Our results show no statistically significant difference in the combined outcome of mortality or BPD between the 2 ventilation groups in prenatally diagnosed congenital diaphragmatic hernia infants. Other outcomes, including shorter ventilation time and lesser need of extracorporeal membrane oxygenation, favored conventional ventilation.

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Day care centers (DCCs) are unique settings where young children are at increased risk for colonization by pneumococci and Haemophilus influenzae. Although point prevalence studies in DCCs are frequent, only a few longitudinal studies on the dynamics of colonization have been published. We conducted a 1-year longitudinal study with 11 sampling periods on nasopharyngeal carriage of pneumococci and H. influenzae among 47 children who attended a single DCC. All isolates were antibiotyped and genotyped by pulsed-field gel electrophoresis. Pneumococci were also serotyped. Of the 414 samples obtained, 61.4% contained pneumococci, and 87% contained H. influenzae. Only 8.3% of the samples were negative for both species. Twenty-one pneumococcal clones and 47 H. influenzae clones were identified. Introduction of clones occurred during all year. Ninety-eight percent and 96% of all pneumococcal and H. influenzae isolates, respectively, belonged to clones shared by more than one child. Children were sequentially colonized with up to six pneumococcal clones (mean, 3.6) and five serotypes and nine H. influenzae clones (mean, 7.1). Clones with increased capacity for transmission and/or prolonged colonization were identified in both species. These two fitness properties appeared to be independent. In conclusion, among DCC attendees, a high rate of acquisition and turnover of strains was observed, and all children were overwhelmingly colonized by clones shared with others. DCCs are units where permanent introduction of new clones occurs, and attendees, as a whole, provide a pool of hosts where the fittest clones find privileged opportunities to persist and expand.Studies conducted during the last decade have highlighted the important role of day care centers (DCCs) as unique places where young children with immature immune systems and poor hygienic behavior are crowded together, resulting in an increased risk for colonization and transmission of upper respiratory tract pathogens such as Streptococcus pneumoniae and Haemophilus influenzae (1,4,5,10,23,30).While point prevalence studies in DCCs to study colonization by these bacteria have been conducted in several countries (reviewed in reference 7), longitudinal studies are less frequent and have often focused on the individual host and not on a particular epidemiological setting (9,14,16). By looking at the DCC as a unit, one would expect to obtain additional information on the fitness capacities (for transmission and persistence) of individual clones, as they would be exposed to the same pool of hosts (the attendees). To our best knowledge, extended longitudinal studies that have systematically applied genotyping techniques to study pneumococci and H. influenzae in DCCs with such objectives in mind are very scarce. Trottier et al. studied H. influenzae colonization among 38 DCC attendees for 4 months (29), and Yagupsy et al. conducted a 7-month study focusing on the transmission of drug-resistant pneumococci among 48 children from two DCCs (30). A third study by Raymond et al. f...

Pneumococcal vaccination did not change the frequency of carriage of drug-resistant strains being the initially dominant vaccine serotypes replaced by others expressing nonvaccine serotypes. Reduction in the carriage of DRPn may require a combination of the conjugate vaccine and a decrease in antibiotic pressure.