Bronchopulmonary dysplasia in infants with respiratory distress syndrome in a developing country: a prospective single centre-based study

Over-reaching with causality language in neurodevelopmental infant research: A methodological literature review

BACKGROUND

A methodological review of 78 empirical articles focusing on the neurodevelopmental outcomes of at-risk infants was conducted.

AIMS

To examine ways language and terminology are used to describe methods, present results, and/or state conclusions in studies published during 1994-2005, a decade reflecting major advances in neurodevelopmental research and in medical intervention. More specifically, to investigate to what extent the design of the study and the language in the results section aligned in regard to causality.

METHODS

A process of search and selection of studies published in pediatric journals was conducted through Google Scholar. Criteria of inclusion and exclusion, following PRISMA, were used. Selected studies reported neurodevelopmental outcomes of infants and young children considered at-risk, and were further categorized accordingly to their study designs. Language use in regard to whether the presentation and interpretation of results may convey causal relationships between birth risk factors and neurodevelopmental outcomes was examined following two analytical steps.

RESULTS

Forty out of 78 studies, (51.28 %) used causality-implying language (e.g., effect, predict, influence) notwithstanding that the study design was non-causal.

CONCLUSIONS

Anticipating the next generation of neurodevelopmental-outcomes research, a framework that aims to raise awareness of the importance of language use and the impact of causality-related terms often used in longitudinal studies is proposed. The objective is to avoid ambiguities and misunderstandings around causal or non-causal connections between birth risk factors and developmental outcomes across diverse audiences, including early intervention practitioners working directly with infants and their families.

The value of ultrasound examination of the lungs in predicting bronchopulmonary dysplasia

BACKGROUND

Bronchopulmonary dysplasia (BPD) is one of the most serious complications of neonatal mechanical ventilation. Early diagnosis may influence treatment options such as early steroid administration.

OBJECTIVE

To assess the role of US of the lungs in predicting the development of BPD in infants with hyaline membrane disease (HMD) and to determine the earliest possible age at which the diagnosis of BPD could be made with certainty.

PATIENTS AND METHODS

Consecutive premature newborn infants requiring assisted ventilation during 1997-1998 who were admitted because of HMD were studied prospectively. US of the lungs was performed within 3 days of birth and three times a week thereafter until discharge from the neonatal intensive care unit. Each patient was also clinically and radiographically evaluated for the presence or absence of BPD at day 28 of life. Lung US scans were correlated with the development of BPD.

RESULTS

Retrodiaphragmatic hyperechogenicity (RH) was initially observed in 28 of the 36 patients with HMD, but resolved completely in 24 (96%) of 25 infants who had an uncomplicated clinical course. In eight of the ten infants who developed BPD, RH persisted. Day 9 was the earliest day where persistence of abnormal RH was observed with the highest predictor values for the development of BPD.

CONCLUSIONS

Lung US is a valuable technique for predicting the development of BPD.

Is management of neonatal respiratory distress syndrome feasible in developing countries? Experience from Karachi (Pakistan)

There is a marked paucity of data on the prevalence, management, and outcome of respiratory distress syndrome (RDS) among newborn infants born in developing countries. We reviewed the clinical profile, presentation, mode of therapy, and immediate and 12-month outcomes in 200 consecutive infants with documented RDS admitted to the Neonatal Intensive Care Unit at Aga Khan University Hospital, Karachi. One hundred fifty-six (79%) of these infants required assisted ventilation. Infants requiring ventilatory assistance had higher rates of maternal antenatal complications, were more frequently asphyxiated at birth, and were hypothermic on admission. The overall mortality was 39%, and a further 3 infants died in early infancy after discharge. The mean duration of hospitalization for ventilated survivors (n = 122) was 24.6 +/- 21.1 days, with an average cost of therapy per survivor of Rs 50,067 (US $1,391). While our experience from Karachi indicates that it is possible to provide successful respiratory support at comparatively low cost to newborn infants weighing >1,000 g with severe RDS, there is considerable room for improvement in outcome with the use of preventive measures such as antenatal steroids, appropriate intrapartal care, and attention to early stabilization after birth.