BackgroundRemifentanil has been suggested for its short duration of action to replace standard opioids for induction of general anaesthesia in caesarean section. While the stabilizing effect of remifentanil on maternal circulation has been confirmed, its effect on postnatal adaptation remains unclear, as currently published studies are not powered sufficiently to detect any clinical effect of remifentanil on the newborn.MethodsUsing a double-blinded randomized design, a total of 151 parturients undergoing caesarean delivery under general anaesthesia were randomized into two groups – 76 patients received a bolus of remifentanil prior to induction, while 75 patients were assigned to the control group. Remifentanil 1 μg/kg was administered 30 seconds before the standard induction of general anaesthesia. The primary outcome measure was an assessment of neonatal adaptation using the Apgar score, while secondary outcomes included the need for respiratory support after delivery and differences in umbilical blood gas analysis (Astrup).ResultsThe incidence of lower Apgar scores between 0 and 7 was significantly higher in the remifentanil group at one minute (25% vs. 9.3% of newborns, p = 0.017); whilst at five minutes and later no Apgar score differences were observed. There was no difference in the need for moderate (nasal CPAP) or intensive (intubation) respiratory support, but significantly more neonates in the remifentanil group required tactile stimulation for breathing support (21% vs. 7% of newborns, p = 0.017). There was no difference in the parameters from umbilical cord blood gas analysis between the groups.ConclusionAt a dose of 1 μg/kg, remifentanil prior to induction of general anaesthesia increases the risk of neonatal respiratory depression during first minutes after caesarean delivery but duration of clinical symptoms is short.Trial registrationClinicalTrials.gov: NCT01550640.

Background There is no strict correlation between early bronchopulmonary dysplasia and long‐term respiratory disease. Early inhaled corticosteroids seem to reduce the incidence of bronchopulmonary dysplasia, but the long‐term outcome remains unknown. Research Question The aim of this study was to evaluate the effect of early inhaled corticosteroids on chronic respiratory morbidity. Methods Fifty‐nine survivors from the Prague cohort included in Neonatal European Study of Inhaled Steroids underwent further follow‐up comprising of respiratory morbidity monitoring during the first 2 years of life followed by objective lung function testing performed at the age of 5.9 years (range 5‐7 years). Both outcomes were pursued and finalized before the unblinding of budesonide subgroups. Results Fifty randomized (budesonide vs placebo group, 56% vs 44%) survivors were included in the study. Spirometry was successfully performed in 48 children. No statistically significant differences were found in the lung function test (forced expiratory flow [FEF] ‐ FEF75, FEF50, FEF25, and FEF25‐75; FEV1, forced vital capacity [FVC], FEV1/FVC) although mild trend to the improvement of expiratory flow pattern was observed in the budesonide group (median z‐score of FEV1/FVC −0.376 vs −0.983, P = .13; median z‐score of FEF25‐75 −1.004 vs −1.458, P = .13; median z‐score of FEF75 −0.527 vs −0.996, P = .17). Children assigned to budesonide had a significantly lower rate of symptoms of chronic lung disease (34.6% vs 68.2%; P = .04) than children assigned to placebo. Interpretation Our study suggests that early inhaled budesonide was associated with the trend to the improvement of functional lung parameters and with a lower rate of symptoms of chronic lung disease within the first 2 years of life.

Current recommendations for resuscitation may fail to achieve timely lung aeration in infants born at the borderline of viability, leading to higher mortality and morbidity. Sustained inflation and delayed cord clamping may be effective alternatives.