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OBJECTIVE: To determine patterns of respiratory medications used in neonatal intensive care unit (NICU) graduates. STUDY DESIGN: The Prematurity Respiratory Outcomes Program enrolled 835 babies

To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs).We enrolled ELGANs (29 weeks' gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks' postmenstrual age. We surveyed caregivers at 3, 6, 9, and 12 months' corrected age to identify postdischarge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheostomy, ventilation), medications, or symptoms (cough/wheeze). Infants were classified as having postprematurity respiratory disease (PRD, the primary study outcome) if respiratory morbidity persisted over ≥2 questionnaires. Infants were classified with severe respiratory morbidity if there were multiple hospitalizations, exposure to systemic steroids or pulmonary vasodilators, home oxygen after 3 months or mechanical ventilation, or symptoms despite inhaled corticosteroids. Mixed-effects models generated with data available at 1 day (perinatal) and 36 weeks' postmenstrual age were assessed for predictive accuracy.Of 724 infants (918 ± 234 g, 26.7 ± 1.4 weeks' gestational age) classified for the primary outcome, 68.6% had PRD; 245 of 704 (34.8%) were classified as severe. Male sex, intrauterine growth restriction, maternal smoking, race/ethnicity, intubation at birth, and public insurance were retained in perinatal and 36-week models for both PRD and respiratory morbidity severity. The perinatal model accurately predicted PRD (c-statistic 0.858). Neither the 36-week model nor the addition of bronchopulmonary dysplasia to the perinatal model improved accuracy (0.856, 0.860); c-statistic for BPD alone was 0.907.Both bronchopulmonary dysplasia and perinatal clinical data accurately identify ELGANs at risk for persistent and severe respiratory morbidity at 1 year.ClinicalTrials.gov: NCT01435187.

The issues explored in this article are the role of exproprioceptive input and the nature of exteroceptive input provided by the visual system in the control of limb elevation as obstacles are stepped over during locomotion. In the first experiment, the differences in limb trajectory of movements over solid and fragile obstacles of similar dimensions were examined. Subjects increased their toe clearance, vertical position of the hip, and the hip vertical velocity when going over a fragile obstacle with the leading limb. This suggests that in addition to visually observable properties of obstacles such as height or width, other properties, such as rigidity or fragility, which may be classified as visually inferred, also influence the limb trajectory. Part of the first and the second experiment was focused on understanding differences in leading limb and trailing limb trajectory over obstacles. The toe clearance of the trailing limb was lower for smaller obstacles. There was no consistent correlation between the toe clearance values of the leading and trailing limbs. The variability in toe clearance was higher for the trailing limb, which is attributable to lack of visual exproprioceptive input about trailing limb movements and to the shorter time available following toe-off to fine-tune the trailing limb trajectory. Because the body center of mass is moving toward the supporting foot when the trailing limb goes over obstacles and the trailing limb foot is moving up, the chances of a trip are minimized and recovery from an unexpected trip are more likely. These results highlight the role of exproprioceptive input provided by the visual system and possible cognitive influences on the limb trajectory as one travels over uneven terrains.

The characteristics of visual sampling required for successful locomotion over various terrains is the focus of this work. In the first experiment we directly address the role of continuous visual monitoring of the environment in guiding locomotion by allowing the subjects to choose when and where to take a visual sample of the terrain and examine the effects of different terrains on characteristics of visual sampling. Young subjects walked over travel paths of varying difficulties while wearing opaque liquid crystal eyeglasses and pressed a hand-held switch to make the glasses transparent when they needed to sample the environment. Travel time and visual sampling characteristics were recorded. Results show that intermittent sampling (less than 50%) of the environment is adequate for safe locomotion, even over a novel travel path. The frequency, duration and timing of visual samples are dependent on terrain characteristics. Visual sampling of the environment is unaffected by preview restriction of the travel path and is increased when specific foot placement is required and there is a potential hazard in the travel path. In the second experiment we dissociated steering control and obstacle avoidance from specific foot placement and examined visual sampling demands prior to the initiation of the swing phase and during the swing phase. The results show that steering control and obstacle avoidance do influence the visual sampling time, which is scaled to the magnitude of change. Vision was used in a feedforward control mode to plan for and initiate appropriate changes in the swing limb trajectory: its use during the swing phase to provide on-line control was minimal.