Inhaled bronchodilator use for infants with bronchopulmonary dysplasia.

OBJECTIVE: To identify factors associated with bronchodilator administration to infants with bronchopulmonary dysplasia (BPD) and evaluate inter-institutional prescribing patterns. STUDY DESIGN: A retrospective cohort study of <29-week-gestation infants with evolving BPD defined at age 28 days within the Pediatric Health Information System database. Controlling for observed confounding with random-effects logistic regression, we determined demographic and clinical variables associated with bronchodilator use and evaluated between-hospital variation. RESULT: During the study period, 33% (N=469) of 1429 infants with BPD received bronchodilators. Lengthening mechanical ventilation duration increased the odds of receiving a bronchodilator (odds ratio 19.6 (11 to 34.8) at ⩾ 54 days). There was profound between-hospital variation in use, ranging from 0 to 81%.C ONCLUSION: Bronchodilators are frequently administered to infants with BPD at US children's hospitals with increasing use during the first hospital month. Increasing positive pressure exposure best predicts bronchodilator use. Frequency and treatment duration vary markedly by institution even after adjustment for confounding variables.

Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation.

OBJECTIVE: The goal of this study was to delineate the epidemiology of echocardiographically diagnosed pulmonary hypertension (PH) in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) requiring prolonged positive pressure ventilation (PPV), and to determine the independent relationship between PH and mortality in these patients. STUDY DESIGN: Our retrospective cohort included ELBW infants, with BPD requiring prolonged PPV, hospitalized in Cincinnati, Ohio during 2003-2009, as recorded in the National Institute of Child Health and Human Development Neonatal Research Network Database. Following chart review, a logistic regression model was constructed to understand the contribution of PH to mortality in infants with BPD requiring prolonged PPV. RESULT: We identified 216 patients (19%) with BPD requiring prolonged PPV among 1156 ELBW infants. Of these patients, 41% received echocardiography after 4 weeks of life, with 37% showing evidence of PH. Logistic regression analysis demonstrated that infants with BPD requiring prolonged PPV, with PH detectable by echocardiogram, were four times more likely to die (adjusted odds ratio): 4.6, 95% confidence interval: 1.3-16.5) when compared with infants with BPD requiring prolonged PPV without echocardiographic evidence of PH. CONCLUSION: Pulmonary hypertension appears to be an important, independent determinant of death in infants with BPD requiring prolonged PPV.

Methotrexate therapy. Nonsurgical management of ectopic pregnancy.

Ectopic pregnancy has become a surgical epidemic over the past two decades. To minimize the morbidity, mortality, and financial burden created by this rapidly growing health problem, nonsurgical alternatives have been investigated, including treatment with methotrexate. We reviewed current literature to evaluate the safety, efficacy, and costs associated with methotrexate treatment of tubal pregnancy. To date, 17 studies have reported on 400 patients with tubal pregnancies treated with parenteral methotrexate; the overall success rate was 92% (95% confidence interval, 89% to 95%). Single-dose parenteral methotrexate has been shown to be safe, effective, and associated with minimal costs when used in carefully selected patients. A prospective, randomized clinical trial comparing medical and surgical management of ectopic pregnancy is needed to assess the risks, benefits, and costs of these two approaches.

6-substituted tricyclic partial ergoline compounds are selective and potent 5-hydroxytryptamine1A receptor agents.

A series of 6 tricyclic partial ergoline derivatives was analyzed using radioligand binding assays. Four agents (LY 178210, LY 254089, LY 197205, and LY 197206) display high affinity (Ki less than or equal to 1.3 nM) for 5-hydroxytryptamine1A (5-HT1A) receptor binding sites labeled by [3H]8-hydroxy- 2-(di-n-propylamino) tetralin (8-OH-DPAT) and display greater than or equal to 150 fold selectivity for the 5-HT1A over the 5-HT1D receptor binding site. The most potent agent investigated, LY 178210, is essentially inactive (Ki greater than 1500 nM) at a total of 12 other neurotransmitter receptor binding sites in the brain. Using a forskolin-stimulated adenylate cyclase assay as a model of 5-HT1A receptor function, LY 178210 was found to display partial agonist activity which was blocked by 10(-5) M (-)pindolol. These data indicate that LY 178210 is a potent and selective 5-HT1A receptor partial agonist.