颅内出血早产儿脑血流动力学早期监测的临床价值

目的探讨应用颅脑多普勒超声早期测量大脑中动脉(MCA)血流速度在早产儿颅内出血(IVH)中的临床价值。方法选择2013年3月至2014年1月在我院产科出生后24 h内收入我院新生儿科、胎龄30~34周的早产儿。应用超声多普勒技术,测量生后24~72 h MCA的收缩期峰值血流速度(Vs)、舒张期峰值血流速度(Vd)、阻力指数(RI)和搏动指数(PI)等血流参数,根据有无IVH将入选早产儿分为IVH组和非IVH组,并将IVH组根据出血程度分为轻度组及重度组,比较不同组间患儿MCA的Vs、Vd、RI和PI的变化。结果共纳入65例早产儿,29例确诊为IVH,检出率44.6%,其中31.0%为重度出血。IVH重度组和轻度组生后早期Vs、Vd均高于非IVH组[Vs:(48.6±5.0)、(44.9±4.2)比(39.6±4.6)cm/s,Vd:(13.6±2.9)、(10.5±2.3)比(9.2±2.1)cm/s],重度组高于轻度组,差异有统计学意义(P<0.05);RI、PI低于非IVH组[RI:(0.68±0.01)、(0.75±0.04)比(0.80±0.06),PI:(1.37±0.20)、(1.55±0.25)(1.68±0.29)],重度组低于轻度组,差异有统计学意义(P<0.05)。结论早产儿早期IVH呈现脑血流的低阻力及高灌注现象,表现为MCA的Vs、Vd值增高和RI、PI值降低。生后早期动态监测早产儿MCA的血流参数变化,可一定程度预测IVH的发生并协助判断IVH程度。     

经颅多普勒超声在昏迷危重患儿中的应用

目的应用经颅多普勒超声(TCD)观察昏迷患儿脑血流动力学的一般情况及变化趋势,以及了解脑血流动力学与颅内压之间的联系。方法以大脑中动脉(MCA)为靶血管,观察昏迷组及对照组患儿(其中56例昏迷患儿)脑血流变化;腰穿或应用甘露醇前后各指标的变化;昏迷患儿不同时期及不同昏迷程度时的各指标的变化。结果昏迷组收缩期峰流速(Vp)、平均血流速度(Vm)、脉动指数(PI)、阻力指数(RI)明显高于对照组;昏迷患儿在治疗前Vp、Vm、PI、RI均高于治疗后;患儿在腰穿前大脑中动脉Vp、Vm、PI、RI均高于腰穿后;甘露醇使用前Vp、Vm、PI、RI均高于其使用后;Glasgow评分分值低者Vp、舒张期流速(Vd)、Vm偏低,而RI、PI偏高。结论昏迷患儿的脑血流动力学异于正常,TCD可反映颅内脑血流灌注情况,脑血流动力参数可随颅内压而变;因此TCD有助于判断病情、指导临床治疗和评估预后。     

选择性头部亚低温治疗对新生儿缺氧缺血性脑损伤脑血流动力学的影响

目的探讨选择性头部亚低温治疗新生儿缺氧缺血性脑损伤(hypoxic-ischemic braindamage,HIBD)期间脑血流动力学的变化。方法38例中重度HIBD新生儿随机分为常温组(20例)和低温组(18例)。生后6 h内开始治疗,常温组维持体温在36℃;低温组维持鼻咽温度在34℃,持续72h,然后自然复温。其他治疗方法两组相同。7例无窒息史及呼吸系统疾病的新生儿作为对照组。三组均持续观察84 h,分别在生后6、12、24、48、72和84 h采用经颅多普勒血流诊断仪测定大脑中动脉血流速率。结果常温组HIBD新生儿生后6h收缩期峰流速率(Vs)为(32.42±5.28)cm/s、舒张末期血流速率(Vd)为(14.28±7.54)cm/s、平均血流速率(Vm)为(20.42±2.76)cm/s,明显低于对照组[分别为(24.05±6.87)(、7.27±5.06)和(15.15±5.55)cm/s](P均<0.05);阻力指数(RI)0.81±0.15,较对照组(0.67±0.09)明显增加,(P<0.05)。生后12 h,Vs和Vm与对照组无差异,但RI(0.72±0.12)较对照组(0.62±0.08)仍显著升高(P<0.05)。生后24、48 h,Vs[(28.0±7.28)(、32.0±6.29)cm/s]和Vm[(17.55±5.28)、(18.65±4.61)cm/s]较对照组显著降低(P<0.05)。生后72和84 h两组各指标无统计学差异。亚低温治疗后大脑中动脉Vs和Vm在生后12和48 h较常温组增加(P<0.05),RI降低(P<0.05),且与对照组无差别。结论中重度新生儿HIBD脑血流速率明显降低,选择性头部亚低温治疗新生儿HIBD可以改善脑血流动力学。     

经颅多普勒超声检测血管迷走性晕厥患儿脑血流动力学变化分析

目的 采用经颅多普勒超声（TCD）分析血管迷走性晕厥（VVS）的脑血流动力学特点,并探讨TCD对VVS的临床应用价值。方法 对2011年12月至2013年8月于兰州大学第二医院小儿心血管科就诊的38例血管迷走性晕厥患儿,及20名体检健康儿童行直立倾斜试验,并应用TCD进行监测。结果 基础状态下,观察组与对照组比较,左右大脑中动脉的收缩期血流速度（Vs）、舒张末期血流速度（Vd）、平均血流速度（Vm）差异无统计学意义（P＞0.05）,脉冲指数（PI）值差异无统计学意义（P＞0.05）;对照组行直立倾斜试验后与基础状态时比较,左右大脑中动脉的Vs、Vd、Vm差异无统计学意义（P＞0.05）,PI值差异无统计学意义（P＞0.05）;观察组通过直立倾斜试验诱发血管迷走性晕厥阳性反应时与基础状态时比较,左右大脑中动脉的Vs、Vd、Vm明显加快（P＜0.05）,PI值明显升高（P＜0.05）。结论 VVS发生时,脑血管阻力增加,脑血流调节障碍;TCD检查对于判断VVS患儿脑血流状态具有重要价值。     

脑功能损害危重患儿经颅多普勒超声监测的临床研究

目的 应用经颅多普勒超声(transcranial Doppler ultrasonography,TCD)观察脑功能损害患儿脑血流动力学变化,探讨TCD在监测与评估脑损害患儿预后中的价值.方法 以大脑中动脉为靶血管,检测脑功能损害组20例及无脑损害组(对照组)20例患儿的脑血流动力学参数[收缩期峰流速(Vs)、平均血流速度(Vm)、舒张期流速(Vd)、搏动指数(PI)、阻力指数(RI),对比两组患儿各参数间的差异.脑功能损害组患儿按Glasgow评分、预后再分组,比较不同Glasgow评分(≤6分组和7~13分组)、不同预后患儿的TCD各参数的差异.每日动态监测脑功能损害组患儿的TCD直至TCD参数正常,将TCD参数达正常时间与Glasgow评分、意识障碍持续时间进行相关分析.对比脑功能损害组不同Glasgow评分、不同预后患儿TCD达正常时间的差异.结果 (1)脑功能损害组大脑中动脉的Vs、PI、RI均较对照组高,Vd较对照组低,差异均有统计学意义(P均<0.05).(2)脑功能损害组Glasgow评分≤6分患儿的PI(0.91±0.21)高于Glasgow评分7~13分患儿(0.83±0.14),两组比较差异有统计学意义(P<0.05);而Vs、Vd、RI两组比较差异均无统计学意义(P均>0.05).脑功能损害组不同预后患儿间的大脑中动脉血流动力学各参数比较差异均无统计学意义(P均>0.05).(3)脑功能损害组患儿TCD参数达正常时间与入院当日Glasgow评分呈负相关(r=-0.653,P<0.01);TCD参数达正常时间与意识障碍持续时间呈正相关(r=0.923,P<0.01).不同Glasgow评分、不同预后患儿的TCD参数达正常时间差异均有统计学意义,Glasgow评分≤6分、预后差患儿的TCD达正常时间更长(P均<0.05).结论 脑功能损害患儿的脑血流动力学异常,脑损害程度越重者,PI越高,TCD参数恢复正常的时间越长;动态监测TCD可反映脑血流变化,对评估病情和预后有一定价值.     

新生儿早期脑血流变化规律的研究

目的探讨新生儿早期脑血流随日龄的动态变化。方法选择本院新生儿科住院的早产适于胎龄儿和健康足月儿,应用经颅多普勒超声测定不同胎龄新生儿生后7d内每天大脑中动脉(MAC)血流速度及阻力指数(RI)和搏动指数(PI)。结果早产适于胎龄儿组65例,足月儿组49例。足月儿组脑血流速度较早产儿组明显增快(P<0.05);各组2～7d各时间段大脑中动脉收缩期峰值流速(Vs)、平均血流速度(Vm)、舒张期末血流速度(Vd)均较第1天增快(P<0.05);早产适于胎龄儿组3～7d各时间段Vs、4～7d各时间段Vm与第2天比较均增快(P<0.05);足月儿组4～7d各时间段Vs和Vm均较第2天增快(P<0.05);早产适于胎龄儿与足月儿Vs、Vm4～7d各时间段呈逐渐增加趋势,但差异无统计学意义;Vd增加较缓慢,2～7d各时间段差异不明显;新生儿早期RI、PI亦呈渐增趋势,生后第1天较高,2～7d内RI、PI短时期降低之后RI、PI又逐渐升高。结论新生儿早期脑血流速度随日龄增大逐渐增快,生后前3d波动较大,然后缓慢增加,逐渐趋于稳定。     

新生儿早期脑血流变化规律的研究

目的 探讨新生儿早期脑血流随日龄的动态变化.方法 选择本院新生儿科住院的早产适于胎龄儿和健康足月儿,应用经颅多普勒超声测定不同胎龄新生儿生后7 d内每天大脑中动脉(MAC)血流速度及阻力指数(RI)和搏动指数(PI).结果 早产适于胎龄儿组65例,足月儿组49例.足月儿组脑血流速度较早产儿组明显增快(P<0.05);各组2～7 d各时间段大脑中动脉收缩期峰值流速(Vs)、平均血流速度(Vm)、舒张期末血流速度(Vd)均较第1天增快(P<0.05);早产适于胎龄儿组3～7 d各时间段Vs、4～7 d各时间段Vm与第2天比较均增快(P<0.05);足月儿组4～7 d各时间段Vs和Vm均较第2天增快(P<0.05);早产适于胎龄儿与足月儿Vs、Vm 4～7 d各时间段呈逐渐增加趋势,但差异无统计学意义;Vd增加较缓慢,2～7 d各时间段差异不明显;新生儿早期RI、PI亦呈渐增趋势,生后第1天较高,2～7 d内RI、PI短时期降低之后砌、PI又逐渐升高.结论 新生儿早期脑血流速度随日龄增大逐渐增快,生后前3 d波动较大,然后缓慢增加,逐渐趋于稳定.     

输血对贫血早产儿脑血流动力学及脑损伤的影响研究

目的 初步探讨输血对贫血早产儿脑血流动力学及脑损伤的影响.方法 采用前瞻性队列研究方法,以2012年10月至2013年9月入住我院新生儿重症监护病房、胎龄≤34周且出生1周后接受输血治疗的贫血早产儿为研究对象,运用便携式超声诊断仪测定输血前与输血后各24 h内大脑前动脉（ACA）、大脑中动脉（MCA）的5个血流动力学参数,包括收缩期峰流速（Vs）、舒张末期血流速度（Vd）、平均血流速度（Vm）、搏动指数（PI）、阻力指数（RI）.运用二维超声观察输血前24 h及输血后1周内头颅超声变化.结果 本研究共纳入40例早产儿,输血后ACA的Vs、RI较输血前降低[Vs：（46.0＆#177;10.8） cm/s比（50.6＆#177;10.9） cm/s,RI：（0.79＆#177;0.10）比（0.84 ＆#177;0.13）,P＜0.05],Vm、PI、Vd输血前后差异无统计学意义（P＞0.05）;MCA各血流动力学参数与ACA血流动力学变化趋势基本一致,但差异无统计学意义（P＞0.05）;输血后89.3％的早产儿脑损伤较前无变化或减轻,10.7％的早产儿输血后出现脑室周围-脑室内出血或出血程度较前加重.结论 输血可影响早产儿大脑血流动力学,以ACA最为显著.输血可能对早产儿脑损伤产生影响.     

新生儿缺氧缺血性脑病脑血流动力学变化与血浆内皮素-1、一氧化氮的关系

目的　探讨一氧化氮 (NO)、内皮素 1 (ET 1 )在新生儿缺氧缺血性脑病 (HIE)脑血流动力学变化中的作用。方法　HIE各组均在生后 48～ 72h采用经颅多谱勒超声 (TCD)检测双侧大脑前、中、后动脉收缩峰流速 (Vs)、舒张末期流速 (Vd)、搏动指数 (PI)和阻力指数 (RI) ,同时用硝酸还原酶法和放射免疫法分别测定血浆NO和ET 1水平。对照组同期进行上述检测。结果　 1 .脑血流于轻度组Vd、Vs局部降低 ;中、重度组Vd广泛降低 ,Vs呈局部降低 ,重度组尤为显著 (P均 <0 .0 5)。 2 .PI、RI轻度组与对照组无显著性差异 ;中度组局部增高 ;重度组双侧大脑动脉PI、RI普遍增高 (P均 <0 .0 5)。 3 .HIE各组NO、ET 1水平均高于对照组 ,且与病变程度成正比。但NO/ET 1比值低于对照组 (P均 <0 .0 1 ) ,且重度组 <中度组 <轻度组。结论　HIE患儿脑血流灌注减少与NO、ET 1过量合成、功能失调有关。     

新生儿脑血流速度正常值检测

125例正常足月新生儿，按不同日龄分为5组，以经颅多谱勒超声（TCD）测量其大脑前动脉（ACA）、大脑中动脉（MCA），颈内动脉（ICA）的收缩峰流速VS，舒张峰流速Vd，平均流速Vm及收缩、舒张流速比（S／D），搏动指数（PI），阻力指数（RI）。统计各参数左右两侧的平均值及标准差。统计结果指示：新生儿期脑内各血管各期血流速度（s，Va，Vm）均较成人及年长儿低。各期血流速度均随日龄增加而加快。S／D，PI，RI也随日龄增加而增加。     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

alpha -SMOOTH MUSCLE ACTIN DISTRIBUTION IN THE PULMONARY VASCULATURE COMPARING HYPOPLASTIC AND NORMAL FETAL LUNGS

We investigated the intra-acinar pulmonary vascular muscularization in the developing human fetal lung between the 17th and 24th gestational weeks, that is, during the canalicular phase of lung development. Fifteen hypoplastic and 25 normal developed lungs were included in this study using monoclonal alpha -smooth muscle (sm) actin antibodies for smooth muscle detection. Computer-aided image analysis was performed for morphometrical measurements and statistical evaluation. Alphasm-actin-immunoreactive intra-acinar vessels down to a luminal diameter of less than 10 mu m were detected in hypoplastic as well as in normally developed lungs. Crucial differences presented as follows: significantly higher density of intra-acinar vessels, especially due to alpha -sm-actin-negative vessels less than 30 mu m in luminal diameter, in the control group; significantly higher alpha -sm-actin immunoreactivity per section unit as well as per vessel in the hypoplastic lung group. As suggested by others, alpha-sm-actin-positive cells of the intra-acinar vessel wall in the developing human lung were demonstrated to be smooth muscle cells, their immediate precursors, and pericytes. We conclude that the increased alpha -sm-actin immunoreactivity represents muscularization of the vessel wall in functional terms and may be regarded as one structural cause among others for the establishment of persistent fetal circulation in hypoplastic lungs.     

Whole-body mineral measurements in Swedish adolescents at 17 years compared to 15 years of age

Aim: To provide reference data for bone mineral variables in 15- and 17-y-old adolescents and to analyse the relationships between these variables and measures of bone and body size, gender, puberty, growth, various lifestyle and environmental factors and socioeconomic background.

Methods: In the same 321 randomly selected adolescents (147 boys and 174 girls) living in two different regions of Sweden, the total bone mineral content (TBMC), bone area (BA) and total bone mineral density (TBMD) were assessed by dual-energy X-ray absorptiometry at ages 15 and 17 y. The effects of bone and body size, gender, growth, sexual maturity, physical activity, region of domicile, social conditions, food habits, smoking and alcohol intake on TBMC and TBMD were examined in multivariate analyses.

Results: In the 15-y-old adolescents, BA, height, gender, physical activity, maturity and weight explained 91% and 48%, of the variance in TBMC and TBMD, respectively. In similar analyses in the 17-y-olds, the corresponding figures were 92% and 62%, respectively, when BA, height, growth, physical activity, gender and region emerged as significant in the model. In all these analyses, BA explained most of the variance in TBMC and TBMD. No significant reduction of variance was found when different measures of social conditions, smoking, food habits, alcohol or dietary intakes of energy, calcium or vitamin D were included in the models. The reason why region of domicile had a significant impact on TBMC in the 17-y-olds is not known. The fact that the normal fluoride concentration in drinking water (1.1 mg/L) is 10 times higher in the region where TBMC was higher than in the other region is an interesting observation.

Conclusion: Almost 90% of the variance in TBMC and 50% of that in TBMD was explained by measures of bone and body size and only a few percent by gender, physical activity, Tanner stage, growth and region of domicile.     

The potential role of rapamycin in pediatric transplantation as observed from adult studies

Although pediatric patient and renal graft survival rates have shown marked improvements during the past decade, the persistent toxicities of immunosuppressive drugs and chronic allograft attrition remain major obstacles in transplant therapy. Results in adult patients suggest that complete steroid withdrawal is possible in the majority of recipients under treatment with a cyclosporin A-rapamycin (CsA RAPA) regimen. Furthermore, preliminary studies suggest that a marked reduction in the dose of CsA may be possible under the umbrella of RAPA coverage. The gain in immunosuppressive efficacy afforded by RAPA has not only been obtained without an increased morbidity owing to infectious or neoplastic causes, but also with the potential for reducing the incidence and/or progression of chronic rejection.     

VARICELLA ZOSTER VIRUS INFECTIONS IN THE PEDIATRIC STEM CELL TRANSPLANT PATIENT

Varicella zoster virus (VZV), a member of the human herpesvirus family, causes the clinical syndromes of chickenpox during primary infection and shingles on later reactivation. In immunocompromised patients, including those undergoing hematopoietic stem cell transplantation, VZV can produce life-threatening infections. The most serious forms of VZV infection involve hematogenous dissemination of the virus to vital organs, such as the lung, brain, and liver. Advances in immunoprophylaxis, antiviral chemotherapy, and vaccine development have provided effective tools to limit the morbidity and mortality previously associated with VZV infection in hematopoietic stem cell transplant patients. In this review, we discuss virologic aspects of VZV, pathogenesis of VZV infection, methods of viral diagnosis, clinical manifestations of infection in both normal and immunocompromised patients, and available preventative and therapeutic measures.     

Génétique des schizophrénies : mise en perspective des schizophrénies à début précoce et autres pathologies du développement

Schizophrenia (SCZ) is a severe brain disorder characterized by hallucinations, delusions, flat and/or inappropriate affect and cognitive impairment. The lifetime risk is about 0.5% with heritability of 65–85%. The prevalence of early-onset schizophrenia (defined here as before 15 years of age) has not been well studied, but is likely to be 5–10% of all cases. The rarity of early-onset SCZ has made it difficult to study. We focus on genetic studies of adults with schizophrenia, highlighting results for early-onset schizophrenia where available. Prior to the past 5 years, studies failed to find replicable association or linkage between SCZ and specific genes when appropriate statistical corrections for multiple testing were used. Many false positive results were probably reported using the candidate gene approach. Recently, the development of single nucleotide polymorphism (SNP) “chips” has permitted large genome-wide association study (GWAS) analyses that suggest that across all age groups, a proportion of genetic risk can be attributed to a large number of common SNP, each with a very small effect on risk (odds ratios of 1.1 or less). The greatest known genetic effect is conferred by the 1.5–3 Mb 22q.11.2 deletions, which occurs in ∼ 1/4000–1/6000 births with SCZ developing in 20–30% of carriers. Large SNP and aCGH microarray studies have now identified associations between SCZ and other rare, large copy number variations (CNV, insertions and deletions) with high odds ratios (5–10), including deletions of 1q21, 2p16.3 (neurexin-1 gene), 3q29 and 15q13.3, and duplications of 16p11.2. Some of these CNV are also associated with autism or other developmental disorders as well as epilepsy or intellectual deficiency, suggesting some overlap in the mechanisms that contribute to risks of these disorders. Based on preliminary data from larger-scale analyses in progress, approximately 1–2% of cases carry a CNV that has been clearly associated with SCZ (ORs 4–12). Whole exome and genome sequencing studies of large adult samples will be the next steps to identify rarer SCZ-associated mutations, including point mutations and smaller as well as rarer CNV. Genetic findings are beginning to contribute to an understanding of biological mechanisms of SCZ risk and may lead to new approaches to treatment.     

INACTIVATION OF PULMONARY SURFACTANT AND THE TREATMENT OF ACUTE LUNG INJURIES

Inactivation of pulmonary surfactant may be important in acute lung injury and acute respiratory distress syndrome. Treatment of surfactant dysfunction by instilling exogenous surfactants may improve gas exchange and pulmonary mechanics. Surfactants used for treatment vary in their attributes and effects, so when various surfactants are considered for therapy, resistance to inactivation is an important consideration. Animal models of acute lung injury exist in which the relative merits of surfactants can be compared. We hypothesize that the surfactants most resistant to inactivation in vitro will be the ones that are most effective in treatment of animal models of acute lung injury. Surfactants with higher concentrations of surfactant proteins (specifically A, B, and C) are more resistant to inactivation. Nonionic polymers mimic surfactant proteins in preventing surfactant inactivation under some conditions. Adding nonionic polymers to surfactant containing minimal amounts of SP-B and SP-C markedly improves lung function of animals with lung injury. Making surfactants more "inactivation-proof" may improve surfactant therapy of acute lung injuries.     

Plasma Proinsulin and C-Peptide Concentrations in Children with Hyperinsulinaemic Hypoglycaemia

ABSTRACT. Plasma concentrations of proinsulin and C-peptide were measured in five children presenting with svere hypoglycaemia associated with elevated plasma levels of immunoreactive insulin (IRI) in order to determine whether the profile of circulating B-cell products related to the underlying pathophysiology of the pancreas. Results were compared with data from 13 normal infants. Four children, three neonates and a nine year old girl, were subjected to partial or total pancreatectomy. The neonates had nesidioblastosis, nesidioblastosis with a microadenoma, and a functional abnormality without histological derangement respectively; the older child had a localised adenoma. The remaining child, a neonate, had transient hypoglycaemia and elevated IRI levels associated with hyperlactataemia and hyperalaninae-mia. All the children had markedly elevated plasma proinsulin concentrations; the highest levels were seen in the child with an isolated adenoma and in the neonate with nesidioblastosis and a microadenoma. Both of these children also had substantially elevated plasma C-peptide concentrations. The remaining three neonates had plasma C-peptide levels, which although in the normal range for normoglycaemia were inappropriately elevated during hypoglycaemia. It is concluded that elevated proinsulin and C-peptide concentrations are seen in children with hypoglycaemia associated with increased plasma IRI levels and that the profile of the concentrations does not provide a reliable marker for the nature of the underlying pancreatic abnormality.     

Growth tracks in early childhood

Aim: Child growth is modulated by numerous factors and, particularly in infancy and early childhood, often tends to follow apparently irregular patterns, with many centiles crossed before the later growth channels are reached. The aim of this study was to visualize the diversity of individual growth. Design: The study investigated 333 girls and 329 boys without chronic illnesses from four paediatric practices in Kiel, Germany. The children were measured on natural     

Residual pulmonary hypertension in children after treatment with inhaled nitric oxide: a follow-up study regarding cardiopulmonary and neurological symptoms

Inhaled nitric oxide is a potent vasodilator in acute severe pulmonary hypertension and is increasingly used as rescue treatment in intensive care algorithms aiming at reducing severe hypoxaemia in neonates and children. Although the immediate effects may seem impressive, longterm outcome regarding residual pulmonary hypertension and other sequelae has been studied in only a very few patients. The aim of the present study was to evaluate residual pulmonary hypertension, cardiopulmonary or neurological symptoms in children after treatment with inhaled nitric oxide in severely hypoxaemic and/or pulmonary hypertensive mechanically ventilated children. The study was performed in four paediatric intensive care units in university hospitals in Sweden, Norway and Australia. Patients who had received inhaled nitric oxide as part of their intensive care treatment for severe hypoxaemia and/or pulmonary hypertension, and in whom 6 mo had elapsed since treatment, were included for evaluation. Thus 36 paediatric or neonatal patients were examined for circulatory, respiratory or neurological disorders with clinical examination, echocardiography, chest X-ray and a capillary blood sample. Four patients with congenital heart disease had residual pulmonary hypertension. Nine patients were receiving bronchodilators. Sixteen patients had minor (n = 15) or moderate (n = 1) changes on a chest X-ray. One patient had a possible delay in psychomotor development. Conclusions: In spite of the severity of their primary illness, we found that the overwhelming majority of the surviving children were asymptomatic and doing well. The few residual circulatory and respiratory symptoms could be related to the initial condition.