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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 156 (1997), S. 148-151 
    ISSN: 1432-1076
    Keywords: Key words Chronic lung disease ; Functional residual capacity ; Prematurity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Lung function abnormalities, including hyperinflation, are common in young children born prematurely. The aim of this study was, in such patients, to determine factors associated with hyperinflation, that is an elevated lung volume. Lung volume was estimated by measuring functional residual capacity (FRC) before and after bronchodilator therapy in 41 5-year-old children who had been born prematurely at a median of 30 weeks gestational age. Hyperinflation was defined as an FRC greater than 120% of that predicted for height and a positive bronchodilator response as a greater than or equal to 10% change in FRC. Twelve (29%) of the children were symptomatic at 5 years, their median FRC (132%) was significantly higher than that of the asymptomatic children (109%), P 〈 0.01. Twelve (29%) children were hyperinflated; a greater proportion of the hyperinflated compared to the non-hyperinflated patients were symptomatic at 5 years (7 or 58% versus 5 or 17%) (P 〈 0.05) and responded to bronchodilator therapy (9 or 75% versus 4 or 14%) (P 〈 0.01). Regression analysis demonstrated that hyperinflation related significantly only to current symptom status, but not perinatal variables. Conclusion Hyperinflation in young children born prematurely reflects current symptom status and not adverse neonatal events.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 157 (1998), S. 336-339 
    ISSN: 1432-1076
    Keywords: Key words Prematurity ; Functional residual capacity ; Chronic lung disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Infants born prematurely who develop chronic lung disease (CLD) have airways obstruction and hence may have low lung volume. The aim of this study was to test that hypothesis and ascertain whether the nature of the comparison control group influenced the results. Sixteen infants who were oxygen dependent for more than 28 days (CLD) and eight infants without CLD had measurements of functional residual capacity (FRC) at 14 and 28 days. The 16 CLD infants consisted of eight less than 27 weeks gestational age (group A) and eight greater than 26 weeks gestational age (group B). The eight infants without CLD (group C) were each matched for gestational age and gender to infants in group B. Group A compared to group C had lower FRCs both at 14 days (median 18 ml/kg vs 27 ml/kg, P〈0.01) and 28 days (median 20 ml/kg vs 26 ml/kg, P〈0.05), but group A differed from group C with respect to both gestational age (P〈0.01) and birth weight (P〈0.01). The FRC results of group B were lower than those of their matched controls (group C) only at 28 days (median 22 vs 26 ml/kg, P〈0.05). Overall, the FRC results at 14 and 28 days correlated significantly with the duration of oxygen and ventilator dependence and weakly with gestational age. Conclusion These results support the hypothesis that FRC results are lower in infants with CLD compared to those without CLD when measured in the neonatal period and emphasize the importance of an appropriate control group. Measurement of lung volume may facilitate assessment of the response to therapies for CLD.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 158 (1999), S. 888-891 
    ISSN: 1432-1076
    Keywords: Key words Respiratory distress syndrome ; Mechanical ventilation ; Lung volume ; Positive end expiratory pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Positive end expiratory pressure (PEEP) is routinely used when ventilating preterm infants, and high levels are recommended in those with severe respiratory distress syndrome (RDS). Elevation of PEEP increases lung volume, as does surfactant administration. We postulated that in surfactant-treated infants even modest PEEP levels could result in overdistension and (CO2) retention. To test that hypothesis, lung volume, compliance and arterial blood gases were measured in eight preterm infants (median gestational age 28 weeks, range 26–35 weeks) at three PEEP levels. The infants, all with RDS, were studied at a median time of 18 h, (range 12–68 h) after their last dose of surfactant. Infants were routinely nursed at 3 cmH2O of PEEP, the PEEP level was then raised to 6 cmH2O or lowered to 0 cmH2O in random order. The new setting was maintained for 20 min; the PEEP level was then changed to the third level (0 or 6 cmH2O) again for 20 min. At the end of each 20-min period, lung volume, compliance and blood gases were measured. Lung volume was assessed by measuring functional residual capacity (FRC) using a helium dilution technique. Compliance was measured by relating the volume change from a positive pressure inflation maintained until no further volume change occurred to the pressure drop (peak inflating pressure PEEP). Increasing PEEP from 0 to 3 cmH2O and particularly to 6 cmH2O resulted in increases in FRC (P 〈 0.05), oxygenation (ns) and paCO2 (P 〈 0.02). Specific compliance (compliance/FRC) (P 〈 0.05) and pH (P 〈 0.02) fell. Conclusion Following surfactant treatment, relatively low levels of positive end expiratory pressure (≤3 cmH2O) may be appropriate.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1076
    Keywords: Key words Fluid balance ; Lung function ; Very low birthweight
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fluid overload worsens respiratory failure; conversely, fluid restriction has been associated with a higher survival rate without chronic lung disease. We therefore hypothesised that fluid restriction in the perinatal period might improve lung function in ventilated, prematurely born infants of very low birthweight. As a consequence, we compared in a randomised trial the effect of two fluid regimes on perinatal lung function. On one regime infants were to receive 60 ml/kg on day 1, increasing to 150 ml/kg by day 7, and on the other regime approximately 25% less fluid was to be prescribed. Lung function was assessed by measurement of functional residual capacity (FRC) and compliance. Measurements were made daily on days 1 to 5 and then on day 7. Ninety infants, median gestational age 28 weeks (range 23–33), were included in the study. There were no significant differences between the two groups regarding their gestational age or birthweight, or in the proportions who received antenatal steroids or postnatal surfactant. The infants on the restricted regime received significantly less fluid (P 〈 0.01). The only significant differences in lung function between the two groups, however, were that the infants on the restricted regime had a higher mean compliance on day 3, but thereafter the difference was reversed. Colloid intake, however, unfavourably affected lung function, total colloid intake being negatively correlated with both the area under the curve of birth-adjusted FRC (P=0.003) and compliance (P=0.001). Conclusion We conclude that early fluid restriction appears to have very little impact on perinatal lung function.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1076
    Keywords: Key words Chronic lung disease ; Prematurity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Neonatal chronic lung disease (CLD) is usually diagnosed if an infant remains oxygen dependent beyond 36 weeks postconceptional age (PCA). Our aim was to determine whether a shorter duration of respiratory support accurately predicted subsequent respiratory morbidity. A total of 103 infants, median gestational age 29 weeks (range 23–35), were followed prospectively for 5 years. They had a birth weight of 〈1500 g or, if a birth weight of between 1500 and 2000 g, had required neonatal ventilatory support. Parents completed diary cards; their child had positive symptom status if, in any one year, they coughed and/or wheezed on at least 3 days per week for a 4-week period or for at least 3 days following each upper respiratory tract infection. Subsequent respiratory morbidity, positive symptom status in years 1 and 2 or all 5 pre-school years, was related to various definitions of prolonged respiratory support: intermittent positive pressure ventilation dependence 〉7 days; oxygen dependence 〉28 days and oxygen dependence 〉36 weeks PCA. In years 1 and 2, 25 children were symptomatic and 22 in all 5 years. The patients with subsequent respiratory morbidity were distinguished from those without by requiring longer respiratory support (P 〈 0.05). Logistic regression analysis demonstrated only oxygen dependence beyond 28 days was independently related to subsequent respiratory morbidity (P 〈 0.01). The positive predictive values and likelihood ratios (95% confidence intervals) for positive symptom status in all 5 years were for intermittent positive pressure ventilation 〉7 days 35% (16–53) and 19.5 (1.01–3.76), for oxygen dependency 〉28 days 42% (23–61) and 2.20 (1.45–5.02) and for oxygen dependency 〉36 weeks PCA 35% (13–58) and 1.67 (0.65–4.31). Conclusion Oxygen dependency at 28 days of age remains a useful criterion on which to diagnose “neonatal” chronic lung disease.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 157 (1998), S. B520 
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 158 (1999), S. 589-591 
    ISSN: 1432-1076
    Keywords: Key words Air leak ; Nitric oxide ; Prematurity ; Respiratory distress syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Our aim was to identify factors predictive of death in preterm infants in whom inhaled nitric oxide was administered in response to poor oxygenation (oxygenation index ≥15). Of the 23 (median gestational age 28 weeks, range 24–36) infants consecutively so treated, 15 died. Non-survival was commoner in infants with air leaks (12 of 12, P 〈 0.002) and/or a change in their oxygenation index of less than 30% in response to inhaled nitric oxide administration (P 〈 0.05). Conclusion In preterm infants given inhaled nitric oxide because of poor oxygenation, a diagnosis of airleak and a lack of initial response are predictive of death.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 155 (1996), S. 823-826 
    ISSN: 1432-1076
    Keywords: Chronic lung disease ; Prematurity ; Respiratory morbidity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Abstract Children born prematurely and recruited into a prospective follow up study were examined at 5 years of age. Our aim was to determine actiological associations of respiratory symptoms in such children and in particular, to determine the importance of severe chronic lung disease (CLD, oxygen dependence beyond 36 weeks post conceptional age). Respiratory status was documented from parental history in 103 children of median gestational age 29 weeks (range 23–35), 17 of whom had suffered from severe CLD. In 90 of the 103 children lung function had been assessed at 1 year of age. Regression analysis revealed that neither severe CLD nor other perinatal variables, but only a family history of atopy, significantly related to a positive symptom status. A high airways resistance at 1 year also significantly related to positive symptom status. Conclusion Reduction in severe CLD (oxygen dependence beyond 36 weeks postconceptional age) may make relatively little impact on respiratory morbidity in young school children born prematurely.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1432-1076
    Keywords: Key words Chronic lung disease ; Prematurity ; Respiratory morbidity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Children born prematurely and recruited into a prospective follow up study were examined at 5 years of age. Our aim was to determine aetiological associations of respiratory symptoms in such children and, in particular, to determine the importance of severe chronic lung disease (CLD, oxygen dependence beyond 36 weeks post conceptional age). Respiratory status was documented from parental history in 103 children of median gestational age 29 weeks (range 23–35), 17 of whom had suffered from severe CLD. In 90 of the 103 children lung function had been assessed at 1 year of age. Regression analysis revealed that neither severe CLD nor other perinatal variables, but only a family history of atopy, significantly related to a positive symptom status. A high airways resistance at 1 year also significantly related to positive symptom status. Conclusion Reduction in severe CLD (oxygen dependence beyond 36 weeks postconceptional age) may make relatively little impact on respiratory morbidity in young school children born prematurely.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 156 (1996), S. 51-55 
    ISSN: 1432-1076
    Keywords: Key words Chronic lung disease ; Prematurity ; Steroids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The speed of action and side-effects of systemic versus inhaled steroids was compared in infants with mild-moderate oxygen dependency. Forty infants (median gestational age 27 weeks) were randomized to receive either 10 days of dexamethasone (systemic group) or budesonide (100 μg qds) (inhaled group). At randomization, there was no significant difference in the gestational or postnatal age, inspired oxygen requirements or compliance of the respiratory system of the two groups. After 36 h of treatment, there were significant changes (P 〈 0.01) in both the inspired oxygen concentration and compliance of the respiratory system in the systemic but not the inhaled group. Only after 1 week of inhaled therapy were improvements in respiratory status noted but, even at that time, the inspired oxygen requirement was significantly lower in the systemic versus the inhaled group. In the systemic group only, however, were there significant increases in blood pressure. Conclusion Systemically administered rather than inhaled steroids appear to have a faster onset of action.
    Type of Medium: Electronic Resource
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