There has been substantial growth over the last decade in the number of UK neonatal units that provide some premedication for non-emergent newborn intubation, increasing from 37% in 1998 to 93% in 2007. This includes a concomitant increase in the use of paralytic drugs from 22% to 78%. However, the variety of drugs used merits further research.

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Background: Meta analyses on neonatal mechanical ventilation suggested no difference between conventional and patient triggered ventilation (PTV) in preterm neonates. Newer forms of respiratory support with perceived advantages continue to entice Neonatologists. Objective: To ascertain the current trends in respiratory management of the very preterm infant (< 28 weeks) in level 3 neonatal units. Methods: A structured questionnaire was designed and a senior staff interviewed in all level 3 neonatal units in England telephonically by one interviewer in September 2010. Results: Of the 54 units identified from BAPM database 98% responded. Pressure controlled ventilation was the primary mode of mechanical ventilation in 69.8% units, volume targeted ventilation in 24.5% and HFOV used in 5.7% units. SIMV or SIMV with Pressure Support (PSV) was the most preferred method in 83.1% units for weaning off mechanical ventilation. PSV was used in 50.9% units with 7.5% units using more than 50% PSV. Tidal volume was targeted in 69.8% units with 54.7% aiming a tidal volume of 4-7mls/kg. High flow nasal cannula oxygen was used in 47.2% units along with CPAP or BiPAP. 28.3% units administered Caffeine in the acute phase of RDS; the rest administered it when the infant was ready for extubation. Only 7.6% used an objective criterion to assess readiness for extubation. Conclusions: Contrary to the current evidence, neonatal ventilation practices have evolved using patient triggered modes of ventilation. Further trials are warranted to improve generalisability of evidence into clinical practice.

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Background Chronic cough is one of the most common symptoms in children. Postinfectious etiologies plays an important role in chronic cough in childhood. The pathogenesis of the postinfectious cough may be related persistant inflammation and the epithelial damage in the upper and lower airways, with or without transient airway hyperresponsiveness. We evaluated Mycoplasma pneumoniae and Chlamydia pneumoniae serology and treatment in children referred with chronic cough. Methods This study enrolled 41 children between 6 and 14 years of age having cough which lasted than 4 weeks. They were evaluated according to American College of Chest Physicians guideline. Pulmonary function test and chest x-ray were performed to all patients. M. pneumoniae and C. pneumoniae serologies were analayzed by ELISA. They were reevaluated with 2 to 4 weeks intervals until cough disappeared. Results The study included 41 children, 27 of whom were female (65.9%). The mean age was 8.00±1.96 year. M. pneumoniae IgM positivity was found in 17.07% (7/41) of patients, C. pneumoniae IgM positivity in 2.85% (1/35), M. pneumoniae IgM and/or IgG positivity in 41.46% (17/41), C. pneumoniae IgM and/or IgG positivity in 25.7% (9/35). Symptoms were not improved alone with clarithromycine treatment so inhaled/nasal steroids were added according to diagnosis. Conclusion In children with chronic chough, aged 6 to 14 years old, M. pneumoniae and C. pneumoniae play important roles in the etiology. Clarithromycine alone may not be enough in the treatment of chronic cough due to these agents, so the treatment should be planned according to clinical findings.