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Objective  The aim of the study is to assess the correlation between maternal methadone dose and severity of neonatal abstinence syndrome (NAS) in infants that required pharmacological treatment for NAS. Study Design  This is a retrospective analysis of 574 infants ≥35 weeks' gestation exposed to methadone in utero, born between August 2006 and May 2018, and who required pharmacological therapy for NAS. Indicators of NAS severity (duration of morphine treatment, maximum morphine dose, use of phenobarbital, and length of hospitalization) were compared between infants exposed to high (≥200 mg), intermediate (100–199 mg), and low doses (<100 mg) of methadone. Logistic and linear regression models were used to adjust for the covariates. Results  Median (interquartile range) duration of medical treatment with morphine was higher in infants exposed to higher doses of methadone (low dose 23 [14–37] days, intermediate dose 31 [18–45] days, and high dose 35 [20–48] days, p  < 0.001). Higher methadone doses were also predictive of longer duration of hospitalization, higher maximum morphine dose, and increased likelihood of treatment with phenobarbital. The association between maternal methadone dose and the severity of NAS persisted in multivariable regression models. Conclusion  Infants exposed to higher methadone doses displayed more severe NAS, as indicated by longer durations of treatment, higher maximum morphine dose, longer duration of hospitalization, and increased likelihood of phenobarbital use. Key Points Methadone maintenance therapy is used during pregnancy to control maternal withdrawal symptoms. Relationship between maternal methadone dose and severity of NAS is not adequately investigated. Increased doses of methadone during pregnancy correlate with increased severity of NAS. [ABSTRACT FROM AUTHOR]

The Baby Friendly Hospital initiative (BFHI) is a global initiative of the World Health Organization developed in 1991 to promote and support successful breastfeeding. It has led to increased rates of exclusive breastfeeding. Exclusive breastfeeding may increase risk for hypoglycemia, hyperbilirubinemia, and dehydration requiring higher level of neonatal care. To determine if there was a change in admissions to the Neonatal Intensive Care Unit (NICU) from the newborn nursery after the adoption of BFHI in a large urban hospital. This is a retrospective analysis of all neonates admitted to the NICU from the newborn nursery between January 2007 and December 2016 at Thomas Jefferson University Hospital, in Philadelphia, PA, USA. Demographics, clinical characteristics and primary diagnosis for admission were compared between those admitted before (January 2007 to December 2011) and after (January 2012 to December 2016) the initiation of BFHI. A total of 20,124 infants were born and 3,684 infants (18.3%) were admitted to NICU. 570 infants (2.8% of live birth) were admitted to the NICU from the newborn nursery, 282 (49.5%) were born before and 288 (50.5%) born after BFHI. There was no significant difference in the number of infants admitted from the newborn nursery either as a percentage of total deliveries (2.8 versus 2.9%, p =.6) or percentage of total NICU admissions (15.5 versus 15.5%, p = 1.0) before and after the BFHI. Additionally, there was no difference in number of infants admitted with a diagnosis of possible sepsis, hypoglycemia, neonatal abstinence syndrome (NAS) and hyperbilirubinemia between the two groups. However, significantly more infants admitted with hypoglycemia required IV fluids for hypoglycemia after the initiation of BFHI (8 out of 27 versus 21 out of 28, p.001). The age of admission was higher and the duration of NICU stay was shorter in infants admitted after the initiation of the BFHI. The BFHI has not led to a significant change in the number of infants admitted to NICU from the newborn nursery or reasons for their admissions. However, since its adoption, there has been an increase in the use of IV fluids for treatment of hypoglycemia. These findings suggest a role for additional treatments other than formula to prevent IV fluid use, such as glucose gel. Change in NICU guidelines for the management of possible sepsis and NAS may have impacted the duration of hospitalization in infants born after BFHI. [ABSTRACT FROM AUTHOR]

The administration of perflubron during artificial ventilation may be effective in the treatment of premature infants with respiratory distress syndrome. Perflubron is liquid perfluorocarbon that is chemically inert and can carry oxygen and carbon dioxide. It was given to 10 premature infants in severe respiratory distress in combination with artificial ventilation. It improved the function of their lungs and increased their blood levels of oxygen. Seven infants were eventually weaned off the ventilator and at the age of 4 months, six had developed normally with no sign of cerebral palsy.

Administration of drugs to the lungs of newborns using liquid ventilation of the lungs may be more effective than intravenous administration. Researchers compared the effects of drugs administered intravenously or by perfluorochemical (PFC) liquid ventilation in 16 premature and newborn lambs undergoing liquid ventilation. Three drugs known to affect blood pressure produced their expected overall effects by both administration methods. One drug, priscoline, produced a greater pulmonary response when administered by liquid ventilation, which may help minimize the effects of this drug on the rest of the body. Another substance was shown to be well distributed in the lung after administration by liquid ventilation. Filling the lung with PFC liquids improves the stability, blood flow and gas exchange properties of the lung, which may become compromised as a result of pulmonary illness. In addition, the inertness and high gas solubility of PFC liquids makes them good vehicles for drugs, while the exchange properties of the lung make it a good recipient for drugs., ABSTRACT. Objectives. Therapeutic management of respiratory distress syndrome, pneumonia, and pulmonary hypertension includes delivery of biologically active agents to the neonatal lung. However, mechanical abnormalities of the lung, intrapulmonary shunting, [...]

Functional residual capacity (FRC) of the lungs may predict survivors of congenital diaphragmatic hernia (CDH). With CDH, a flaw in the development of the diaphragm allows the viscera to enter the chest cavity, compressing the lungs. Symptoms range from mild pulmonary insufficiency to severe respiratory failure. CDH can cause underdevelopment of the lungs. It would be helpful to determine the prognosis of infants before undertaking expensive and potentially futile therapies. Researchers measured FRC and airflow in 25 infants born at full term with CDH. Overall, 60% survived, including all seven infants requiring only mechanical ventilation. The remaining 18 infants required extracorporeal membrane oxygenation for severe respiratory failure. Fifteen of these infants required patches of synthetic material to repair the hernia, only two of whom survived. All infants who died had FRC measurements below 9 milliliters per kilogram. Only two survivors had FRC measurements this low., Objectives. To determine whether fatal pulmonary hypoplasia, as assessed by functional residual capacity (FRC), can be distinguished from other reversible causes of respiratory failure in infants with congenital diaphragmatic hernia (CDH). Methods. In the present study, 25 term neonates having CDH without other anomalies (mean birth weight [+ or -] SD, 3.25 [+ or -] 0.50 kg) were enrolled prospectively into a protocol evaluating pulmonary function. Lung compliance ([C.sub.L]) and FRC were measured before diaphragmatic repair and compared with the highest oxygenation index (01) and lowest [Paco.sub.], also obtained preoperatively. Pulmonary function assessment was repeated after diaphragm repair on postoperative days 3 and 7. [C.sub.L] was determined by esophageal manometry and pneumotachography, and FRC was determined by helium diluticln. Results. Fifteen infants (60%) survived to hospital discharge. Eighteen (72%) required extracorporeal membrane oxygenation (ECMO) for support, and of these, 8 (44%) survived. [Paco.sub.2] was similar preoperatively in infants grouped as survivors without ECMO, survivors with ECMO, and nonsurvivors. In nonsurvivors (all of whom received ECMO), the preoperative OI was significantly higher (51 [+ or -] 21), [C.sub.L] was less (0.11 [+ or -] 0.04 mL/cm of water per kg), and FRC was smaller (4.5 [+ or -] 1.0 mL/kg) than in the survivors who required ECMO (26 [+ or -] 18, 0.18 [+ or -] 0.08 mL/cm of water per kg, and 12 :t 5 ml/kg, respectively), as well as in the survivors without ECMO, (6 [+ or -] 2, 0.32 [+ or -] 0.16 mL/cm of water per kg, and 15.8 [+ or -] 4 mL/kg, respectively). The group surviving with ECMO had a higher OI than the infants surviving without ECMO. All nonsurviving infants had FRCs of less than 9.0 mL/kg preoperatively. In contrast, only 2 of the 15 survivors had preoperative FRCS less than 9 mL/kg. Conclusions. The results of this study suggest that preoperative assessment of FRC may predict fatal pulmonary hypoplasia in most infants with CDH. Pediatrics 1995;96:1117-1122; congenital diaphragmatic hernia, pulmonary function, lung volume., ABBREVIATIONS. CDH, congenital diaphragmatic hernia; [C.sub.L], pulmonary compliance; ECMO, extracorporeal membrane oxygenation; FRC, functional residual capacity; OI, oxygenation index; MAP, mean airway pressure; ANOVA, analysis of variance. Recent advances in [...]

The administration of oxygen through a nasal cannula - a tube inserted into the nasal cavity - may change the breathing pattern of premature infants suffering from respiratory insufficiency. The change in breathing pattern is caused by the delivery of positive end-distending pressure through the nasal cannula. A study examined the use of a nasal cannula to administer different concentrations of supplemental oxygen to premature infants. Administration of oxygen through a nasal cannula with a diameter of 0.2 centimeters (cm) did not generate positive end-distending pressure or change the breathing pattern of infants. Administration of oxygen through a nasal cannula with a diameter of 0.3 cm generated positive end-distending pressure and changed the breathing pattern of the infants. The amount of pressure generated increased as the concentration of oxygen increased., In the clinical setting, nasal cannulas are frequently used to deliver supplemental oxygen to neonates and are not believed to affect the general respiratory status. In contrast, it was hypothesized that clinical changes associated with nasal cannula gas flow may be related in part to the generation of positive end-distending pressure. To test this hypothesis, alterations in esophageal pressure were quantified as an indication of end-distending pressure and thoracoabdominal motion was quantified as an indication of breathing patterns in 13 preterm infants at gas flow levels of 0.5, 1, and 2 L/min delivered by nasal cannula with an outer diameter of either 0.2 or 0.3 cm. Changes in esophageal pressure were assessed by esophageal balloon manometry. Ventilatory patterns were assessed from thoracoabdominal motion by using respiratory inductive plethysmography. Thoracoabdominal motion was quantitated as a phase angle ([theta]); larger values represent greater asynchrony. The 0.2-cm nasal cannula did not deliver pressure or alter thoracoabdominal motion at any flow. In contrast, the 0.3-cm nasal cannula delivered positive end-distending pressure as a function of increasing levels of gas flow (r = .92) and reduced thoracoabdominal motion asynchrony. The mean pressure generated at 2 L/min was 9.8 cm [H.sub.2]O. These data demonstrate that nasal cannula gas flow can deliver positive end-distending pressure to infants and significantly alter their breathing strategy. This finding raises important concerns about the indiscriminate therapeutic use, size selection, and safety of nasal cannulas for the routine delivery of oxygen in preterm infants. Pediatrics 1993; 91:135-138; End-distending pressure, nasal cannula, thoracoabdominal motion, oxygen delivery.