A low lung volume performed best in predicting extubation failure when compared to the results of other lung function measurements and commonly used 'clinical' indices, i.e. ventilator settings. A low gestational age, however, was a better predictor of extubation failure than a low lung volume.

This study suggests that one in six women in South London are using drugs in early pregnancy and that cannabinoid use is associated with a poorer pregnancy outcome.

Background-Fluid restriction has been reported to improve survival of infants without chronic lung disease (CLD), but it remains unknown whether it reduces CLD in a population at high risk of CLD routinely exposed to antenatal steroids and postnatal surfactant without increasing other adverse outcomes. Aim-To investigate the impact of fluid restriction on the outcome of ventilated, very low birthweight infants. Study design-A randomised trial of two fluid input levels in the perinatal period was performed. A total of 168 ventilated infants (median gestational age 27 weeks (range 23-33)) were randomly assigned to receive standard volumes of fluid (60 ml/kg on day 1 progressing to 150 ml/kg on day 7) or be restricted to about 80% of standard input. Results-Similar proportions of infants on the two regimens had CLD beyond 28 days (56% v 51%) and 36 weeks post conceptional age (26% v 25%), survived without oxygen dependency at 28 days (31% v 27%) and 36 weeks post conceptional age (58% v 52%), and developed acute renal failure. There were no statistically significant diVerences between other outcomes, except that fewer of the restricted group (19% v 43%) required postnatal steroids (p < 0.01). In the trial population overall, duration of oxygen dependency related significantly to the colloid (p < 0.01), but not crystalloid, input level; after adjustment for specified covariates, the hazard ratio was 1.07 (95% confidence interval 1.02 to 1.13). Conclusions-In ventilated, very low birthweight infants, fluid restriction in the perinatal period neither reduces CLD nor increases other adverse outcomes. Colloid infusion, however, is associated with increased duration of oxygen dependency. (Arch Dis Child Fetal Neonatal Ed 2000;83:F91-F96) Keywords: chronic lung disease; prematurity; very low birthweight; fluid restriction; lungs; survival High volumes of fluid input increase the likelihood of a patent ductus arteriosus (PDA), 1 a known risk factor for the development of chronic lung disease (CLD).2 It is therefore surprising that fluid restriction in only one 3 of four 1 3-5 randomised trials was associated with improved outcome. Interestingly, the positive eVect was a lower mortality rather than a lower CLD rate.3 The population investigated were relatively mature and it is not clear how many were exposed to antenatal steroids or postnatal surfactant.3 Fluid restriction has a number of important possible side eVects, including hypovolaemia which could result in renal impairment. We therefore felt it important to determine, in a high risk population, whether fluid restriction compared with a more liberal regimen was associated with a lower incidence of CLD but no increase in other adverse outcomes. MethodsA randomised trial of two levels of fluid input was undertaken. Infants born prematurely with a birth weight of < 1500 g, without major congenital anomalies and requiring ventilation from within the first six hours of birth were eligible for entry into the study. If informed written consent was given by the pa...

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