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To analyze the risk of cannula sepsis from indwelling umbilical arterial catheters and the indication for prophylactic antibiotics, 137 catheterized neonates with respiratory distress were prospectively placed into either antibiotic-treated (penicillin 50,000U/kg/day and kanamycin 15 mg./kg./day) or non-treated groups. Although bacteria were frequently isolated from blood and catheter tip cultures obtained upon removal of the catheter, especially among non-antibiotic treated infants, these isolates were predominantly non-pathogens and probably skin flora. Corresponding peripheral blood cultures were usually sterile. No cases of cannula-associated sepsis occurred among treated and non-treated newborns. The risk of bacteriologically proven sepsis resulting from an indwelling umbilical artery catheter appears insufficient to justify prophylactic antibiotics.

Ninety-one infants with respiratory failure secondary to primary pulmonary disease and with a birth weight of 1000 g. or over have been managed in a negative-pressure respirator (Air-Shields) over a three-year period. Of these the failure in 87 was due to respiratory distress syndrome (RDS) and in four it resulted from massive meconium aspiration. Respiratory failure was indicated initially by arterial blood gas tensions (while breathing 100% O(2)) of Po(2) <40 mm. Hg, pH <7.10 and Pco(2) >75 mm. Hg in the initial 47 cases; these levels were subsequently raised to Po(2) < 50 mm. Hg, pH <7.20 and Pco(2) >70 mm. Hg for the remainder. Fifty-four (59.3%) of the infants survived the use of the respirator and 47 of these (51.6%) were subsequently discharged alive and well. Mean time in hours to normalization of blood gas values while on the respirator were as follows: for Po(2), 10.5; for pH, 11.6; and for Pco(2), 22.6. These values indicate that the respirator is more efficient in promoting oxygenation (raising Po(2)) than ventilation (lowering Pco(2)). They also suggest that the observed acidosis is in large part secondary to the hypoxia rather than the result of co(2) retention. For the survivors the average time of total respirator dependency before commencement of weaning was 53.7 hours. All the infants were managed without the use of endotracheal tubes although the use of the respirator and/or administration of 100% oxygen were either continuous or intermittent for periods of up to two weeks. There have been no instances of so-called respirator lung disease in the survivors or in those who died, which suggests that the use of high oxygen concentration by itself is not the major factor in the pathogenesis of this complication.

A case of Reye's syndrome in a newborn infant, believed to be the first recorded in the perinatal period, is reported. The clinical, biochemical and histological findings are those previously recognized in older infants. The intractable acidosis, hypoglycemia and extreme degree of lactic acidosis reflect an advanced degree of hepatic involvement, probably initiated in utero, with resultant impairment of glycogenolysis and intermediary metabolism.