奥美拉唑快速纠正先天性肥厚性幽门狭窄代谢性碱中毒的临床研究

目的探讨奥美拉唑在快速纠正先天性肥厚性幽门狭窄代谢性碱中毒中的作用。方法将本院80例诊断为先天性肥厚性幽门狭窄的患儿随机分成两组,治疗组40例,对照组40例。根据人院时pH值又分为pH〉7．5组（治疗组21例,对照组22）,pH≤7．5组（治疗组19例,对照组18例）。对照组采用补充生理盐水、平衡液等纠正电解质紊乱及酸碱失衡,治疗组除采用上述治疗外加用奥美拉唑0．7mg·kg^-1·d^-1静脉滴注,每日1次。人院后每12h行动脉血气分析,数据通过SPSS13．0软件包进行统计学处理。结果pH〉7．5组：入院后12h治疗组有8例（8／21,38．1％）pH值恢复正常,对照组仅2例（2／22,9．1％）恢复正常（P〈0．05）。入院后24h,治疗组有18例（18／21,85．7％）pH值恢复正常,而对照组仅5例（5／22,22．7％）pH值恢复正常,两组比较差异有统计学意义（P〈0．01）。pH≤7．5组：人院后12h治疗组有15例（15／19,78．9％）pH值恢复正常,对照组有9例（9／18,50．0％）恢复正常。人院后24h治疗组有15例（15／19,78．9％）pH值恢复正常,对照组有13例（13／18,72．2％）恢复正常。入院后36h治疗组pH值已全部恢复正常,对照组有16例（16／18,88．8％）恢复正常。两组比较,差异无统计学意义（P〉0．05）。结论奥美拉唑能快速纠正先天性肥厚性幽门狭窄代谢性碱中毒,对纠正中重度代谢性碱中毒尤为显著。     

Current management of hypertrophic pyloric stenosis

Hypertrophic pyloric stenosis (HPS) is a common condition affecting infants that presents with progressive projectile nonbilious vomiting. The pyloric portion of the stomach becomes abnormally thickened and manifests as gastric outlet obstruction. The cause is unknown. Pyloromyotomy remains the standard of treatment and outcome is excellent. This article reviews the diagnostic work up and imaging, preoperative resuscitation, the various surgical approaches used, and the effect of subspecialty training on outcomes after pyloromyotomy. Postoperative care and the variety of postoperative feeding regimens applied after pyloromyotomy are reviewed, as well as intra- and postoperative complications. Finally, medical management, in lieu of surgery, is discussed.     

Pyloric stenosis: evolution from pylorospasm?

Over a 10-year period, we have performed pyloromyotomy on 260 infants with hypertrophic pyloric stenosis (HPS), 10 of whom had a history suggestive of pyloric stenosis but initially had neither the physical nor radiological findings to confirm the diagnosis. All 10 demonstrated pylorospasm on upper gastrointestinal series (UGIS), were treated medically without improvement, and subsequently developed classic HPS confirmed by repeat UGIS. Age at diagnosis ranged from 3 to 16 weeks (mean 8 weeks). Vomiting was progressively more projectile and severe from the onset until diagnosis and operation, with a duration of 5–50 days (mean 24 days). In 9 of the 10 patients a second UGIS demonstrated the diagnostic signs of HPS in 8 and suggested an antral web in the 9th. The interval between the two UGIS ranged from 2 to 46 days (mean 13 days). The 10th patient had a palpable hypertrophic pyloric muscle 9 days after the first UGIS and was operated upon without a follow-up UGIS. All 10 patients had classic HPS at operation. We conclude that although most infants with pylorospasm on UGIS improve with medical management, a small but significant number go on to develop HPS. Awareness of this variant of pyloric stenosis and appropriate follow-up UGIS will help to avoid undue delay in correctly diagnosing infants with persistent non-bilious vomiting.     

Inflation times during resuscitation of preterm infants

Data on the effects of a prolonged inflation time during the resuscitation of very prematurely born infants are limited; one study showed no effect, and in another, although lower bronchopulmonary dysplasia (BPD) rates were seen, that effect could have been due to the prolonged inflation time, the positive end expiratory pressure applied or the combination of the two. The aims of our study were to assess the length of inflation times used during face mask and t-piece resuscitation of prematurely born infants in the labour suite and determine whether prolonged inflations led to longer inflation flow times. A respiration monitor (NM3 respiratory profile monitor) was used to record flow, airway pressure and tidal volume changes. The first five inflations for each baby were analysed. Forty prematurely born infants (median gestational age 30, range 26–32 weeks) were examined. Their median inflation pressure was 17.6 (range 12.2–27.4) cm H₂O, inflation time 0.89 (range 0.33–2.92) s, expiratory tidal volume 1.01 (range 0.02–11.41) ml/kg and inflation flow time 0.11 (range 0.04–0.54) s. There was no significant relationship between the inflation time and the inflation flow time, but there was a significant relationship between the inflation pressure and the inflation flow time (p = 0.024). Conclusion: These results suggest that prolonging inflation times during face mask resuscitation of prematurely born infants would not improve ventilation as prolonged inflation did not lead to longer inflation flow times.     

Retroperitoneoscopic Anderson–Hynes dismembered pyeloplasty in infants and children: a 60-case report

Purpose  To present a new technique of retroperitoneoscopic Anderson–Hynes dismembered pyeloplasty (AHDP) in infants and children with ureteropelvic junction obstruction (UPJO) based on our clinical experience. Methods  From March 2003 to February 2007, retroperitoneoscopic AHDP was performed in 60 (44 boys and 16 girls) UPJO infants and children with a three-port lateral retroperitoneal approach. The retroperitoneal space was entered via a 1-cm longitudinal incision beneath the 12th rib and further developed by a glove balloon. Video-retroperitoneoscopy was undertaken with a 5-mm laparoscope between the mid axillary line and 1 cm away from the superior border of iliac crest. Dismembered pyeloplasty was carried out with the Anderson–Hynes anastomosis where 5-0 or 6-0 vicryl sutures were over a double-J ureteric stent. Anastomosis was completed with freehand intracorporeal suture techniques. Follow-up studies were conducted by intravenous urography and renal ultrasonography. Results  Among the 60 patients (62 sides) with retroperitoneoscopic AHDP, only the first two cases were converted to open surgery due to difficulties in developing the retroperitoneal space, and the remaining cases succeeded. The average operative time was 70 ± 12.6 min (ranging from 55 to 130 min), the average estimated blood loss was 10 ± 2.2 ml (ranging from 5 to 20 ml), and the average postoperative hospital stay was 7 ± 1.3 days (ranging from 3 to 15 days). Aberrant artery vessel was intraoperatively observed in seven patients. Postoperative urinary leakage occurred in two patients, but spontaneously disappeared on the 6th and 11th days after the surgery, respectively; and one of them underwent open surgery for recurrent UPJO 8 months later. During an average follow-up period of 24 months, we performed radiographic assessment by intravenous urography and found that all the cases showed good results except the patient who underwent open surgery later. Conclusions  Our experience with retroperitoneoscopic AHDP demonstrates that this technique is safe, effective and time saving for treating UPJO in infants and children. H. Zhou and H. Li contributed equally to this work.     

Hypocarbia and cystic periventricular leukomalacia in premature infants

One hundred sixty seven survivors among very low birthweight infants with a gestational age of less than 35 weeks have been studied prospectively. The purpose of this study was to clarify the relationship of severe prenatal and perinatal complications and hypocarbic alkalosis, defined as a carbon dioxide tension (Paco₂) of less than or equal to 2.67 kPa and a pH of 7.50 or greater during the first 24 hours of life, to cystic periventricular leukomalacia (PVL) depicted by serial cranial ultrasonographic examinations. Complications occurred in 16 infants, five of whom presented with PVL, while eight of 151 infants without complications had PVL. Twenty six of the infants had hypocarbic alkalosis, six with evidence of PVL, and seven of the 136 infants without hypocarbic alkalosis had PVL. These results suggest a significant relationship of complications and hypocarbic alkalosis to PVL. Mechanical ventilation should be managed carefully in premature infants to avoid Paco₂ of lower than 2.67 kPa.     

Hypocarbia and cystic periventricular leukomalacia in premature infants

One hundred sixty seven survivors among very low birthweight infants with a gestational age of less than 35 weeks have been studied prospectively. The purpose of this study was to clarify the relationship of severe prenatal and perinatal complications and hypocarbic alkalosis, defined as a carbon dioxide tension (PaCO2) of less than or equal to 2.67 kPa and a pH of 7.50 or greater during the first 24 hours of life, to cystic periventricular leukomalacia (PVL) depicted by serial cranial ultrasonographic examinations. Complications occurred in 16 infants, five of whom presented with PVL, while eight of 151 infants without complications had PVL. Twenty six of the infants had hypocarbic alkalosis, six with evidence of PVL, and seven of the 136 infants without hypocarbic alkalosis had PVL. These results suggest a significant relationship of complications and hypocarbic alkalosis to PVL. Mechanical ventilation should be managed carefully in premature infants to avoid PaCO2 of lower than 2.67 kPa.     

Postnatal body weight curves for infants below 1000 g birth weight receiving early enteral and parenteral nutrition

No body weight curves are available for preterm infants <1000 g birth weight receiving early enteral and parenteral nutrition. Postnatal weight changes of 136 infants with a birth weight <1000 g were analysed retrospectively. Body weight curves for the first 30 days of life were generated for five separate birth weight groups (430–599 g, 600–699 g, 700–799 g, 800–899 g, 900–999 g). All infants had received intravenous glucose and amino acids from day 1 and intravenous lipids from day 2. Enteral feeding was started on day 1. Thus caloric intake (±SD) was advanced to 384 ± 46 kJ/kg per day (92 ± 11 kcal/kg/day) in the 1st week of life. In 136 preterm infants mean postnatal weight loss was 10.1% ± 4.6% of birth weight, birth weight was regained at a mean postnatal age of 11 ± 3.7 days, but significantly earlier (7.8 ± 3.5 days) in the lowest compared to the highest weight group. Mean subsequent weight gain was 15.7 ± 7.2 g/kg per day. This was accomplished by exclusive enteral nutrition from day 20 (median). Conclusion Our body weight curves are more adequate to evaluate growth of preterm infants than older published reference values because they are based on infants treated according to current nutritional standards. Received: 6 July 1997 and in revised form 5 October 1997 / Accepted: 15 October 1997     

Pyloric motor abnormality in patients with infantile hypertrophic pyloric stenosis

There are no published data of manometric studies of pyloric motor function in patients with infantile hypertropic pyloric stenosis (IHPS). The present study attempted to examine the characteristics of motor abnormality of the pylorus in five children with IHPS. Using a transducer-built-in manometric catheter cannulated through the pylorus under fluoroscopy, the pressure in the pyloric canal was recorded continuously over 3 h during fasting. Clusters of high-amplitude spastic contractions of over 300 mmHg were recorded at intervals. The frequency was 1–3/min (mean 1.7 cpm) and the duration was 7–15 s. These periodic spastic contractions were suppressed temporarily for 20–30 min after intravenous injection of 0.01 mg/kg atropine. After pyloromyotomy, these spastic contractions decreased remarkably in amplitude, but there were no changes in frequency. It is concluded that the underlying motor abnormality observed in hypertrophied pyloric muscle is clusters of high-amplitude contractions, although more precise measurements of basal pyloric pressure are needed to explore the pathophysiology of IHPS in detail. The effect of pyloromyotomy may be related to the decrease in high-amplitude contractions. Accepted: 26 May 1998     

Efectos hemodinámicos del omeprazol por vía intravenosa en niños en estado crítico

IntroductionCritical patients usually have hemodynamic disturbances which may become worse by the administration of some drugs. Omeprazole is a drug used in the prophylaxis of the gastrointestinal bleeding in these patients, but its cardiovascular effects are unknown. The objective was to study the hemodynamic changes produced by intravenous omeprazole in critically ill children and to find out if there are differences between two different doses of omeprazole.Material and methodsA randomized prospective observational study was performed on 37 critically ill children aged from 1 month to 14 years of age who required prophylaxis for gastrointestinal bleeding. Of these, 19 received intravenous omeprazole 0.5 mg/kg every 12 hours, and 18 received intravenous omeprazole 1 mg/kg every 12 hours. Intravenous omeprazole was administered in 20 minutes by continuous infusion pump. Heart rate, systolic, diastolic and mean arterial blood pressure, central venous pressure and ECG were recorded at baseline, and at 15, 30, 60 and 120 minutes of the infusion.ResultsThere were no significant changes in the electrocardiogram, heart rate, blood pressure and central venous pressure. No patients required inotropic therapy modification. There were no differences between the two doses of omeprazole.ConclusionsIntravenous omeprazole administration of 0.5 mg/kg and 1 mg/kg is a hemodynamically safe drug in critically ill children.     

Breastfeeding protects against acute gastroenteritis due to rotavirus in infants

To assess whether breastfeeding protects against acute gastroenteritis (AGE) due to rotavirus (RV) infection compared to RV-negative AGE (RV−) in children age 0–12 months. Data from a community-based study of children with AGE from 30 pediatric practices in Germany, Switzerland, and Austria were evaluated. A case–control design was conducted with RV-positive AGE (RV+) cases and RV− AGE as controls. Odds ratios and 95% confidence intervals were estimated using log-linear regression models adjusting for child’s age, family size, number of siblings, child care attendance, and nationality. A total of 1,256 stool samples were collected from infants with AGE; 315 (25%) were RV+ and 941 RV−. Being breastfed in the period of disease inception reduced the risk of AGE due to RV+ (OR, 0.53; 95% CI, 0.37–0.76). In infants 0–6 months of age, the protective effect was stronger (OR, 0.33; 95% CI, 0.19–0.55) than in 7–12-month-old children. Our study adds to the evidence of a protective concurrent effect of breastfeeding against rotavirus infection in infants, particularly in children 6 months and younger. Breastfeeding is important to diminish rotavirus-related gastroenteritis in infants before vaccination can be introduced.     

Frequency and clinical correlates of radiographic patterns of bronchopulmonary dysplasia in very low birth weight infants by term age

Our aim was to study the frequency and clinical correlates of two radiographic patterns of bronchopulmonary dysplasia (BPD), the cystic BPD (cBPD) and the leaky lung syndrome (LLS). Radiographic findings of BPD from sixth day of life until term in a cohort of 82 very low birth weight (VLBW) infants were evaluated and scored independently by a neonatologist and a paediatric radiologist. Data on prenatal factors and events during the first hospitalisation were collected prospectively. Forty-four (53.7%) infants showed radiographic evidence of BPD, 19 (23.2%) cBPD and 25 (30.5%) LLS. In multivariate analysis, the best predictors for radiographic BPD were oxygen dependency at 28 days (odds ratio (OR) 10.2 [95% confidence interval (CI) 2.49–41.4]), more than 2 days on ventilator (OR 10.4 [95% CI 1.8–61.5]) and volume expanders in the first 2 h (OR 7.36 [95% CI 1.32–41.2]). During the first week of life, infants with radiographic BPD received less energy per kilogram (p < 0.001) and more daily fluids per kilogram of body weight (p = 0.013). Sixty-two percent of the infants with radiographic BPD were not oxygen dependent at 36 weeks postmenstrual age (PMA). Seventeen (89.5%) of the 19 infants who needed oxygen supplementation at 36 weeks PMA also had abnormal chest X-rays. Conclusions: Radiographic BPD findings appeared to be common in VLBW infants. In addition to the well-known respiratory risk factors (oxygen and ventilator therapy), poor nutrition and excessive fluid administration in early life seem to be significantly associated with radiological findings of lung injury in these patients.     

Conservative treatment of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate does not replace pyloromyotomy

Pyloromyotomy as described by Weber and Ramstedt has been the standard therapy for infantile hypertrophic pyloric stenosis since the 1960’s and conservative therapy has been abandoned. The objective of this study was to test the effectiveness of systemic atropine applied intravenously for 7 days as a conservative therapeutic strategy and as an alternative to primary operation. Forty-two consecutive term infants with infantile hypertrophic pyloric stenosis were enrolled in the study over a period of 5 years. After confirmation of the diagnosis they all received intravenous atropine at a dose of 0.04 mg/(kg day) and increased by 0.01 mg/(kg day) up to 0.12 mg/(kg day), given as 6–8 single doses per/day. Nine pairs of parents requested that their child should be operated before completing the 7 days of medical therapy. Surgery was necessary in 8 of the remaining 33 infants (24,.2%) who did not improve after 7 days of conservative treatment. Successful treatment with i.v. atropine sulfate was achieved only in 25/33 term infants at an average maximal dose of 0.11 mg/(kg day), without any major side effects. Intravenous atropine sulfate has been considered as a potential alternative therapeutic strategy in the treatment of infantile hypertrophic pyloric stenosis. Clinical improvement however was often not seen before the 6th or 7th day of intravenous treatment. A success rate for the conservative approach of only 75% at day 7 in our study does not favour atropine therapy, in view of success rates above 95% with surgical repair.     

Quantitative bone US measurements in neonates and their mothers

Background  Factors that affect quantitative ultrasound (QUS) bone measurements have not been clearly defined for all clinical populations. Objective  To determine some technical and clinical aspects that may affect QUS bone measurement in the neonate–maternal dyad. Materials and methods  Speed of sound (SOS) was measured at the radius and tibia using a commercial multisite axial transmission QUS instrument and three manufacturer-provided probes (CS, CR and CM). Results  The study included 183 singleton neonates and 159 mothers. The type of probe, weight and edema significantly affected SOS measurements. In infants, the CS and CR probes measured SOS consistently at the tibia but not the radius. Gestational age was predictive of SOS from the CS probe and remained significant when race, gender, and birth weight were included. None of these parameters predicted SOS when using the CR probe. Maternal SOS at the radius and tibia was correlated with the CM probe. Maternal SOS was predicted by age but not by gravid status, number of living children, or race. There was no consistent correlation between maternal–infant dyad SOS measurements. Conclusions  Axial transmission SOS of bone varies with probe and site and is affected by technical and clinical factors. Valid data depend on documentation of the probes used and the clinical population studied.     

Intravenous Induction of Therapeutic Hypothermia in the Management of Junctional Ectopic Tachycardia: A Pilot Study

Therapeutic hypothermia has been used to treat children with postcardiotomy junctional ectopic tachycardia (JET). However, cooling techniques have not been systematically studied. This pilot study investigates the safety and efficacy of intravenous cold saline infusions used to augment surface cooling to achieve a core temperature of 32–34°C for pediatric patients with JET. For this study, 10 patients with JET were cooled using cooling blankets and 4°C normal saline infusions to a target central temperature of 32–34°C. Vital signs and central temperatures were monitored continuously during the cooling period. Comprehensive metabolic panels, complete blood counts, coagulation studies, and cultures were obtained per study protocol. Therapeutic hypothermia was achieved within 65 min (interquartile range [IQR], 45–75 min). The median heart rate decreased from 187 beats per min (bpm) (IQR, 184–190 bpm) to 158 bpm (IQR, 121–162 bpm). For all the patients, atrioventricular synchrony was restored either with conversion to normal sinus rhythm or with successful atrial pacing. No clinically significant electrolyte abnormalities or bleeding events occurred. Two deaths, not directly attributable to the cooling protocol, occurred. Intravenous induction of therapeutic hypothermia can be safely and effectively performed for children with JET. Further studies, powered for clinically relevant outcomes, should evaluate this potentially valuable therapeutic method.     

Hypertrophic pyloric stenosis: predicting the resolution of biochemical abnormalities

Purpose  

Hypertrophic pyloric stenosis (HPS) is a common condition of infancy, often presenting with marked biochemical derangement, requiring correction. Previous studies have looked at the relationship between serum electrolytes and acid–base balance in HPS but not at the relationship between the degree of biochemical derangement and time taken to resolve the biochemical abnormality.     

Total serum bilirubin levels during the first 2 days of life and subsequent neonatal morbidity in very low birth weight infants: a retrospective review

To determine the relationship between total serum bilirubin (TSB) during the first 2 days of life and subsequent neonatal morbidity in very low birth weight (VLBW, less than 1500 g) infants. We performed a prospective study of 582 VLBW infants born between July 1, 2005 and December 31, 2009. TSB was measured in umbilical cord blood (UCB), at 24 and 48 h after birth. Demographic and clinical characteristics of infants in hospital were recorded. The interaction between TSB variables during the first 48 h of life and subsequent neonatal morbidity were assessed in logistic regression analyses adjusted for multiple risk factors. It was found that TSB in UCB was in a negative correlation with occurrence of respiratory distress syndrome (RDS) [OR 0.626, 95% confidence interval (95% CI): 0.446–0.879, p = 0.007], and there was also a negative correlation between TSB in UCB and occurrence of intraventricular hemorrhage (IVH) [OR 0.695, 95% CI 0.826–0.981, p = 0.020]. However, TSB in UCB positively correlated with hyperbilirubinemia [OR 2.471, 95% CI 1.326–3.551, p = 0.012], and TSB at 24 h after birth was also in a positive correlation with early onset sepsis (EOS) [OR 1.299, 95% CI 1.067–1.582, p = 0.011]. VLBW infants with low TSB levels in UCB were more likely to develop RDS and IVH, and those with low TSB levels in UCB were less likely to develop hyperbilirubinemia. Infants with high TSB levels at 24 h after birth were more likely to develop EOS. The protective effect of raised TSB in UCB with respect to RDS and IVH warrants further investigation.     

Feasibility of complex minimally invasive surgery in neonates

The aim of this study was to assess the feasibility of complex minimally invasive surgery in neonates (and infants <5 kg). A systematic search of databases was performed. Inguinal herniotomy and pyloromyotomy were specifically excluded. Various operations were assessed for operative times, conversion rates, complications and centres performing the procedures. From 479 abstracts, 50 papers were identified describing 1,215 patients. Common operations performed were fundoplication (n = 473), operations for ovarian pathology (n = 151) and oesophageal atresia repair (n = 123). Other not-so-common operations included Kasai procedure (n = 61), Ladd’s procedure (n = 55), bowel atresia surgery (n = 45) and congenital diaphragmatic hernia repair (n = 41). Mean operation times varied from 43 min for fundoplication to 209 min for Kasai procedure, with other operation times falling in between the two extremes. Likewise, conversion rates varied from 0.2% for fundoplication to 15% for congenital diaphragmatic hernia, with other conversion rates falling in between. Complications ranged from 0 to 67%. About 70–94% of the cases were performed in six pioneering centres. Fundoplication and operations for ovarian pathology have low complication and conversion rates and appear to be well suited to the average-trained paediatric laparoscopic surgeon. More complex procedures are feasible and safe, but technically demanding and need further expertise.     

Prophylaxis of intravenous immunoglobulin and acyclovir in perinatal varicella

Maternal chickenpox around the time of delivery can cause severe and even fatal illness in the newborn but an effectively preventive method has not yet been established. We proposed that a combination of intravenous immunoglobulin (IVIG) and acyclovir (ACV) intravenously could effectively prevent perinatal varicella. A group of 24 newborn infants whose mother had developed a varicella rash within 14 days before and after delivery were studied. Some 15 infants whose mothers' rash appeared within 7 days before and 5 days after delivery were categorised as an at-risk group and received IVIG prophylaxis (500 mg/kg) administered soon after birth or post-natal contact either alone or with intravenous acyclovir (5 mg/kg every 8 h) for a total of 5 days starting from 7 days after the onset of maternal rash. Of four infants receiving IVIG alone, two developed clinical varicella. None of ten infants receiving both IVIG and ACV contracted varicella. One infant receiving ACV alone had no varicella vesicles either. Of nine infants in the not at-risk group four had undetectable varicella-zoster virus antibody on admission and developed clinical varicella subsequently. Conclusion The combination of intravenous immunoglobulin given soon after birth and prophylactic acyclovir intravenously administered 7 days after the onset of maternal rash can effectively prevent perinatal varicella. Received: 16 February 2000 / Accepted: 2 August 2000     

Early versus late dexamethasone treatment in preterm infants at risk for chronic lung disease: a randomized pilot study

The purpose of this controlled, prospective pilot study was to compare the short-and long-term efficacy of early versus late treatment with dexamethasone (Dex) in preterm infants at risk for chronic lung disease (CLD). Thirty ventilated premature infants with a birth weight ≤ 1250 g were randomized to receive Dex either from day 7 or from day 14. Dex was administered over 16 days tapering from 0.5 mg/kg per day to 0.1 mg/kg per day. The infants of the early treatment group could be weaned significantly earlier from the ventilator – after 14 days (median; range 9–24) versus 24 days (median; range 8–44) in the late treatment group. The need for supplemental oxygen was shorter if Dex was started early – 24 days (median; range 10–57) versus 40 days (median; range 10–74). Oxygen dependency at 28 days of age was similar between the groups – 6 out of 14 infants (42.9%) versus 10 out of 16 patients (62.5%). The long-term efficacy of the two Dex regimens on lung function was evaluated by body plethysmographic measurements made at the age of 3 months. Thoracic gas volume and airway resistance were measured and specific airway conductance calculated. No statistically significant differences between the groups were demonstrated. Conclusion Early dexamethasone treatment led to earlier extubation in our study population, but was not associated with significant advantages regarding oxygen dependency at 28 days of life and pulmonary function test at 3 months of age. Received: raised 31 July 1997 / Accepted in revised form: 15 March 1998