Chronic lung disease in very low birth weight infants: Persistence and improvement of a quality improvement process in a tertiary level neonatal intensive care unit.

OBJECTIVE: We previously demonstrated a significant reduction in our incidence of chronic lung disease in our NICU using potentially better practices of avoiding delivery room endotracheal intubation and using early nasal CPAP. We sought to demonstrate whether these improvements were sustained and or improved over time. STUDY DESIGN: We conducted a retrospective, cross-sectional analysis of infants 501-1500 grams born at our hospital between 2005 and 2013. Infants born during the 2005-2007, 2008-2010 and 2011-2013 epochs were grouped together, respectively. Descriptive analysis was conducted to determine the number and percent of maternal and neonatal characteristics by year grouping. Chi-squared tests were used to determine whether there were any statistically significant changes in characteristics across year groupings.. Two outcome variables were assessed: a diagnosis of chronic lung disease based on the Vermont Oxford Network definition and being discharged home on supplemental oxygen. RESULTS: There was a statistically significant improvement in the incidence of chronic lung disease in infants below 27 weeks' gestation in the three year period in the 2011-2013 cohort compared with those in the 2005-2007 cohort. We also found a statistically significant improvement in the number of infants discharged on home oxygen with birth weights 751-1000 grams and infants with gestational age less than 27 weeks in the 2011-2013 cohort compared to the 2005-2007 cohort. CONCLUSIONS: We demonstrated sustained improvement in our incidence of CLD between 2005 and 2013. We speculate that a multifaceted strategy of avoiding intubation and excessive oxygen in the delivery room, the early use of CPAP, as well as the use of volume targeted ventilation, when needed, may help significantly reduce the incidence of CLD.

Neonatal auditory cortex lesions result in aberrant crossed corticotectal and corticothalamic projections in rats.

Ablation of one auditory cortex at birth in rats results in the formation of aberrant crossed projections from the intact hemisphere. These aberrant projections extend throughout most of the corticorecipient zone of the contralateral inferior colliculus and can be traced as far rostral as the contralateral medial geniculate nucleus. The aberrant crossed corticothalamic axons arise from layer V pyramidal neurons in the intact auditory cortex.

Glycosaminoglycans of solid and ascites forms of the P1798 murine lymphosarcoma.

Total glycosaminoglycan levels are similar from subcutaneous, ascites and mesenteric forms of the P1798 lymphosarcoma. However, P1798 cells implanted subcutaneously produce a solid tumor rich in hyaluronic acid with lesser amounts of chondroitin 4-/6-sulfates as well as an undersulfated species of chondroitin sulfate, while cells implanted intraperitoneally produce ascites tumors which generate hyaluronic acid, almost exclusively. Mice bearing advanced ascites tumors develop solid mesenteric tumors which exhibit chondroitin 4-/6-sulfates and under-sulfated chondroitin sulfate in addition to hyaluronic acid.