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More on periventricular leucomalacia and outcome
Pierrat and colleagues from France and the Netherlands remind us that repeated cranial ultrasound scanning is necessary in order not to miss the important diagnosis of periventricular leukomalacia (page 152). The incidence of cystic PVL in their cohort of almost 3500 babies was very low at 2.8% (96 cases). This large study provides some interesting information on timing, because the first cranial ultrasound scan was performed on admission to the neonatal unit; seven babies already had cystic change apparent at that time. In most of the remainder, there was an echodensity apparent on the first scan which subsequently evolved into cysts. Cysts mostly developed within four weeks of birth. Virtually all of the infants who developed extensive periventricular cystic lesions had cerebral palsy at follow up, whereas 29/39 of those with small localised cysts had CP. Only three of the first (extensive) group achieved independent walking whereas 22 of the children with more localized lesions could walk without assistance.
Collagenases and chronic lung disease
The search for the mechanism of lung injury in premature babies continues, and this month's contribution from Belfast provides another piece of the jigsaw (page 168). Babies who developed chronic lung disease had higher levels of matrix metalloproteinase 8 in their lung wash than those who did not. Matrix metalloproteinases are enzymes involved in collagen degradation. At present there is no therapeutic option based on these findings, but in future perhaps a targeted intervention will replace steroid therapy.
Oral erythromycin speeds up feed tolerance in preterm infants
Achieving full enteral feeding in preterm infants is a slow and frustrating business, and anything which can safely speed up the process is welcome. Oral erythromycin has long been known to have a motilin agonist effect, and to promote gut motility. Ng and colleagues describe the results of a randomised controlled trial (page 177) which showed that oral erythromycin 12.5 mg/kg q.d.s. for 14 days shortened the time taken to establish enteral feeding by 10 days. Babies who did not receive erythromycin took almost twice as long to establish full enteral feeds as the treated group. There were no apparent adverse effects. In spite of their very encouraging results the authors advise caution; they feel that confirmation is required and further safety studies are indicated.
Controversy regarding oxygen saturation limits in preterm babies
The paper by Tin et al in the last issue of the Fetal and Neonatal Archives (OpenUrl) which described the results of a policy of accepting relatively low oxygen saturation levels in preterm babies has already prompted much comment (page 149). Further correspondence on the topic will appear on the website (www.archdischild.com), and should prove an interesting read over the next few weeks.
Reviews this month
May is a bumper month for readers of the Archives who like reading reviews. You can update your knowledge of the management of congenital heart disease and inborn errors of metabolism, blood transfusion practice, and perinatal hepatitis C all without leaving the comfort of your office. We are indebted to all the authors for their papers, which we know will be much appreciated. Good reviews on any important topic are always welcome, and will be subject to peer review. Whilst we welcome systematic reviews at present we do not stipulate that this methodology is used before a review will be published.
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