Early radiologic evidence of severe respiratory distress syndrome as a predictor of nasal continuous positive airway pressure failure in extremely low birth weight newborns.

OBJECTIVE: To determine whether early radiologic evidence of severe respiratory distress syndrome (RDS) is predictive of nasal continuous positive airway pressure (CPAP) failure in extremely low birth weight (ELBW) infants during the first 72 h of age. STUDY DESIGN: Retrospective analysis of 235 consecutively inborn ELBW infants who received initial support with CPAP. CPAP success (n=151) and CPAP failure (n=84) groups were designated according to outcome within the first 72 h of age. We assessed the ability of radiologic evidence of severe RDS in the initial chest radiograph, alone and in combination with other variables available in the first hours of life, to predict CPAP failure. RESULT: Severe RDS had a positive predictive value (PPV) of 0.81 (95% confidence interval (CI) 0.64, 0.92) for CPAP failure. The combination of severe RDS and gestational age (GA) ⩽ 26 weeks had a PPV of 0.92 (95% CI 0.68, 0.96). CONCLUSION: Early radiologic evidence of severe RDS is predictive of CPAP failure, especially in infants with GA ⩽ 26 weeks.

Unilateral laryngeal paralysis in a newborn with congenital varicella syndrome.

We report a case of a newborn with unilateral laryngeal paralysis due to congenital varicella syndrome. The patient needed neonatal resuscitation with positive pressure ventilation for severe respiratory failure. Fiberoptic bronchoscopy showed left unilateral laryngeal paralysis. From the first week of life he presented left Horner's syndrome and difficult swallowing. He was hospitalised during the first 3 months of life for recurrent aspiration pneumonia and failure to thrive. At 11 months an ophthalmic evaluation with Ret-Cam showed a chorioretinal scar in the macular region that allowed the final diagnosis.

Procoagulant activity in children with community acquired pneumonia, pleural effusion and empyema.

UNLABELLED: In patients with community-acquired pneumonia (CAP), bacterial-cell-wall-derived fragments may induce the coagulation cascade. To contribute to the knowledge of underlying mechanisms, we have studied the fibrinolytic activity in children with CAP and parapneumonic effusions. PATIENTS AND METHODS: Twenty previously healthy children admitted to our Department with CAP were studied; with (n = 11) or without (n = 9) pleural effusion (PPE). We also investigated 10 children with empyema. In all children we analyzed coagulation and fibrinolytic parameters and compared the results to nine controls. RESULTS: Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were not significantly modified in the three groups as compared to controls (P = 0.975, P = 0.535, respectively). The fibrinogen levels were significantly increased in respect to the control group (P < 0.0001). The median values of D-dimer showed an increasing trend that was statistically significant: children with pneumonia 244 microg/L, with pneumonia and PPE 751 microg/L and with empyema 2003 microg/L, in respect to values (48 microg/L) of our control group (P < 0.0001). CONCLUSION: The results suggest that plasma level of D-dimer can give an additional contribution for the evaluation of the severity of CAP and its complications in children.