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The article discusses the management of patent ductus arteriosus (PDA) in extreme preterm infants. PDA is a common condition in these infants and its treatment is a subject of debate. The article presents the findings of the Baby-OSCAR trial, which compared early treatment with ibuprofen to placebo. The trial found that early treatment with ibuprofen did not reduce the risk of death or bronchopulmonary dysplasia. The article concludes that there is no evidence to support early treatment with ibuprofen for PDA in extreme preterm infants and that it may be more harmful than the condition itself. [Extracted from the article]

The article discusses a randomized controlled trial that compared the use of higher versus standard nasal continuous positive airway pressure (nCPAP) for extubation of extremely preterm infants. The study found that using a higher nCPAP level of 10cmH2O reduced the rate of extubation failure compared to standard nCPAP. However, there was no significant difference in rates of bronchopulmonary dysplasia (BPD) between the two groups. The authors suggest that further research is needed to evaluate the safety and efficacy of higher post-extubation nCPAP levels on important outcomes for clinicians and families. [Extracted from the article]

Pulmonary Hypoplasia (PH) is a decrease in the size and volume of the lungs due to reduced number of cells, alveoli and airways.1 As amniotic fluid is essential for foetal lung development, mid-trimester anhydramnios/oligohydramnios can contribute to the development of PH. There were no defining criteria for either the PH or PPHN diagnosis, and the presence or absence of these conditions was at the discretion of the treating neonatologist. Among the PH with PPHN and PH without PPHN subgroups, no significant difference in mortality has been found in group exposed to iNO and referent group. [Extracted from the article]

Successful first-attempt intubation, regardless of physiologic instability, was 68.5% vs. 54.3% in the high-flow and standard-care groups, respectively, which are comparable to previous studies.[3] In subgroup analysis, regardless of gestation (<= or 28 weeks) and premedication use status (yes or no), the high-flow group had higher success rates at first intubation than the standard-care group. It lacks long-term outcomes, posing the question of the longer-term benefit of a successful first attempt at intubation without physiological instability. In summary, the study showed that using high-flow during non-emergency neonatal endotracheal intubations increased success at the first attempt but sans physiological instability, with greater benefit seen in inexperienced operators. [Extracted from the article]

Aim: National survey to evaluate the uptake of Less Invasive Surfactant Administration (LISA) in neonatal units across England.Methods: A web-based survey was sent out by email to all 150 neonatal units in England. It consisted of questions regarding indications for LISA, the practicalities of the procedure and reasons for not using this technique.Results: The response rate was 96% (144/150 units). Only 11% of units are using LISA, but majority (78%) would consider implementing LISA on their unit. 56% would also consider LISA on delivery suite. Challenges identified are having a guideline and staff training. 61% of units have set the target population ≥27 weeks. On sub-analysis, for tertiary units, the trend for LISA is ≥26 weeks. The median FiO2 threshold for LISA is 0.3 (IQR 0.3-0.4) in less than 28 weeks gestational age (GA), and 0.4 in higher gestations. The most common suggestion for premedication is fentanyl (32%).Conclusion: The uptake of LISA in England is low comparing to the rest of Europe. Even though many units are considering implementing LISA, there is lack of training and national guidelines. There is urgent need for standardisation of practice and clear indications for LISA. [ABSTRACT FROM AUTHOR]