Male sex, volatile anaesthetics and ETT were factors significantly related to ED. Whether gender, choice of respiratory devices and anaesthetics are true predictors or derived factors of surgery procedures, duration of surgery and the patients' physical condition need further investigation. The most notable clinical consequence of ED was the need of additional staff in order to restrain the agitated patient.

In a cohort study with historical controls of non-asphyxiated very low-birth-weight infants (birth weight < or = 1500 g and gestational age < 33 completed weeks), we evaluated the use of a "minitouch" regime for stabilization after birth and treatment of respiratory distress. This combination of early (prophylactic) treatment with nasal continuous positive airway pressure and minimal handling was introduced as a routine in our Department in 1986. We compared infants born in 1987 and in 1985, when ventilator treatment was used initially in all infants with progressing respiratory distress. The frequency of mechanical ventilation was reduced significantly from 76% in 1985 to 35% in 1987 (p = 0.00001). This reduction reflected the smaller number of infants who received ventilator treatment for less than one week, whereas the frequency of long-term ventilator treatment remained unchanged. Intracranial haemorrhage grade II-IV was reduced from 49% in 1985 to 25% in 1987 (p = 0.01). Mortality rate, average duration of hospitalization, number of infants with pneumothorax, patent ductus arteriosus, need for oxygen at 28 days and number of surviving infants with handicap did not differ significantly between the two study periods. Septicaemia was diagnosed in 16% of the infants in 1987 versus 7% in 1985 (p = 0.045). This difference coincided with an increased use of total parenteral nutrition (18% in 1987 versus 3% in 1985, p = 0.007). We conclude that the minitouch regime prevents progression of respiratory distress, reduces the need for ventilator treatment and is a safe and convenient alternative to mechanical ventilation in preterm infants with mild respiratory problems.(ABSTRACT TRUNCATED AT 250 WORDS)

In 18 spontaneously breathing, preterm infants (mean gestational age 30.3 weeks) cerebral blood flow (CBF) was investigated twice, 2 and 3 hours after birth when spontaneous changes in arterial carbon dioxide tension (PaCO2) and mean arterial blood pressure (MABP) were expected. Transcutaneous oxygen tension (TcO2) was kept normal by adjusting the inspiratory oxygen fraction. In 12 infants, plasma adrenaline and noradrenaline were constant throughout the study. Changes in CBF infinity (CBF infinity) were significantly related to changes in PaCO2 (p = 0.0001) whereas neither changes in MABP nor TcO2 reached a significant association to changes in CBF infinity (p = 0.67 and p = 1.0, respectively). The calculated CBF infinity -CO2 reactivity of 28.9% per kPa PaCO2 (95% confidence interval 16.1-43.0) is comparable to findings in older newborns and healthy adults. Only one of 18 infants developed germinal layer haemorrhage (grade I) in spite of the hypercapnic state which was observed during the first hours of life. Periventricular leucomalacia was not detected. It is suggested that the cerebral blood flow is well regulated within physiological variations of PaCO2 and MABP in the healthy, preterm newborn even shortly after birth.

An outbreak of infections due to Flavobacterium meningosepticum type C in a neonatal intensive care unit is described. During a period of two weeks, two infants developed meningitis and a third was colonized in the respiratory tract and had transient bacteremia. The two meningitis patients were treated with clindamycin, rifampicin and cefotaxime systemically, plus rifampicin intraventricularly. Bacteriological eradication was achieved within 48 h, and both infants recovered from the meningitis without apparent neurological sequelae; however, one infant died two months later of unrelated causes. Environmental surveillance cultures failed to demonstrate a reservoir for the epidemic strain, but other Flavobacterium strains were recovered. Two clinically healthy infants were found to be colonized in the nasopharynx with strains that were extremely difficult to differentiate phenotypically from the epidemic strain. Extensive characterization of strains is necessary in order to differentiate between strains and subsequently to determine a certain source of infection.