No abstract

Aim-To compare the eYcacy of hydrocortisone with dopamine for the treatment of hypotensive, very low birthweight (VLBW) infants. Methods-Forty infants were randomly allocated to receive either hydrocortisone (n=21) or dopamine (n=19). Results-All 19 infants randomised to dopamine responded; 17 of 21 (81%) did so in the hydrocortisone group. Three of the four non-responders in the hydrocortisone group had clinically significant left to right ductal shunting. The incidence of bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular haemorrhage, necrotising enterocolitis, symptomatic patent ductus arteriosus, hyperglycaemia, sepsis (bacterial or fungal) or survival did not diVer between groups. The adrenocorticotrophic hormone (ACTH) stimulated plasma cortisol activity, either before or after treatment, did not diVer between the two groups of infants. Although a significant diVerence in eYcacy between dopamine and hydrocortisone was not noted (P = 0.108), there were four treatment failures in the hydrocortisone group, compared with none in the dopamine group. Conclusion-Both hydrocortisone and dopamine are eVective treatments for hypotension in very low birthweight infants. (Arch Dis Child 1997;76:F174-F178)

Plasma aldosterone levels in this extremely premature cohort were significantly greater than those reported in more mature infants. Important determinants were severity of illness and sodium homeostasis.

Sixteen children (mean age 1.9 years)admitted to hospital with viral croup were assigned randomly toeither a high humidity atmosphere or room air. No other treatment was given. During the initial 12 h both groups of patients showed a similar rate of recovery as measured by pulse rate, respiration rate, transcutaneous oxygen (Tc02), transcutaneous carbon dioxide (TcC02) and a clinical rating. No therapeutic benefit was demonstrated from the provision of a high humidity atmosphere. The widespread use of humidification in the management of croup requires reappraisal.

Introduction: Necrotizing enterocolitis (NEC) affects mainly preterm infants, has a multifactorial etiology and is associated with intestinal dysbiosis and disordered immunity. Use of probiotics for prophylaxis is beneficial with studies indicating reduction in NEC ≥ stage 2, late onset sepsis (LOS) and mortality. However, not all studies have shown a reduction, there are questions regarding which probiotic to use, whether infants <1,000 g benefit and the risk of probiotic sepsis. All neonatal intensive care units in New Zealand (NZ) use probiotics and contribute to an international database (Australian and New Zealand Neonatal Network or ANZNN). Objective: To use ANZNN data to investigate the experience of NZ neonatal units with probiotics for NEC prevention in a setting where the baseline incidence of severe NEC was low, to compare results of 2 commonly used probiotic regimes and report on the extremely low birth weight subgroup. Method: Outcomes before (Pre group 2007-2010) and after (Probiotic group 2013-2015) starting routine probiotics for preterm infants <1,500 g or <32 weeks were compared. Clinicians reviewed cases to ensure they met database criteria. Five units used Infloran (Bifidobacterium bifidum and Lactobacillus acidophilus) and 1 unit used Lactobacillus GG (LGG) and bovine lactoferrin (bLF). Results: Four thousand five hundred and twenty nine infants were included and Pre and Probiotic groups were well-balanced with regard to gestation, birth weight and gender. The incidence of NEC in the Probiotic group was 1.6 and 2.7% in the pre group (corrected OR 0.62 CI 0.41-0.94). There was one case of probiotic sepsis. There was no significant difference between the Infloran and LGG/bLF combinations in regard to observed NEC rates. Late onset sepsis rates were significantly lower in the Probiotic group (p < 0.01). Conclusions: Introduction of probiotics for preterm infants in NZ has been associated with significant reductions in NEC and late onset sepsis.