High prevalence of minor neurologic deficits in a long-term neurodevelopmental follow-up of children with severe persistent pulmonary hypertension of the newborn: a cohort study.

BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) is a severe condition that determines a profound brain hypoxia. Inhaled nitric oxide was approved for the treatment of PPHN since the end of the 1990s. The debate upon the long term outcome of these children is still open. Our aim was to investigate the incidence of minor long-term neurodevelopmental problems in a cohort of children affected by severe PPHN. METHODS: All neonates with severe PPHN treated with inhaled nitric oxide in our facility between 01.01.02 and 31.12.07 were seen in a follow up visit and evaluated with a neurodevelopmental scale, according to their age at the time of observation. RESULTS: in the study period 31 children were diagnosed with severe PPHN. 29 survived. 27 accepted to come for follow-up. Mean age: 41 months (range 12 - 70 months).26% of the evaluated children had some behavioural problems, while 22% had some language disturbances. CONCLUSIONS: This is the first neurodevelopmental follow-up of neonates with PPHN in which children older than 36 months have been evaluated.There is an unexpected high incidence of minor neurological deficits, mainly regarding the fields of language and behaviour. These deficits seem to be related to the severity of illness rather than to the treatment. Language and behaviour are considered "higher functions" in humans and their integrity can be better defined in older children.

Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis.

BACKGROUND: Respiratory distress syndrome (RDS) is a severe form of neonatal respiratory distress which occurs almost exclusively in premature infants. At present, the diagnosis is based on radiological findings and clinical course. Lung ultrasound in RDS has not yet been fully assessed. OBJECTIVES: The aim of the study was to define the ultrasonographic appearance of RDS and evaluate its clinical relevance. METHODS: Lung sonography was performed in 40 newborn infants with radiological and clinical signs of RDS (mean gestational age 27.2 +/- 2.7 weeks, mean birth weight 1,057 +/- 361 g) and in 15 preterm infants without RDS (mean gestational age 30.4 +/- 3.4 weeks, mean birth weight 1,775 +/- 669 g). RESULTS: In all the studied infants with RDS, lung ultrasound consistently showed generalized alveolar-interstitial syndrome (echographic 'white lung'), pleural line abnormalities (small subpleural consolidations, thickening, irregularity and coarse appearance) and an absence of areas with a normal pattern ('spared areas'). When presented simultaneously, these signs identify RDS with a sensitivity and specificity of 100%. CONCLUSIONS: We found that lung ultrasound is a reliable tool in the diagnosis of RDS. We speculate that it may be considered as a screening method for the diagnosis of RDS, and for early administration of surfactant in preterm infants with respiratory distress.