ABSTRACT. Objective. To determine whether early versus late treatment with porcine surfactant (Curosurf) reduces the requirement of mechanical ventilation in very preterm infants primarily supported by nasal continuous positive airway pressure (nasal CPAP).Design. Multicenter randomized, controlled trial.Patients. The study population comprised 60 infants <30 weeks' gestation with respiratory distress syndrome (RDS) who had an arterial to alveolar oxygen tension ratio (a/APO 2 ) of 0.35 to 0.22.The cohort from which the study population was generated comprised 397 infants.Results. The need for mechanical ventilation or death within 7 days of age was reduced from 63% in the latetreated infants to 21% in early-treated infants. Increasing numbers of antenatal steroid doses also improved the outcome, especially in the early-treated infants. Six hours after randomization mean a/APO 2 rose to 0.48 in the earlytreated infants compared with 0.36 in the late-treated. The need of mechanical ventilation before discharge was reduced from 68% in the late-treated to 25% in the earlytreated infants.Conclusions. Nasal CPAP in combination with early treatment with Curosurf significantly improves oxygenation and reduces the subsequent need for mechanical ventilation in infants <30 weeks' gestational age with RDS. Pediatrics 1999;103(2). URL: http://www.pediatrics. org/cgi/content/full/103/2/e24; respiratory distress syndrome, pulmonary surfactant, Curosurf, nasal continuous positive airway pressure.ABBREVIATIONS. RDS, respiratory distress syndrome; nasal CPAP, nasal continuous positive airway pressure; a/APo 2 , arterial to alveolar oxygen tension ratio; Fio 2 , fraction of inspired oxygen; TcPo 2 , transcutaneous partial pressure of oxygen; TcPco 2 , transcutaneous partial pressure of carbon dioxide; PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; PVL, periventricular leucomalacia; ROP, retinopathy of prematurity. I n a randomized, controlled study we have shown that a single dose of surfactant (Curosurf, Chiesi Farmateutici, Parma, Italy) given by short-lasting intubation reduces the need for mechanical ventilation and improves oxygenation in infants with moderate to severe respiratory distress syndrome (RDS) treated with early nasal continuous positive airway pressure (nasal CPAP).1 Very few pulmonary and extrapulmonary complications were observed in these infants. However, some of the surfactanttreated infants supported by nasal CPAP developed apnea despite good oxygenation and needed mechanical ventilation for that reason. In the same trial, there seemed to be a higher need for ventilation among infants randomized relatively late after birth and in infants with relatively low birth weight. From the literature we know that surfactant given prophylactically, 2-4 or as early treatment to infants requiring mechanical ventilation, 5 is more effective than late rescue treatment.The present study was designed to test the hypothesis that infants Ͻ30 we...

Brain aluminium concentration has been found significantly higher in patients dying with dialysis encephalopathy than in uraemic patients without this syndrome, and it has previously been reported only in haemodialysed patients. We report a case of high brain aluminium concentration in a uraemic boy showing symptoms of severe encephalopathy. He was never dialysed but only treated with aluminium hydroxide orally. Baluarte reported corresponding symptoms in nondialysed uraemic children, but brain aluminium concentrations were not reported. His patients as well as our had very high levels of parathormone which may play a role in the resorption and distribution of aluminium. Aluminium preparations should be avoided in children with renal failure.

To evaluate a possible relationship between urinary tract infections (UTI) and diurnal incontinence (DIC), we studied 251 girls aged 4 years or more who were referred with a history of recurrent UTI and/or DIC. During follow up (mean 35 months), 110 girls (44%) had both UTI and DIC, 50 (20%) only infections, and 41 (16%) only DIC whereas 50 (20%) had neither infection nor DIC. In 110 girls with infections occurring with intervals of at least 6 and 12 months, DIC was definitively initiated by infection on 32 (19%) occasions. Most girls were continent before the infection occurred. When the girls remained free of infection for 6 or 12 months respectively, the frequency of DIC remained unchanged. In conclusion, no support for the concept of DIC leading to UTI was obtained, whereas the reverse was found in some cases and suggested in others.

Despite no signs of rickets, a high incidence of subclinical vitamin D deficiency (46% in the age-group 0-8 years and 81% in the age-group 9-16 years) is found in immigrant children in Denmark.In a recent retrospective study [3] from Copenhagen covering a population area of 1.2 million people, fewer than five cases of rickets per year were reported among immigrant children during a 10-year period. Previously, however, we have reported severe vitamin D deficiency (25-hydroxyvitamin D 2+3(ergoÀ+cholecalciferol) ; 7.1±1.

Striking transient increases in serum alkaline phosphatase in 6 infants are reported. Isoenzymes were studied in 3 infants and increased activity was found in bone as well as in liver fractions. Repeated serum determinations demonstrated a duration of about 11 weeks with a peak serum value in the 6th week. The etiology is unknown but an infectious cause is discussed. The condition may be rather frequent but gives no obvious symptoms. It is important to know this condition to avoid unnecessary diagnostic procedures.