640 e-Letters

  • Premedication before intubation of neonates in The Netherlands
    Harry Molendijk

    Dear Editor

    With great interest we read the paper by Whyte et al regarding the practice of premedication before intubation in UK neonatal units.[1] Their finding that only 37% of the units gave any sedation before intubation is worrysome in view of the known physiologic responses to awake intubation.[2-4] However, one potential bias in their study design was not discussed.

    Since the information regarding...

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  • To trigger or not to trigger?
    M Yadav
    Dear Editor

    International randomised controlled trial by Dr Baumer[1] concluded that there was no benefit of patient triggered ventilation (PTV), but an added risk of increased pneumothorax in those less than 28 weeks gestation. In the same issue Beresford et al[2] concluded in a similar trial (with slightly more mature newborns 29 weeks vs 27), that PTV was feasible with no significant differences noted in medium term outcom...

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  • Guidelines for prevention of neonatal Group B Streptococcal infections
    Yim-Yee Chan
    Dear Editor

    The article by Beardsall et al[1] once again raises awareness of this important and as yet unresolved issue for the UK. We would like to make two related points:

    (1) Although the authors have discussed both early and late onset Group B Streptococcus disease, perinatal intervention is effective in preventing only early onset Group B Streptococcus disease.

    (2) A common related scenario...

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  • 'PTV': should it be patient triggered and patient terminated ventilation?
    Nadarasa Visveshwara
    Dear Editor

    We were surprised at the results of the two studies published in your journal by Baumer[1] and Bersford et al[2]. Our experience with triggered ventilation over 10 years is shown in the table below:

    Complications of prematurity 1991-99

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  • Use of antenatal steroids
    HD Dellagrammaticas
    Dear Editor

    We read with interest the excellent review by Dr Ng on the fetal and neonatal hypothalamic-pituitary-adrenal axis.(1) Although the issue of antenatal administration of steroids is addressed in a separate section of the paper it is practically restricted to their antenatal use for the prevention of respiratory distress syndrome and other complications of prematurity.

    We would agree that this is the commonest...

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  • Re: Triggered ventilation in neonates
    JH Baumer
    Dear Editor

    The interest displayed in the trigger ventilation trial by Burmester and Petros is welcome.(1) Their letter raises questions about the interpretation of the performance of the Dr�ger babylog 8000, which was used in a minority of infants in the study.

    The trigger sensor device is different, and I agree with their implied statement that as each trigger ventilator performs differently results obtained...

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  • Re: Parental participation in decision making
    Marina Cuttini

    Dear Editor,

    The rapid response from Dellagrammaticus and Iacovidou (17 May) provides interesting information and further support to the conclusion of our study (1): namely, that NICUs from Southern European countries (Italy, Spain and, according to Dellagrammaticus, also Greece) adopt parental visiting policies more restrictive than in Northern countries.

    We agree that exploring the role of parents in deci...

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  • Re: Need for prospective studies
    W H Ouwehand

    The letter from Dr Mantadakis addresses the important issue of the absence of randomised studies on the clinical effectiveness of the interventions used to prevent the possible severe sequelae of fetal alloimmune thrombocytopenia. Studies in small series are suggestive of some benificial effect of the current interventions like high dose intravenous immunoglobulin to the mother or intrauterine transfusion of HPA compat...

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  • Parental participation in decision making
    HD Dellagrammaticus


    We read with interest the paper by Cuttini et al (1). Although policy regarding parental visiting is a relatively easier issue to evaluate, parental participation in decision making, particularly in decisions with strong ethical overtones, is a much more complex issue. It is difficult to evaluate with accuracy with accuracy and by its nature much more controversial. The paper does not stress that data col...

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  • Triggered ventilation in neonates
    Margarita Burmester


    Baumer reports the results of large multi-centre study comparing the effects of patient triggered ventilation (PTV) with conventional ventilation (IMV)1. There appears to be no benefit from PTV compared to IMV in death rate, development of chronic lung disease, pneumothorax rates and cerebral ultrasound abnormality. In addition, because of an increased trend toward a higher pneumothorax rate, Baumer conc...

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