Selective bronchial intubation in a preterm infant with congenital cystic adenomatoid malformation and pulmonary air leak syndrome

A preterm infant with congenital cystic adenomatoid malformation (CCAM) who developed a right‐sided pulmonary air leak syndrome (pulmonary interstitial emphysema and bronchopleural fistula) following CCAM resection is reported. The pulmonary air leak syndrome was successfully ameliorated by intubating the right mainstem bronchus using a modified endotracheal tube that allowed selective ventilation of the left lung. The procedure was used successfully as rescue treatment to control the pulmonary air leak and to confirm the functional adequacy of the left lung prior to definitive operative surgery.     

Bronchopulmonary dysplasia: A review of the pulmonary sequelae in the post‐surfactant era

We describe the respiratory complications of bronchopulmonary dysplasia (BPD) in childhood and adolescence. The pathophysiology of bronchopulmonary dysplasia has evolved in the era of modern neonatal intensive care. In this review, we aim to summarise the contemporary evidence base and describe the common respiratory morbidities related to BPD including; home oxygen therapy, rehospitalisation, asthma and exercise limitation.     

Persistent pulmonary interstitial emphysema in a preterm infant

Persistent pulmonary interstitial emphysema is a chronic disease reported in mechanically ventilated premature newborns. We describe a case of localized persistent pulmonary interstitial emphysema in a preterm infant without mechanical ventilation but on continuous positive airway pressure using nasal prongs. The condition resolved without surgery.     

Persistent Staphylococcus capitis septicemia in a preterm infant

A preterm infant had persistent Staphylococcus capitis septicemia with 11 consecutive positive blood cultures over a period of 33 days. The clinical evidence suggested that the source of infection probably originated from the gastrointestinal tract. The combination of rifampin and linezolid treatment, together with prolonged stoppage of enteral feeding, successfully terminated the infection. Rifampin and linezolid should be considered as alternative antimicrobial agents when glycopeptides fail to eradicate Gram-positive pathogens from the host.     

早产儿持续高血压2个月

患儿（36周胎龄出生）,男,2个月,因咳嗽、呼吸困难入院。入院后发现患儿存在持续性高血压、蛋白尿和惊厥持续状态,影像学提示主动脉及大分支广泛钙化,腹主动脉、右肾动脉局部管腔变窄伴血流速度增快。患儿新生儿期因湿肺、肺动脉高压住院,期间曾发现高血压、蛋白尿。进一步行全外显子组基因高通量测序,发现患儿ENPP1基因存在源自父母的复合杂合突变：c.130C > T（p.Q44X）和.c.1112A > T（p.Y371F）。c.130C > T为无义突变,可造成蛋白质从44个氨基酸之后的部分缺失,为一级致病性突变形式;c.1112A > T为错义突变,为已报道的与特发性婴儿动脉钙化症（ⅡAC）相关的致病性突变。因此确诊为ⅡAC。给予膦酸盐及降压、止惊、呼吸支持等对症治疗,血压维持在正常高限,动脉钙化未恶化。对于持续高血压伴广泛大血管钙化的小婴儿,应注意ⅡAC的可能,尽早行影像学及基因检查确诊。     

Persistent pulmonary hypertension in a very low birthweight preterm infant

Persistent pulmonary hypertension of the neonate (PPHN) characteristically is seen in full-term or postterm infants. Occasionally, PPHN complicates the course of hyaline membrane disease in preterm infants. This report documents the unusual occurrence of PPHN in a preterm very low birthweight infant without apparent pulmonary parenchymal disease.     

Remarkably delayed occurrence of normal surfactant composition in an extremely preterm infant

Reported herein is the first case of a remarkably delayed occurrence of normal surfactant composition in an extremely preterm infant who required a total of 15 doses of artificial pulmonary surfactant (Surfacten®). A male infant, born at 26 weeks gestation, developed respiratory distress at birth. Chest radiography was consistent with respiratory distress syndrome. The infant required repeated doses of surfactant, each resulting in transient periods of decreased ventilator requirement and improved blood gas values. Surfactant proteins (SP)‐A, SP‐B, SP‐C, and SP‐D from tracheal aspirate samples were analyzed on the 13th day (deterioration period) and 36th day (recovery period) after birth. On the 13th day sufficient SP‐A and SP‐D but no SP‐B no SP‐C were detected on western blot analysis. SP‐B and SP‐C were eventually detected on the 36th day. This infant therefore required almost 3 months to achieve normal surfactant function.     

Procalcitonin in the early diagnosis of nosocomial sepsis in preterm neonates

Aim:   To examine the diagnostic usefulness of procalcitonin (PCT), C-reactive protein and immature to total neutrophil ratio (I : T) in nosocomial sepsis among neonates treated in an intensive care unit.
Methods:   A retrospective analysis and comparison of diagnostic utility performed in preterm neonates using receiver operating characteristic curves for the diagnosis of culture-proven sepsis.
Results:   A total of 78 clinically suspected sepsis episodes in 73 newborns were analysed. The median values of PCT were: 0.56 ng/mL (interquartile range (IQR) 0.33–1.32) in group with aseptic blood culture ( n  = 15), 2.69 ng/mL (IQR 1.10–5.29) in Gram-positive ( n  = 47) and 9.36 ng/mL (IQR 3.11–39.35) in Gram-negative sepsis ( n  = 16). Only PCT values were significantly different ( P  < 0.01) among all groups. This was also true when correction for differences in blood withdrawal time was implemented. The positive and negative predictive values of PCT in the diagnosis of sepsis equalled 97.5% and 88.9%, respectively, for a cut-off value of 0.99 ng/mL. PCT was significantly better in diagnosis of sepsis than I : T ( P  = 0.03). No other significant differences in diagnostic efficacy were noted. The diagnostic efficacy was the highest for measurements made two or more hours since the onset of symptoms.
Conclusions:   The PCT serum concentration is a valuable tool for early detection of nosocomial sepsis in infants. Highest levels of PCT were observed in Gram-negative infections.     

Shwachman–Diamond syndrome (SDS) in a preterm neonate

A preterm neonate at 29‐week gestational age was born with intrauterine growth restriction, severe pancytopaenia and gross skeletal dysplasia. Antenatal screening bloods, TORCH/parvovirus tests and karyotype were unremarkable. Postnatally, he had normal microarray comparative genomic hybridization and serum B12/folate levels, and human immunodeficiency virus and cytomegalovirus polymerase chain reaction and antoimmune screening were negative. Targeted gene testing for Shwachman–Diamond syndrome (SDS) revealed the pathognomic mutation (c.183_184delTAinsCT). His postnatal clinical course was complicated by: (i) Ventilator dependency because of a combination of a pathologically compliant chest wall and preterm‐associated chronic lung disease. (ii) Progressive bone marrow failure, resulting in transfusion dependence and profound neutropenia associated with recurrent sepsis. (iii) Gastrointestinal failure and TPN dependency. (iv) Poor postnatal growth with weight/length/head circumference all <3rd centile. (v) Prognostication was complicated by the lack of published literature on the presentation of SDS in a preterm infant. However, because of inexorable progression of multiorgan failure, intensive care was withdrawn on day 54 of life. SDS is a rare autosomal recessive disorder characterised by haematological abnormalities, skeletal dysplasia and exocrine pancreatic dysfunction. Neonatal presentation is thought to be extremely rare. However, with the availability of genetic testing, it has now become clear that because of overlap in clinical presentation, term‐born infants with skeletal dysplasia and severe respiratory distress may initially be misdiagnosed as asphyxiating thoracic dystrophy. This case report highlights the complexities of preterm birth complicating clinical manifestations of SDS.     

Percutaneous administration of theophylline in the preterm infant

The preterm infant's skin is a poor barrier to the absorption of chemical agents. The possibility of turning this to the infant's advantage was explored by using the percutaneous route to administer theophylline. A standard dose of theophylline gel, equivalent to 17 mg anhydrous theophylline, was applied to an area of skin 2 cm in diameter over the upper abdomen under an occlusive dressing, and serial theophylline levels were measured; 25 studies were performed in 20 infants of less than or equal to 30 weeks gestation. Therapeutic theophylline levels (greater than 4 mg/L) were achieved in 11 of 13 infants who had not previously received the drug, and were maintained for up to 72 hours. In 12 studies in infants who were previously receiving aminophylline intravenously, theophylline levels were maintained for up to 70 hours. There was a significant decline in the amount of theophylline absorbed in the first 24 hours after application as the infant's postnatal age increased, but satisfactory blood levels were achieved in infants up to 20 days of age. The percutaneous route is a feasible method of administering theophylline in preterm infants.     

Nasal high flow therapy for neonates: Current evidence and future directions

Nasal high flow (nHF) therapy is a commonly used method of providing non‐invasive respiratory support for neonates. It has several potential mechanisms of action: continuous distending pressure, nasopharyngeal dead space washout, provision of heated and humidified gases and reduction of work of breathing. nHF is used in a number of clinical scenarios for preterm and term infants, including primary respiratory and post‐extubation support. In recent years, large trials have generated evidence pertinent to these indications. Novel applications for nHF in neonates warrant further research: during endotracheal intubation, for initial delivery room stabilisation of preterm infants and in conjunction with minimally invasive surfactant therapy.