Clinically significant upper GI bleeds are rare in critically ill children. Prophylaxis to prevent them may be limited to patients who present with at least two risk factors.

rs12252 was not associated with susceptibility to influenza-related critical illness in children or with critical illness severity. Our data also do not support it being a splice site.

Influenza-MRSA coinfection is associated with high fatality in critically ill children. These data support early addition of a second anti-MRSA antibiotic to vancomycin in suspected severe cases.

ABSTRACT.Objective. This randomized, controlled trial was designed to determine the efficacy of inhaled fluticasone propionate on oxygen therapy weaning in a population of preterm infants who were born at <32 weeks of gestation and experienced moderate bronchopulmonary dysplasia (BPD).Methods. Thirty-two infants who were <32 weeks of gestation, had moderate BPD that required supplemental oxygen (fraction of inspired oxygen >0.25), and were aged between 28 and 60 days were randomized. Fluticasone propionate 125 g twice daily for 3 weeks and once daily for a fourth week was delivered to infants who weighed between 500 and 1200 g. The dosage was doubled for infants who weighed >1200 g.Results. Compared with placebo, treatment had no effect on either duration of supplemental O 2 therapy or ventilatory support as assessed by survival analysis. At 28 days, a trend toward a lower cortisol/creatinine ratio in the treatment group was noted compared with placebo (25.1 ؎ 18.9 vs 43 ؎ 14.4). In the fluticasone group at 28 days, the systolic arterial pressure (78 ؎ 3 vs 68 ؎ 3 mm Hg) and diastolic arterial pressure (43 ؎ 3.4 mm Hg vs 38 ؎ 2.0 mm Hg) were higher compared with baseline fluticasone values. The chest radiograph score was lower than baseline (2.8 ؎ 1.4 vs 3.7 ؎ 2.2) in the fluticasone group at 28 days. This study has a statistical power of 1.0 to detect a significant difference in the duration of oxygen supplementation of >21 days between the study groups.Conclusion. We conclude that fluticasone propionate reduces neither supplemental O 2 use nor the need for ventilatory support in this patient population. However, fluticasone does have a positive radiologic effect in lowering chest radiograph scores. In addition, our data point to a possible association among inhaled fluticasone treatment and higher arterial blood pressure. ABBREVIATIONS. BPD, bronchopulmonary dysplasia; Fio 2 , fraction of inspired oxygen. B ronchopulmonary dysplasia (BPD) is an important sequela in the successful treatment of premature infants; BPD can occur without initial respiratory distress syndrome. 1 The development of BPD is strongly associated with respiratory distress syndrome, prematurity, low birth weight, male gender, and the presence of patent ductus arteriosus. 2 The pathophysiology of BPD is multifactorial; therefore, the treatment is multipronged. 3 At least 4 different mechanisms can explain abnormalities found in infants with BPD: (1) pulmonary edema, (2) bronchoconstriction and airway hyperactivity, (3) airway inflammation, and (4) chronic lung injury and repair. Inflammation is thought to be an important factor in the development of BPD. 4 Mechanical ventilation, oxygen use, and infection (either prenatally or postnatally acquired) are associated with an increase in the proinflammatory response of the immature lung. 5 Proinflammatory cytokines are present in the air spaces of ventilated preterm infants and in higher concentration in infants who subsequently develop BPD. 6 This inflammatory response, although possibly benefi...