gas exchange to support life.” The study appeared in the March 22 Epub edition of Medical Hypotheses. READ ABSTRACT

Lasting Health Consequences of Preterm Birth
A new study conducted by Duke University investigators finds lasting health consequences from preterm birth. The researchers reviewed data from the Medical Birth Registry of Norway, finding higher early and late childhood mortality rates for boys born at 22 to 27 weeks, and higher early childhood mortality rates for girls. Boys born at 28 to 32 weeks also had higher early and late childhood mortality rates, but girls showed no similar increase. Men who were born at 22 to 27 weeks were 76% less likely to reproduce; women were 67% less likely. For those born at 28 to 32 weeks, the reproduction rates were 30% and 19% lower, respectively. Preterm women were also at increased risk of having preterm offspring. The study appeared in the March 25 edition of JAMA. READ PRESS RELEASE