[Retinopathy in premature infants]. / Retinopati hos praemature.

Retinopathy of prematurity (ROP) is a complication of very preterm birth. The problem is relatively common in Denmark; although only 10 infants are blinded each year, this represents a high incidence in international comparison. The very complete Danish registry of the blind may be partly responsible. The incidence remains high due to the increased survival rate in very preterm infants. Although free oxygen radical injury most likely plays a central role, it is doubtful if reduction of supplementary oxygen under careful monitoring can reduce the risk of ROP. Unfortunately, the most preterm and most unstable infants, who are at highest risk of ROP, are also particularly exposed to hypoxia. It is possible that light increases the risk, even for other reasons it is recommended to reduce the intensity of light in the ward or to use eye pads, at least some of the time. There is no effective drug prevention, in particular there is no evidence that vitamin E is useful. Cryotherapy, however, in the acute phase of threshold disease (stage 3+), can reduce the risk of permanent loss of central vision from about 50% to 25%. Effective screening for ROP has become part of modern neonatology. Diagnosis as well as cryotherapy requires particular skill and experience.

[Description of activities in the neonatal department at Rigshospitalet during the period 1983-1990]. / Aktivitetsbeskrivelse for Rigshospitalets neonatalafdeling 1983-1990.

Since 1983, the gestational age (GA in completed weeks), use of mechanical ventilation, duration of hospitalization and the diagnosis-related group were registered routinely for all infants admitted to the Neonatal Department, Rigshospitalet, Copenhagen. The data were analysed concerning the 6,636 infants treated during the seven-year period until the end of 1991. The annual number of admissions decreased during the period (p < 0.001) whereas the number of extremely preterm infants (GA < 28 weeks) increased from 30 to 45 annually (p < 0.05). The total mortality remained constant at about 7% of all admissions but decreased significantly for the extremely preterm infants. The use of mechanical ventilation was almost halved during the period: from 235 to 146 annually. Even where the extremely preterm infants were concerned, the use of mechanical ventilation decreased from 77% to 51% (p < 0.05). The gestational age specific duration of hospitalization for the surviving infants remained constant. The number of infants with surgical anomalies or congenital heart disease increased among the infants born at term. The cost of treatment increased by 40% in fixed prices to DDK 4,000 per day (approximately 333 pounds). The authors conclude that the introduction of nasal continuous positive airway pressure (CPAP) has permitted treatment of moderately preterm infants in county hospitals and has also resulted in avoidance of mechanical ventilation in extremely preterm infants without preventing improved survival. Although the patients have become more selected, the duration of hospitalization remains unchanged.

[Treatment of severe respiratory distress syndrome with surfactant]. / Surfaktantbehandling af svaert respiratorisk distress-syndrom.

The first Danish experience of treatment of the respiratory distress syndrome (RDS) in preterm infants with exogenous surfactant is described. Fifteen infants with birthweights of 645-1,865 g and gestational ages of 25-32 weeks, all receiving artificial ventilation with at least 60% oxygen for severe RDS, were treated with purified porcine surfactant (Curosurf) within the first 28 hours of life. Pulmonary function improved immediately in all of the infants. Four infants (27%) died, four (27%) developed bronchopulmonary dysplasia (pulmonary fibrosis) and two (13%) had late neurological sequelae. These preliminary results are considered to be promising and they are in complete agreement with the results of randomised, controlled investigations from abroad. Systematic registration is, however, still necessary.