Three-year follow up of term and near-term infants treated with inhaled nitric oxide.

BACKGROUND: The present study describes the outcome at 3 years in term and near-term infants treated with inhaled nitric oxide (iNO) for persistent pulmonary hypertension of the newborn (PPHN). METHODS: The study population consisted of 18 infants delivered at 34 weeks by best obstetric estimate who were admitted to the neonatal intensive care units with a diagnosis of PPHN. RESULTS: Eighteen infants (mean gestational age 38.5 +/- 2.6 weeks, mean birthweight 3015 +/- 587 g) were treated with iNO. The mean oxygenation index before iNO was 27.2 +/- 15.2. Responses to iNO were classified into three groups: (i) early response in eight infants; (ii) late response in two; and (iii) poor response in eight infants. Three infants died within seven postnatal days. Fifteen surviving infants were followed up to 3 years. The mean developmental scale was 98.4 +/- 9.0. One infant was diagnosed with severe neurodevelopmental disability due to cerebral palsy. Another infant was diagnosed with mild neurodevelopmental disability because of a low developmental scale. No infant showed significant hearing loss. Five infants had reactive airway disease (RAD) at 18 months, these infants required a significantly longer duration of mechanical ventilation in their neonatal period than non-RAD infants (P = 0.02). The frequency of survival with normal neurodevelopmental outcome was significantly higher in the early response group than the late or poor response groups (P = 0.03). CONCLUSION: In iNO-treated PPHN, mortality and neurodevelopmental outcome were associated with response to iNO, and pulmonary outcome was associated with duration of mechanical ventilation.

Effect of a laser prepulse on a narrow-cone ejection of MeV electrons from a gas jet irradiated by an ultrashort laser pulse.

Spatial and energy distributions of energetic electrons produced by an ultrashort, intense laser pulse with a short focal length optical system (Ti:sapphire, 12 TW, 50 fs, lambda=790 nm, f/3.5) in a He gas jet are measured. They are shown to depend strongly on the contrast ratio and shape of the laser prepulse. The wave breaking of the plasma waves at the front of the shock wave formed by a proper laser prepulse is found to make a narrow-cone (0.1pi mm mrad) electron injection. These electrons are further accelerated by the plasma wake field generated by the laser pulse up to tens of MeV forming a Maxwell-like energy distribution. In the case of nonmonotonic prepulse, hydrodynamic instability at the shock front leads to a broader, spotted spatial distribution. The numerical analysis based on a two-dimensional (2D) hydrodynamic (for the laser prepulse) and 2D particle-in-cell (PIC) simulation justifies the mechanism of electron acceleration. The PIC calculation predicts that electrons with energy from 10 to 40 MeV form a bunch with a pulse duration of about 40 fs.