Aim: Bronchopulmonary dysplasia (BPD) remains the most common respiratory morbidity in immature infants. This review describes the diagnosis of BPD has evolved and summarises the therapeutic approaches that have made it possible to limit the incidence of BPD. Method: We reviewed the literature from the first definition of BPD by Northway in 1967 to the surfactant treatment policies that are currently in use, drawing on more than 50 papers up to 2017. Results: Our review showed that improvements in neonatal survival have been associated with an increased risk of severe BPD, significant levels of long-term morbidity and the increased use of healthcare resources. These issues have encouraged researchers to explore potential new treatments that limit the incidence of BPD. Repeated surfactant instillation and the use of surfactant as a vehicle for budesonide are promising strategies for alleviating the burden of chronic lung disease. Ongoing research on surfactant or stem cell therapy may further improve the respiratory prognosis for prematurely born children. Conclusion: Considerable research has been carried out into the increase in BPD, which has resulted from improvements in neonatal survival. Key areas of research include repeated surfactant administration, using surfactant as a vehicle for budesonide and stem cell therapy.

Doxapram is used as a third-line treatment for apnea unresponsive to caffeine and continuous positive airway pressure (CPAP) in preterm infants.

Objective: Few studies compared growth and neurodevelopment outcome between asymmetric (aSYM) and symmetric (SYM) small for gestational age (SGA) term infants. We aimed at evaluating their respective outcome at 9 months postnatal age. Study Design: A cohort study including infants born in 2010 to 2011 with a birth weight <5th centile and a head circumference (HC) below (SYM) or above (aSYM) the 5th centile. Catch-up growth was defined as weight, height and HC ⩾−2 s.d. of World Health Organization reference values. Neurodevelopment was evaluated with Brunet–Lezine test items. Result: Of 6586 infants, 194 were SGA: 38.7% SYM and 61.3% aSYM. The aSYM group showed better catch-up growth (85% versus 70%, P =0.03) with larger HC (44.9±1.6 versus 43.7±1.2 cm, P <0.0001). No difference in neurodevelopmental screening was observed between SGA groups, but infants without any catch-up growth were at higher risk of delayed outcome. Conclusion: Term SGA infants must be closely followed, regardless of their characteristics, to improve their outcome.

Moderate hypothermia therapy (HT) after perinatal asphyxia of the newborn has clearly demonstrated its efficacy in reducing both mortality and long-term neurosensory sequelae. HT has now been introduced in many developed countries as a standard of care for term infants meeting the entry criteria for therapeutic cooling. However, this new therapy is only effective in case of an acute perinatal hypoxic-ischemic event. Since a number of potentially deleterious complications have been described during cooling, a strict evaluation of the newborn's status is mandatory. To help clinicians reliably select newborns who may benefit from HT, amplitude-integrated electroencephalography (aEEG) is today strongly recommended. The indication criteria for cooling include aEEG in addition to delivery history, Apgar score, cord pH and lactates, and neurological scoring for encephalopathy. We report a clinical case of a term baby girl, considered for HT in our unit, because of a clinical feature of severe neonatal encephalopathy, metabolic acidosis on cord pH, and a history of fetal distress on fetal heart rate monitoring. However, despite all these criteria, her early aEEG, like her classic EEG, showed no signs of hypoxic-ischemic encephalopathy (HIE). She was then denied HT and her early magnetic resonance imaging (MRI) exam showed no signs of HIE but typical features of a metabolic disorder (Zellweger-like syndrome). Thanks to the HT strict protocols, including early aEEG and MRI exam, the right diagnosis was rapidly made and the hypothesis of a hypoxic-ischemic event during delivery was finally ruled out. (C) 2012 Elsevier Masson SAS. All rights reserved.

Background. Gender differences in mortality and morbidity are often reported in very preterm infants. In studies aiming to understand the underlying mechanisms, better protection against oxidative stress in baby girls has been suggested. Objectives. Shortly after birth, we compared glutathione (GSH) metabolism in female and male preterm infants and its relationship with prenatal and postnatal parameters.Methods. We took the opportunity of a prospective randomised controlled trial evaluating the safety-efficacy balance of inhaled nitric oxide (Hamon and al., 2005) [12] to assess, in vivo, the antioxidant defences within the first 48 h of life in 240 premature infants less than 32 weeks gestational age (GA). We measured total plasmatic GSH level (nmol/L), intraerythrocyte glutathione peroxidase (GPX, mu mol/min/g haemoglobin) and intraerythrocyte glutathione reductase (GR, mu mol/min/g haemoglobin) from venous blood samples withdrawn through central lines.Results. Expressed as mean +/- standard error of the mean: soon after birth (at 24 h median), plasmatic GSH was not different between females (n = 123) and males (n = 117): 0.932 +/- 0.016 vs 0.956 +/- 0.012 nmol/L. However, at the same time, GPX, the enzyme involved in GSH synthesis, was at a significantly higher level in baby girls (p < 0.001): 11.63 +/- 0.25 vs 10.21 +/- 0.24 mu mol/min/g haemoglobin, as was GR, the enzyme responsible for GSH regeneration (p = 0.02): 12.118 +/- 0.23 vs 11.22 +/- 0.21 mu mol/min/g haemoglobin. We observed no significant correlation between GSH levels, GPX, or GR activities with prenatal steroids, GA, birth weight, severity of respiratory disease, and oxygen requirements for the entire population or between the two genders.Conclusion. Whereas the level of glutathione, a key molecule in the defence against oxidative stress in humans, appears to be identical in preterm females and males soon after birth, the enzymes involved in its synthesis (GPX) and regeneration (GR) are higher in females.Speculation. Study of the sequential progression of GSH, GPX, and GR with regard to prolonged oxidative stress exposure in preterm females and males is needed to better evaluate their potential clinical relevance. (c) 2010 Elsevier Masson SAS. All rights reserved.

BACKGROUND:Inhaled nitric oxide (iNO), commonly used for hypoxic neonates, may react with haemoglobin to form methaemoglobin (MetHb). MetHb monitoring during iNO therapy has been questioned since low doses of iNO are used. AIM:To evaluate the incidence of and identify risk factors associated with elevated MetHb in neonates treated with iNO. METHODS:Neonates who were treated with iNO and had at least one MetHb measurement were included. Demographic characteristics and methods of iNO administration (dosage, duration) at the time of each MetHb measurement were analysed. RESULTS:Four hundred and fifty-two MetHb measurements from 81 premature and 82 term and near-term infants were analysed. MetHb was above 5% in one-term infant, and between 2.5-5% in 16 infants. A higher maximum dose of iNO (22.7 vs 17.7 p.p.m.), but not gestational age, was a significant risk factor for elevated MetHb. Significantly higher oxygen levels (75.5% vs 51.7%) were associated with higher MetHb in term infants. Preterm infants had no risk for high MetHb when iNO was kept below 8 p.p.m. These data suggest the possibility of limiting blood withdrawal when low doses iNO are used. CONCLUSION:High MetHb is exceptional in neonates treated with low dose iNO. Associated risk factors are related to high iNO dose and the simultaneous use of high concentrations of oxygen.

Neonatal Bartter syndrome is a rare condition, usually revealed by alkalosis and hypokalemia. Clinical and biological signs of neonatal Bartter syndrome are quite different from those encountered when this disease is diagnosed in older children. Diagnosis of neonatal Bartter syndrome is even more difficult in very preterm infants. The aim of this study was to highlight specific clinical and biological signs that may help direct physicians towards the diagnosis of neonatal Bartter syndrome when premature infants present with an atypical renal tubular disorder. Our case reports focus on excessive diuresis with elevated renal sodium excretion and severe dehydration. Correcting tubular disorders early may help avoid dehydration in the fragile preterm newborn.

We report on a case of a secondary right-sided diaphragmatic hernia following group B streptococcal (GBS) septicaemia in a very low birth weight infant born at 30 weeks. After initial improvement, the diagnosis of a secondary right-sided diaphragmatic hernia was suspected with the persistent radiological pulmonary right-sided image on the chest x-ray and the clinical degradation. The diagnosis was confirmed by ultrasonography on day 43. The postoperative course was simple. Persistent respiratory distress in a neonate, after a GBS septicaemia associated with a right pulmonary opacity on the chest x-ray, should prompt a careful evaluation. A secondary right-sided diaphragmatic hernia should be considered. Treatment is surgery, the prognosis is good in the absence of pulmonary hypoplasia.

We report on a case of a secondary right-sided diaphragmatic hernia following group B streptococcal (GBS) septicaemia in a very low birth weight infant born at 30 weeks. After initial improvement, the diagnosis of a secondary right-sided diaphragmatic hernia was suspected with the persistent radiological pulmonary right-sided image on the chest x-ray and the clinical degradation. The diagnosis was confirmed by ultrasonography on day 43. The postoperative course was simple. Persistent respiratory distress in a neonate, after a GBS septicaemia associated with a right pulmonary opacity on the chest x-ray, should prompt a careful evaluation. A secondary right-sided diaphragmatic hernia should be considered. Treatment is surgery, the prognosis is good in the absence of pulmonary hypoplasia.

OBJECTIVES:To assess the safety-efficacy balance of low-dose inhaled nitric oxide (iNO) in hypoxemic premature infants because no sustained beneficial effect has been demonstrated clearly and there are concerns about side effects. STUDY DESIGN:Eight hundred and sixty infants <32 weeks were randomized at birth to receive 5 ppm iNO or placebo when they presented with hypoxemic respiratory failure (HRF) defined by a requirement for mechanical ventilation, fraction of inspired oxygen (FIO 2 ) >40%, and arterio-alveolar ratio in oxygen (aAO 2 ) <0.22. The primary end point was intact survival at 28 days of age. RESULTS:Sixty-one of 415 infants presented with HRF and were compared with 84 of 445 controls who presented with HRF. There was no difference in the primary end point (61.4% in infants [23% with HRF who were treated with iNO] vs 61.1% in controls [21.4% in controls with HRF]; P = .943). For the infants with HRF who were treated with iNO, there was no significant difference from controls for intraventricular hemorrhage (IVH) (6% vs 7%), necrotizing enterocolitis (8% vs 6 %), or patent ductus arteriosus (PDA) (34% vs 37%). Compared with nonhypoxemic infants, the risk of bronchopulmonary displasia (BPD) increased significantly in HRF controls (OR = 3.264 [CI 1.461-7.292]) but not in infants with HRF who were treated with iNO (OR = 1.626 [CI 0.633-4.178]). CONCLUSIONS:iNO appears to be safe in premature infants but did not lead to a significant improvement in intact survival on day 28.

Healthy newborn death in the delivery room is uncommon. Unlike for sudden infant death syndrome well described in infants between 2 and 6 months of age, few publications have studied this event. We report two cases of asymptomatic term newborns who died unexpectedly in the delivery room. Noteworthy, these newborns were sleeping in prone position on their mother. The Agence Nationale d'Accreditation et d'Evaluation en Sante (ANAES) published recommendations to promote breast-feeding including uninterrupted early contact between the infant and his mother. However, immediately after birth, the newborn may be particularly vulnerable. The application of this recommendation unwisely could be dangerous for newborns allowed to stay on their mother without any monitoring or medical supervision. We would like to point out the importance of healthy newborn supervision within the first hours of life that can be done without interfering with the mother-child bonding. (C) 2004 Elsevier SAS. Tons droits reserves.

Healthy newborn death in the delivery room is uncommon. Unlike for sudden infant death syndrome well described in infants between 2 and 6 months of age, few publications have studied this event. We report two cases of asymptomatic term newborns who died unexpectedly in the delivery room. Noteworthy, these newborns were sleeping in prone position on their mother. The Agence Nationale d'Accreditation et d'Evaluation en Sante (ANAES) published recommendations to promote breast-feeding including uninterrupted early contact between the infant and his mother. However, immediately after birth, the newborn may be particularly vulnerable. The application of this recommendation unwisely could be dangerous for newborns allowed to stay on their mother without any monitoring, or medical supervision. We would like to point out the importance of healthy newborn supervision within the first hours of life that can be done without interfering with the mother-child bonding.