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Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the recommendations of a European panel of expert neonatologists who developed consensus guidelines after critical examination of the most up-to-date evidence in 2007. Strong evidence exists for the role of antenatal steroids in RDS prevention, but it is not clear if repeated courses are safe. Many practices involved in preterm neonatal stabilization at birth are not evidence based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in management of RDS but the best preparation, optimal dose and timing of administration at different gestations is not always clear. Respiratory support in the form of mechanical ventilation may also be life saving but can cause lung injury, and protocols should be directed to avoiding mechanical ventilation where possible by using nasal continuous positive airways pressure. For babies with RDS to have the best outcome, it is essential that they have optimal supportive care, including maintenance of a normal body temperature, proper fluid management, good nutritional support, management of the ductus arteriosus and support of the circulation to maintain adequate blood pressure. [ABSTRACT FROM AUTHOR]

The objectives of this study were to analyze the influence of maternal, perinatal and neonatal factors on the neurological sequelae occurring in asphyxiated infants. The clinical records of 79 infants, 35 weeks of gestation or more, treated in the neonatal intensive care unit in whom the principal diagnosis was asphyxia, and who had no major malformation and who survived for more than 24 hours, were analyzed. Analysis of variance was used to compare neurological outcome classified as 1) normal development or mild neurological sequelae, 2) moderate to severe neurological sequelae, and 3) withdrawal of treatment because of signs and symptoms of severe brain damage. The group in whom treatment was withdrawn had lower mean arterial blood pressure on admission, blood glucose and plasma sodium levels than those in the moderate to severe handicap group. The combined group of brain damaged infants, (2 + 3), had lower Apgar scores at five minutes, umbilical cord arterial blood Standardized Base Excess (SBE), lower urinary output, and higher incidence of seizures and higher plasma potassium level than the group with normal development or those with mild handicap. Stepwise multiple logistic regression confirmed these.

Monitoring of spontaneous brain electrical activity (EEG) has three purposes: Detecting sudden loss of background activity as an early sign of brain hypoxia/ischaemia, detection of silent seizures, and helping to diagnose brain damage. Tape-recording allows storage of upto 8 channels of standard EEG for prolonged periods, but some direct readout is necessary for monitoring purposes and review is time consuming. The Cerebral Function Monitoring technique (CFM) provides a 1/500 time-compressed recording of EEG amplitude overall EEG background activity as well as seizures. Lack of knowledge of when and how to intervene, rather than technical problems, puts a limit to the usefulness.

The aim of this study was to compare the ability of abdominal circumference (AC) and fetal femur length/abdominal circumference ratio (FFL/AC) measured by ultrasound within a period of 2 weeks before birth to predict low birth weight percentile and neonatal signs related to fetal malnutrition. From longitudinal ultrasound measurements in 35 normal pregnancies reference data of AC and FFL was obtained. FFL/AC ratio was constant from 21 weeks until term (mean 20.9, SD 1.2) (figure 1). In 350 risk pregnancies AC standard deviation score (AC-SDS) correlated far better than FFL/AC ratio with the deviation of birth weight from normal (figure 3). Furthermore AC-SDS correlated better with ponderal index (PI) and skinfold thickness (ST) than did FFL/AC ratio. Using cut-off levels on AC-SDS and FFL/AC ratio, which selected about 30% of the population, the sensitivity of AC-SDS in predicting the infant being LGA was 81.8% versus 42.9% using FFL/AC ratio (table II). The prediction of the infant being SGA was not improved when the change in AC-SDS or FFL/AC over the last 6-8 weeks of pregnancy was considered. We conclude that AC-SDS correlates well with birth weight deviation and predicts the infant being SGA with a precision equal to the best results reported in the literature, and that FFL/AC ratio is unreliable even when GA is not known because of a high false positive rate.

Doppler ultrasound has been used extensively to study cerebral hemodynamics in the human newborn. This report presents a continuous recording in an infant with epileptic seizures. Heart rate, mean aortic blood pressure and mean flow velocity, obtained from the anterior cerebral artery by Doppler ultrasound, all increased markedly during the seizures. The Poucelot index was calculated from the cerebral blood flow velocity waveform and is supposed to reflect cerebrovascular resistance. This index decreased. Three mutually contradictive interpretations were possible in terms of cerebral metabolic rate, cerebral blood flow, metabolism-flow coupling and pressure-flow autoregulation. Sympathetic activation and its effects on cerebral hemodynamics is discussed. It is pointed out that the competence of the pressure-flow autoregulation may not be studied reliably during changes in blood pressure associated with altered sympathetic activity. An electrical model of the systemic arterial system is presented and used to demonstrate that the resistance index is likely to be severely affected by changes in cerebroarterial compliance, peripheral resistance, duration of systole as a fraction of heart cycle and patency of the arterial ductus. A pulsatility index ratio, which is corrected for arterial pulse pressure, is suggested to avoid some of these errors.