The aims of this study were to determine whether caffeine administration increased respiratory muscle function and if this was associated with lung function improvement in prematurely born infants being weaned from mechanical ventilation. Respiratory muscle function was assessed by measurement of the maximum pressures generated during occlusions at end inspiration (Pemax) and end expiration (Pimax) and lung function by measurement of lung volume (functional residual capacity (FRC)) and respiratory system compliance (CRS) and resistance (RRS) in 18 infants with a median gestational age of 28 (range 24-36) weeks. Measurements were made immediately prior to caffeine administration (baseline) and 6 h later. Six hours after caffeine administration compared to baseline, the median Pemax (p = 0.017), Pimax (p = 0.004), FRC (p < 0.001), CRS (p = 0.002) and RRS (p = 0.004) had significantly improved. Our results suggest that caffeine administration facilitates weaning of prematurely born infants from mechanical ventilation by improving respiratory muscle strength.

In the present study, prone sleeping did not improve oxygenation in prematurely born infants, 32 weeks' PMA or older and with no ongoing respiratory problems. However, the infants were monitored in each position for an hour, thus it is recommended that oxygen saturation should continue to be monitored after 32 weeks' PMA to be certain that longer periods of supine sleeping are not associated with loss of lung volume and hypoxaemia.

No abstract

A fatal case of pure Proteus mirabilis meningitis complicated by extensive pneumocephalus demonstrated on brain CT is reported. We suggest that early institution of third generation cephalosporin combined with an aminoglycoside and a brain CT scan are warranted in neonates with neurological sepsis caused by this organism.In neonates and infants, Proteus mirabilis is encountered world-wide as an uncommon aetiological agent in sepsis and infections of the central nervous system (CNS), often as a mixed infection.A 5-day-old term baby girl was admitted to our neonatal intensive care unit with a 1-day history of jaundice and 3-day history of poor feeding and lethargy. There was no history of injury. Her mother was a 28-year-old hepatitis B carrier primigravida who was otherwise well. Antenatal, intrapartum and immediate postnatal periods were uneventful. On admission, the baby was poorly hydrated, jaundiced, lethargic and hypotonic. Her sucking reflex was poor. Her anterior fontanelle was soft and normotensive. A full septic screen was done and she was commenced on intravenous penicillin and gentamicin. She was put on nasal continous positive airway pressure which was later changed to ventilation when she became apnoiec and desaturated.Immediate investigations showed unconjugated hyperbilirubinaemia and hypoglycaemia (<1.0 mmol/l) but otherwise normal full blood count and serum electrolytes. Cerebrospinal fluid (CSF) microscopy showed a white cell count of >200 (70% polymorphs, 30% leukocytes), a CSF glucose of <1.0 mmol/l, and a CSF protein of 6.8 g/l, globulin positive but a latex test (for Neisseria meningitidis, Streptococcus pneumoniae, Escherichia coli, Streptococcus group B and Haemophilus influenzae type B) was negative. Penicillin was discontinued and cefotaxime was added to her antibiotic regime when she deteriorated on ventilator.The next day, she became hypotensive needing inotropic support and developed generalised convulsions which responded to phenobarbitone. A brain ultrasound scan revealed multiple areas of echogenicity with cerebral oedema. A brain CT scan was deferred at this stage due to her unstable condition. Later that day, the CSF culture was reported to grow a gram-negative bacillus. On day 3 of admission, she developed generalised hypertonia, hyper-reflexia and a tense anterior fontanelle. Her pupils were dilated and sluggish. Both CSF and blood cultures grew Proteus mirabilis and this was the only organism isolated from both samples. The organism was sensitive to both gentamicin and cefotaxime. Later that day, she had a further convulsion and went into renal failure. Her coagulation profiles were deranged and both platelets and haemoglobin were low. She was transfused with platelets, packed cells, fresh frozen plasma and cryoprecipitate. Her condition remained unchanged the next day. A brain CT scan performed on day 5 of admission showed extensive pneumocephalus replacing the substance of the frontal and temporal lobes. Air density was also present in the subdural space along the falx and in...