On the well-being of adult expremies in Denmark.

AIM: To study health, well-being in daily life, educational level and socio-economic status in adulthood in moderately premature infants and the relationship to gender and socio-economic status at birth. METHODS: Prospective long-term follow-up study of a cohort of infants with a gestational age between 32 and 37 weeks and term controls born between January 1972 and June 1973 in the municipality of Odense in Denmark. Information about life circumstances at 32 years was acquired by a mailed questionnaire. RESULTS: The study comprised 373 participants aged 31-32 years (56% of the original cohort). Questionnaires were returned by 69 participants who were born moderately premature and 304 participants who were born at term (53 and 57%, respectively, of the original cohort). Multivariate analysis showed that social status and level of education at 32 years were predicted by social status and maternal educational level at birth with no demonstrable effects due to gestation or gender. CONCLUSION: Moderately premature infants, born before the era of intensive care, at the age of 32 years with regard to health, quality of life, education and social status proved to fare as well as their term counterparts.

Nasal CPAP and surfactant for treatment of respiratory distress syndrome and prevention of bronchopulmonary dysplasia.

UNLABELLED: The Scandinavian approach is an effective combined treatment for respiratory distress syndrome (RDS) and prevention of bronchopulmonary dysplasia (BPD). It is composed of many individual parts. Of significant importance is the early treatment with nasal continuous positive airway pressure (nCPAP) and surfactant treatment. The approach may be supplemented with caffeine citrate and non-invasive positive pressure ventilation for apnoea. The low incidence of BPD seen as a consequence of the treatment strategy is mainly due to a reduced need for mechanical ventilation (MV). CONCLUSION: Early-postnatal treatment with nCPAP and surfactant decreases the severity and mortality of RDS and BPD. This is mainly due to a diminished use of MV in the first days of life.

[Surfactant treatment of newborn infants receiving continuous positive airway pressure treatment]. / Surfaktantbehandling af nyfødte børn i continuous positive airway pressure-behandling.

INTRODUCTION: The purpose of this study was to examine the efficiency of a single dose of fast-acting exogenous surfactant (Curosurf) given to premature babies with progressive respiratory insufficiency. Curosurf was given as early rescue therapy during a brief intubation (INSURE method: INtubation-SURfactant-Extubation) during treatment with nasal Continuous Positive Airway Pressure (CPAP). MATERIALS AND METHODS: Retrospective study of 115 premature infants with respiratory distress syndrome born and treated at Odense University Hospital during the years 1999 to 2004. The criterion for surfactant treatment was a decrease in the arterial/alveolar oxygen tension ratio (or corresponding values for the fraction of inspired oxygen) below 0.36 in infants with gestational age (GA) < 30 weeks and 0.22 in more mature infants. RESULTS: The primary end point was survival during the first week of life without mechanical ventilation. This end point was reached by 51% of the infants with GA < 30 weeks. However, the effect proved to be GA-dependent, increasing from 22% in infants with a GA of 24-25 weeks to 86% in week 29. Seventy percent survived to be discharged. In infants with GA > 29 weeks the effect was 87%, and all survived. CONCLUSION: The effect of surfactant therapy administered per the INSURE method is GA-dependent, and the method works best after GA week 25. The question is whether earlier therapy will increase its efficiency or the method has reached its limit.

Physical outcome and school performance of very-low-birthweight infants treated with minimal handling and early nasal CPAP.

AIM: To describe physical outcome and school performance in a cohort of very-low-birthweight infants treated with early nasal continuous positive airway pressure (NCPAP)/minimal handling regimen with permissive hypercapnia, in comparison to siblings of normal birthweight. MATERIAL AND METHODS: Neonatal and follow-up data from 213 very-low-birthweight infants from 1983-1988 were registered and a questionnaire concerning school achievements was sent to the families of survivors and siblings attending school. RESULTS: Mortality was 22%. Of the survivors, 4% had moderate-severe and 9% mild sequelae. Eighty-seven per cent of VLBW children and 95% of their siblings attended regular school. Average or above-average achievement was accomplished by 33 (65%) of the VLBW children and 34 (74%) of the siblings in mathematics, and 35 (69%) and 32 (68%), respectively, in reading/spelling. None of these differences reached statistical significance. However, the performance ratings correlated significantly with socio-economic conditions. CONCLUSION: In this study of infants treated with a regimen of early NCPAP/minimal handling, we found a relatively low incidence of handicaps and impairments. Nearly 90% attended ordinary schools, with near-average performances in mathematics and reading/spelling, which were not statistically different to their siblings. The overall results indicate that these infants fare at least as well as survivors after conventional treatment.