Surfactant delivery via a narrow-bore tracheal catheter is feasible and potentially effective, and deserves further investigation in clinical trials.

Background: Preterm infants ≤32 weeks' gestation are increasingly being managed on continuous positive airway pressure (CPAP), without prior intubation and surfactant therapy. Some infants treated in this way ultimately fail on CPAP and require intubation and ventilation. Objectives: To define the incidence, predictors and consequences of CPAP failure in preterm infants managed with CPAP from the outset. Methods: Preterm infants 25-32 weeks' gestation were included in the study if inborn and managed with CPAP as the initial respiratory support, with division into two gestation ranges and grouping according to whether they were successfully managed on CPAP (CPAP-S) or failed on CPAP and required intubation <72 h (CPAP-F). Predictors of CPAP failure were sought, and outcomes compared between the groups. Results: 297 infants received CPAP, of which 65 (22%) failed, with CPAP failure being more likely at lower gestational age. Most infants failing CPAP had moderate or severe respiratory distress syndrome radiologically. In multivariate analysis, CPAP failure was found to be predicted by the highest FiO₂ in the first hours of life. CPAP-F infants had a prolonged need for respiratory support and oxygen therapy, and a higher risk of death or bronchopulmonary dysplasia at 25-28 weeks' gestation (CPAP-F 53% vs. CPAP-S 14%, relative risk 3.8, 95% CI 1.6, 9.3) and a substantially higher risk of pneumothorax at 29-32 weeks. Conclusion: CPAP failure in preterm infants usually occurs because of unremitting respiratory distress syndrome, is predicted by an FiO₂ ≥0.3 in the first hours of life, and is associated with adverse outcomes.

Objectives : To compare the effects of different feeding formulas in very low birth weight neonates. Study Design: Prospective Cohort Study Study Population: Neonatal Intensive care Unit and Post natal ward of Dhiraj Hospital Piperia Methodology: 51 VLBW babies were divided into three groups by randomization; one group was offered EBM alone, second group was offered EBM with HMF and the third group was offered EBM with Preterm formula milk powder. Out of the total 51 number of Babies between weight 1000 to 1500 gms, 10 babies were offered EBM only and fortification was done in rest 41 number of babies. HMF was used for fortification in 20 babies and preterm formula was used in 21 babies. HMF and preterm formula was used for fortification in VLBW babies once they have reached to 100ml/kg/day of enteral feeds in a concentration of 0.2gram/2.5 ml. The growth pattern was studied till the duration of their hospital stay. Results: There was no feed intolerance found in unfortified group on EBM. Amongst the fortified group feed intolerance was found in 3(14.28%) babies with HMF and among 7(33.33%) babies with preterm formula milk powder. The weight gain was better amongst the fortified group with 18.4±1.9 grams/day with HMF and 19±1.17 with preterm formula as compared to the unfortified group 14.6±1.5. Thus the weight gain among the fortified group was highly significant with the p value being 0.0001.The increase in the head circumference/week was same in all the three groups and no significant difference was found The increase in the length/week was same in all the three groups and there was no significant difference found in all the three groups. Conclusions: Weight gain was better amongst those where EBM was fortified with HMF and preterm formula.