Sildenafil therapy was associated with a significant improvement in the echocardiographic markers of PAH and a reduction in FiO2. The medication was well tolerated.

Congenital chylothorax (CC) is the most common cause of pleural effusion in the perinatal period. The etiology is unknown in the majority of the cases. However, in some cases, it can be associated with various syndromes and genetic conditions. CC is associated with a high mortality rate. Most of the clinical manifestations are secondary to pressure effects (pulmonary hypoplasia) and loss of protein and lymphatic fluid (hydrops, malnutrition). Conservative management in the neonatal period is effective in up to 80% of cases and includes pleural drainage, parenteral nutrition/enteral medium-chain triglyceride-based formulae, and medications such as octreotide. Surgical intervention (pleurodesis, thoracic duct ligation/embolization, pleuroperitoneal shunt) may be required in persistent cases. A universal consensus on management of CC is unavailable, and data on the safety of medication use for CC in neonates are sparse.

Background and ObjectiveOctreotide is a somatostatin analogue and has been used off-label for a variety of conditions. There are no specific guidelines for the use of octreotide in neonates and its safety and efficacy have not been systematically evaluated. The objective of this study is to present our experience of using octreotide therapy in neonates.MethodsThis is a retrospective study of neonates who received octreotide therapy during their hospital stay over a 15 years period (2003–2017) in a tertiary neonatal centre. The demographic details and indications of octreotide therapy including time of initiation, route, dose, duration and adverse effects of therapy were noted. The clinical course following octreotide administration was also analysed.ResultsEleven neonates received octreotide therapy during the study period, of which nine had chylothorax and two had chylous ascites. Resolution of the chylous effusion with octreotide therapy was achieved in 4 out of 11 (36.3%) of the cases. The median duration of octreotide therapy in cases with successful resolution was 17.5 days. With the exception of minor side effects such as hyperglycaemia, none of the patients had any significant side effects that required discontinuation of therapy.ConclusionOctreotide was used safely as an adjunctive therapy for the treatment of chylothorax and chylous ascites in neonates. However, larger prospective controlled trials are required to establish the optimal dose, time of initiation, duration and efficacy of octreotide therapy in neonates.

<b><i>Background:</i></b> Fetal growth restriction (FGR) is associated with neonatal and long-term neuro-morbidity. Preferential redistribution of blood flow to the brain is a common antenatal adaptation in FGR. The impact of this “brain sparing,” which may signify severity of FGR, on the growth of brain structures has not been studied. <b><i>Aim:</i></b> To compare corpus callosum (CC), cerebellar, and ventricular measurements of FGR neonates with evidence of fetal blood flow redistribution with those of gestation-matched appropriately grown (AGA) neonates. <b><i>Methods:</i></b> This was a pilot, prospective observational study conducted at a tertiary level neonatal unit in Melbourne, Australia. Cranial ultrasound was done between days 1 and 3 of life in FGR and AGA neonates. <b><i>Results:</i></b> Cranial ultrasound on 20 FGR, gestation (mean ± SD) 31.4 ± 3.1 weeks, weight 1,205 ± 463 g, and 20 AGA neonates, 31.1 ± 3.0 weeks, 1,668 ± 490 g, was performed. CC length was significantly decreased in FGR neonates as compared to AGA neonates (35.28 ± 3.47 vs. 38.83 ± 4.05 mm, <i>p</i> = 0.0002). CC was significantly thinner at genu (3.36 ± 0.66 vs. 4.04 ± 0.83 mm, <i>p</i> = 0.007), body (1.97 ± 0.36 vs. 2.27 ± 0.39 mm, <i>p</i> = 0.02), and splenium (4.07 ± 0.76 vs. 4.72 ± 0.75 mm, <i>p</i> = 0.003) in FGR vs. AGA neonates. CC-fastigium length was also significantly decreased (39.65 ± 3.87 vs. 41.96 ± 4.50 mm, <i>p</i> = 0.04). Similarly, FGR neonates showed decreased transverse cerebellar diameter (36.15 ± 5.51 vs. 38.81 ± 7.21 mm, <i>p</i> = 0.02), but ventricular measurements were comparable. In multivariate analysis, these differences were evident independent of the birth weight. <b><i>Conclusions:</i></b>CC and cerebellar measurements are significantly smaller in FGR neonates with fetal blood flow redistribution, which warrants further study.

Premature infants have a high incidence of bronchopulmonary dysplasia (BPD). Systemic hypertension, arterial thickness and stiffness, and increased systemic afterload may all contribute to BPD pathophysiology by altering left ventricular (LV) function and increasing pulmonary venous congestion by lowering end‐diastolic compliance. This case series studied the usefulness of angiotensin‐converting enzyme (ACE) inhibition by measuring clinical and echocardiographic improvements in six consecutive infants with “severe” BPD unresponsive to conventional therapy. The range of gestation and birthweight were 23–29 weeks and 505–814 g, respectively. All required mechanical ventilation (including high‐frequency oscillation) and all but one were administered postnatal corticosteroids. Other treatments including sildenafil and diuretics made no clinical improvements. Captopril was started for systemic hypertension after cardiac and vascular ultrasounds which were repeated 5 weeks later. A significant reduction in oxygen (55 ± 25 to 29 ± 3%, two‐tailed P = 0.03) and ventilator requirements, and improved cardiovascular parameters were noted. This included a trend toward reduction in aorta intima media thickness [840 ± 94 to 740 ± 83 μm, P = 0.07] and an increased pulsatile diameter [36 ± 14 to 63 ± 25 μm, P = 0.04]). Improvements were observed for both systolic (increased LV output, 188 ± 13 to 208 ± 13 mL/kg/min, P = 0.046 and mean velocity of circumferential fiber shortening, 1.6 ± 0.2 to 2.5 ± 0.3 [circ/sec], P = 0.0004) and diastolic (decreased isovolumic relaxation time, 69.6 ± 8.2 to 59.4 ± 5 msec, P = 0.044) function which was accompanied by increased pulmonary vein flow. Right ventricular output increased accompanied by a significant lowering of pulmonary vascular resistance. These findings suggest that improving respiratory and cardiac indices (especially diastolic function) warrants further exploration of ACE inhibition in BPD infants unresponsive to conventional therapy.