Paediatric respiratory reviews
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Paediatr Respir Rev · Jan 2004
ReviewSurfactant use for neonatal lung injury: beyond respiratory distress syndrome.
Surfactant has led to a significant reduction in neonatal mortality for premature infants with lung immaturity and respiratory distress. However, surfactant therapy has been shown to be effective in the treatment of a number of other neonatal respiratory disorders and the evidence for surfactant use in such circumstances is presented. Meconium aspiration is characterised by severe atelectasis, the influx of neutrophils, edema, and hyaline membranes, with decreased levels of SP-A and SP-B and the large aggregate fraction of lung surfactant, and altered surfactant surface morphology. ⋯ Case reports have reported a benefit of surfactant for infants with CDH. In the near-term infants with severe respiratory distress, surfactant is one of the therapies along with inhaled nitric oxide and high frequency ventilations, that have resulted in improved outcomes. Surfactant treatment may be of significant benefit in newborn infants with respiratory compromise secondary to a number of insults, and further prospective evidence of its efficacy in such disorders is needed.
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Food allergy and asthma are both atopic diseases and therefore frequently co-exist. Food allergy is common in childhood, affecting approximately 8% of infants. The diagnosis is based on a suggestive history supported by skin-prick testing, serum specific IgE or food challenge. ⋯ The mechanism underlying this connection is unclear. The co-existence of food allergy should be considered in any child with asthma. Where food allergy is confirmed, steps should be taken to avoid these foods as this may considerably improve asthma control.
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Extracorporeal life support (ECLS) has become an accepted therapeutic measure in the treatment of infants, children and adults with reversible respiratory or cardiac failure. The principle behind ECLS involves obtaining access to drain blood from the venous circulation into the extracorporeal circuit where it is oxygenated and cleansed of carbon dioxide before being returned to the circulation. The UK Collaborative ECMO Trial showed that an ECLS policy was clinically effective in terms of improved survival without a rise in severe disability at age 1 year. ⋯ The value of ECLS in paediatric and, more recently, adult respiratory failure is becoming clearer. ECLS has a vital role to play in the support of paediatric cardiac surgery programmes. Recent advances include newer oxygenators, greater use of less invasive veno-venous support and the use of ECLS to support novel therapies used to treat severe congenital diaphragmatic hernia.
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Paediatr Respir Rev · Mar 2003
Review Historical ArticleOxygen monitoring in preterm babies: too high, too low?
A small randomised trial in 1952 showed that excess oxygen use might well be causing a major epidemic of retinal blindness in preterm babies. That single study of just 65 babies was enough to throw doubt on a longstanding treatment strategy of oxygen therapy and highlighted just how powerful a tool the randomised controlled trial could be. ⋯ It is now time the same question was asked of babies less than a month old. This is particularly important in babies of less than 28 weeks' gestation, who currently remain at serious risk of chronic lung disease and permanent retinal damage.