Background:The aim of this study was to determine whether small-for-gestational-age (sGA) infants born very prematurely had increased respiratory morbidity in the neonatal period and at follow-up. Methods: Data were examined from infants recruited into the United Kingdom Oscillation study (UKOs). Of the 797 infants who were born at <29 wk of gestational age, 174 infants were sGA. Overall, 92% were exposed to antenatal corticosteroids and 97% received surfactant; follow-up data at 22-28 mo were available for 367 infants. results: After adjustment for gestational age and sex, sGA infants had higher rates of supplementary oxygen dependency at 36 wk postmenstrual age (odds ratio (OR): 3.23; 95% confidence interval: 2.03, 5.13), pulmonary hemorrhage (OR: 3.07; 95% cI: 1.82, 5.18), death (OR: 3.32; 95% cI: 2.13, 5.17), and postnatal corticosteroid requirement (OR: 2.09; 95% cI: 1.35, 3.23). After adjustment for infant and respiratory morbidity risk factors, a lower mean birth weight z-score was associated with a higher prevalence of respiratory admissions (OR: 1.40; 95% cI: 1.03, 1.88 for 1 sD change in z-score), cough (OR: 1.28; 95% cI: 1.00, 1.65), and use of chest medicines (OR: 1.32; 95% cI: 1.01, 1.73). conclusion: sGA infants who were born very prematurely, despite routine use of antenatal corticosteroids and postnatal surfactant, had increased respiratory morbidity at follow-up, which was not due to poor neonatal outcome.

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Background: There is no consensus or evidence as to whether a neuromuscular blocking agent should be used during the initial resuscitation of infants with congenital diaphragmatic hernia (CDH) in the labour ward. Objective: To determine if administration of a neuromuscular blocking agent affected the lung function of infants with CDH during their initial resuscitation in the labour ward. Methods: Fifteen infants with CDH were studied (median gestational age 38 weeks, range 34–41; birth weight 2,790 g, range 1,780–3,976). Six infants had undergone feto-endotracheal occlusion (FETO). Flow, airway pressure, tidal volume and dynamic lung compliance changes were recorded using a respiratory function monitor (NM3, Respironics). Twenty inflations immediately before, immediately after and 5 min after administration of a neuromuscular blocking agent (pancuronium bromide) were analysed. Results: The median dynamic lung compliance of the 15 infants was 0.22 ml/cm H₂O/kg (range 0.1–0.4) before and 0.16 ml/cm H₂O/kg (range 0.1–0.3) immediately after pancuronium bromide administration (p < 0.001) and remained at a similar low level 5 min after pancuronium bromide administration. The FETO compared to the non-FETO infants had a lower median dynamic compliance both before (p < 0.0001) and 5 min after pancuronium administration (p < 0.001) and required significantly longer durations of ventilation (p = 0.004), supplementary oxygen (p = 0.003) and hospitalisation (p = 0.007). Conclusions: Infants with CDH, particularly those who have undergone FETO, have a low lung compliance at birth, and this is further reduced by administration of a neuromuscular blocking agent.