Neonatal Hyaline Membrane Disease Research Articles

Effect of gender and gestational age on short term morbidities and mortality in extremely low birth neonates

Background: The Aim of this study was to see the effect of gender and gestational age on early morbidities and mortalities of extremely low birth weight neonates.Methods: It was cross section retrospective. This retrospective study over a period of 5 years from June 2009 to May 2014 in a tertiary level teaching hospital. All the ELBW neonates admitted during the study period were recruited. Moving in a retrospective manner we collected previous case records relevant to our study from the institute and then categorized our data on the basis of gestational age and gender, then we compared and analysed our data on the basis of incidence of mortalities and morbidities and the effect of gender and gestational age on it.Results: Out of 115 ELBW neonates 61(53%) were born at ≤ 28 weeks, 26 (22%) were born between 29 to 31 weeks and 28(24%) babies were born at 32 to 37 weeks. The most common maternal risk factors responsible for ELBW deliveries were Pregnancy induced hypertension 27 (23%) followed by premature rupture of membranes 20 (17%). Out of short term outcomes HMD (66%), Apnea (71%), hyperbilirubinemia (53%) and sepsis (54.7%) were most common comorbidities. There was no effect of gender on any short-term morbidity and mortality of ELBW newborns. There was a significant higher incidence of hyaline membrane disease, hypoglycemia and neonatal sepsis in ELBW neonates born before 28 weeks of gestational age as compared to born after 28 weeks. 50% of the neonates survived below 28 weeks of gestation.Conclusions: Our study shows the high incidence of short-term neonatal morbidities. ELBW neonates born before 28 weeks of gestation had higher morbidity.

Clinical Observation of neonatal hyaline membrane disease about the treatment injected into the"PS" by tracheal catheter

Objective To investigate the therapeutic effect of injectingPS by Scalp needle-induced tracheal catheter on treatment of neonatal hyaline membrane disease. Methods 26 cases were chosen as control group who were treated in our hospital NICU department during January,2013 to December,2013;the other 31 cases as improved group during January,2014 to January,2015.After administration therapy of drug,the injection time,chest X-ray and blood gas analysis were researched as observation indexes respectively. Results The amelioration of chest X-ray:29 cases in the improved group and 19 cases in the control group after 48 hours treatment,χ2= 4.457,P= 0.035;The amelioration of blood gas analysis:p H:(7.38±0.08)in improved group and(7.26±0.04)in the control group,t= 4.981,P= 0.030;PaCO2(mm Hg):(39±6)in the improved group and(50±10)in the control group,t= 5.897,P= 0.019;PaO2(mm Hg):(77±6)in the improved group and(67±10)in the control group,t= 8.026,P= 0.006. Conclusion The therapeutic effect of improved group is obviously better than the control group. Key words: Hyaline Membrane Disease; PS; Infant,Newborn

The use of nasal CPAP at the Charlotte Maxeke Johannesburg Academic Hospital

Background . Nasal continuous positive airway pressure (NCPAP) is well established as a treatment for hyaline membrane disease (HMD) and other respiratory diagnoses in neonates. NCPAP is an affordable intervention that reduces the number of neonatal admissions to the intensive care unit (ICU) for ventilation. At the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) we have been using NCPAP since April 2006. Objectives. To review the use of early NCPAP in our hospital setting. Methods. This was a retrospective, descriptive study of all neonates ≥750 g admitted to CMJAH between 1 January 2013 and 31 July 2014, who received NCPAP within 72 hours of birth. The characteristics and the survival of all infants who received NCPAP were described using univariate analysis. Results. The NCPAP group ( n =481) of neonates <1 500 g was significantly associated with surfactant use ( p <0.0005), bronchopulmonary dysplasia ( p <0.0005) and late sepsis ( p <0.0005). The survival to day 7 and to discharge of infants treated with NCPAP was significantly decreased ( p <0.0005). NCPAP alone (without ventilation) improved the survival to discharge ( p =0.001). The survival was 95.4% in the ≥1 500 g infants, compared with 87.6% in the very low birth weight infants and 55.2% in the extremely low birth weight infants. Conclusion. NCPAP is an effective intervention for HMD; it is both cost-effective and easy to use in a resource-limited setting, and reduces the morbidity and mortality associated with ICU admission.

Clinical effect analysis on 66 cases of neonatal hyaline membrane disease treated by heated humidified high-flow nasal cannula

Objective To explore the clinical effects of heated humidified high-flow nasal cannula (HHFNC) in treating neonatal hyaline membrane disease (NHMD).Methods 66 infants were diagnosed as mild NHMD according clinical findings and chest X-ray.HHFNC was used after building diagnosis.We adjusted HHFNC parameter according patients' arterial blood gas.Results 59 of 66 patients were fully recovered using HHFNC treatment.7 patients were incubated and used mechanical ventilation.Conclusion HHFNC is an available and effective treatment method for mild NHMD and provide respiratory support,and can improve hyoxemia symptoms. Key words: Heated humidified high-flow nasal cannula (HHFNC); Neonatal hyaline membrane disease (NHMD); Noninvasive ventilation

O156 Gestational diabetes mellitus: an independent risk factor for hyaline membrane disease in neonates delivered after 34 weeks

O156 Gestational diabetes mellitus: an independent risk factor for hyaline membrane disease in neonates delivered after 34 weeks

Amniotic fluid concentration of surfactant proteins in intra-amniotic infection

Objective. Pulmonary surfactant is a complex molecule of lipids and proteins synthesized and secreted by type II alveolar cells into the alveolar epithelial lining. Both lipid and protein components are essential for lung function in postnatal life. Infection is a well-established cause of preterm delivery, and several inflammatory cytokines play a role in the mechanisms of preterm parturition. An increased concentration of inflammatory cytokines in amniotic fluid or fetal plasma has been linked to the onset of preterm parturition and fetal/neonatal injury, including cerebral palsy and chronic lung disease. Experimental evidence indicates that inflammatory mediators also regulate surfactant protein synthesis, and histologic chorioamnionitis is associated with a decreased incidence of hyaline membrane disease in neonates. This study was conducted to determine if amniotic fluid concentrations of surfactant protein (SP)-A, SP-B, and SP-D change in patients with and without intra-amniotic infection (IAI).Materials and methods. A case–control study was conducted to determine amniotic fluid concentrations of SP-A, SP-B, SP-D, and total protein in patients who had an amniocentesis performed between 18 and 34 weeks of gestation for the detection of IAI in patients with spontaneous preterm labor with intact membranes (n = 42) and cervical insufficiency prior to the application of cerclage (n = 6). Amniotic fluid samples were selected from a bank of biological specimens and included patients with (n = 16) and without (n = 32) IAI matched for gestational age at amniocentesis. Intra-amniotic infection was defined as a positive amniotic fluid culture for microorganisms. Each group was further subdivided according to a history of corticosteroid administration within 7 days prior to amniocentesis into the following subgroups: (1) patients without IAI who had received antenatal corticosteroids (n = 21), (2) patients with IAI who had received antenatal corticosteroids (n = 9), (3) patients without IAI who had not received antenatal corticosteroids (n = 11), and (4) patients with IAI who had not received antenatal corticosteroids (n = 7). Amniotic fluid was obtained by transabdominal amniocentesis. SP-A, SP-B, and SP-D concentrations in amniotic fluid were determined by enzyme-linked immunosorbent assay (ELISA). Non-parametric statistics were used for analysis.Results. Women with IAI had a higher median amniotic fluid concentration of SP-B and of SP-B/total protein, but not other SPs, than those without IAI (both p = 0.03). Among patients who had received antenatal corticosteroids, the median amniotic fluid concentration of SP-B and of SP-B/total protein was significantly higher in patients with IAI than in those without IAI (SP-B, IAI: median 148 ng/mL, range 37.3–809 ng/mL vs. without IAI: median 7.2 ng/mL, range 0–1035 ng/mL; p = 0.005 and SP-B/total protein, IAI: median 14.1 ng/mg, range 4.3–237.5 ng/mg vs. without IAI: median 1.45 ng/mg, range 0–79.5 ng/mg; p = 0.003). Among women who had not received antenatal corticosteroids, the median amniotic fluid concentrations of SP-B and of SP-B/total protein were not significantly different between patients with and without IAI (SP-B, IAI: median 4 ng/mL, range 0–31.4 ng/mL vs. without IAI: median 3.4 ng/mL, range 0–37 ng/mL; p = 0.8 and SP-B/total protein, IAI: median 0.55 ng/mg, range 0–6.96 ng/mg vs. without IAI: median 0.59 ng/mg, range 0–3.28 ng/mg; p = 0.9). The median amniotic fluid concentrations of SP-A, SP-A/total protein, SP-D, and SP-D/total protein were not significantly different between patients with and without IAI whether they received antenatal corticosteroids or not (all p > 0.05).Conclusions. IAI was associated with an increased amniotic fluid concentration of SP-B in patients who received antenatal corticosteroids within 7 days prior to amniocentesis.

Expression of nuclear factor-kappaB and its inhibitor in alveolar macrophages of patients with neonatal hyaline membrane disease

Inflammatory reaction and injury in immature lungs are associated with activation of nuclear factor-kappa B (NF-kappaB) to trigger proinflammatory cytokine release, but the mechanism thereof is not fully understood. The present study was conducted to understand possible relationship between expression of NF-kappaB and its inhibitor and severity and outcome of neonates with hyaline membrane disease (HMD). Serial samples of bronchoalveolar lavage fluid (BALF) were obtained during mechanical ventilation from 31 preterm infants with HMD. These infants were divided into two groups: survivors group [n = 22, birth weight (1500 +/- 320) g and gestational age (31.2 +/- 1.8) weeks] and nonsurvivors group [birth weight (1340 +/- 280) g, gestational age (30.8 +/- 2.1) weeks]. Nineteen preterm infants [birth weight (1470 +/- 280) g, gestational age (30.6 +/- 1.9) weeks] without respiratory disorders were enrolled as control subjects. Alveolar macrophages (AM) were isolated by differential adherence. AM was cultured and treated with lipopolysaccharide (LPS) for 1 hr. Then, nuclear extracts of AM were analyzed by electrophoretic mobility shift assay (EMSA) for NF-kappaB expression. NF-kappaB inhibitor (IkappaB-alpha protein) in cytoplasmic extracts was detected by using Western blotting and IL-1beta and IL-8 in BALF by enzyme-linked immunosorbent assay (ELISA). NF-kappaB complexes were observed by EMSA, they were characterized by competition with cold oligonucleotide and p65-specific antibodies. The addition of an excess of cold oligonucleotide, corresponding to the NF-kappaB binding site, turned off the signal of the band, showing that the band was specific. An excess of an irrelevant oligonucleotide (corresponding to the SP-1) did not show any effect. The addition of an anti-p65 antibody caused the supershift of the two upper bands. After EMSA, the NF-kappaB complexes were quantified by using a ImageQuant software. NF-kappaB expression in AM at 24 hrs was higher in all the patients with HMD as compared with control subjects (survives/control, 34.1 vs 11.4 RDU, P < 0.01; nonsurvivors/control, 55.2 vs 11.4 RDU, P < 0.01). The NF-kappaB expression in AM at 72 hrs was higher than that in control subjects but not for nonsurvivors (survivors/control, 47.8 vs 25.6 RDU, P < 0.01; nonsurvivors/control, 21.8 vs 25.6, P > 0.05). The NF-kappaB expression in AM from nonsurvivors was depressed at 72 hrs as compared to 24 hrs (21.8 vs 55.2, P < 0.01), whereas the NF-kappaB expression in AM from survivors was still higher at 72 hrs than that at 24 hrs (47.8 vs 34.1, t = 4.43, P < 0.01). Altered NF-kappaB activation in AM of BALF of neonates with HMD was observed, and it may be mediated by decreased IkappaB synthesis, increased IkappaB degradation, or both. In HMD nonsurvivors NF-kappaB translocation was hampered upon LPS activation.

Maladie des membranes hyalines chez le nouveau-né à terme

Objectives. – Evaluation of the consequences of preplanned delivery near term on the neonatal respiratory distress syndrome and its mechanism of occurrence. Patients and methods. – During five years, full-term infants (≥37 weeks gestational age) admitted in the Institut de Puériculture de Paris, with a well characterized hyaline membrane disease, were included in a retrospective study. Results. – During this period, 97 full-term neonates with respiratory distress syndrome were hospitalized in the neonatal intensive care unit. The diagnosis of hyaline membrane disease was made in view of clinical and radiological criteria. The study of mode of delivery has shown a high frequency of pre-planned delivery: 54% caesarean and 24% vaginal delivery. A high-risk of occurrence of hyaline membrane disease was identified around 37 weeks gestational age in the case of preplanned delivery. Conclusion. – Preplanned delivery near 37 weeks gestational age may increase the risk of occurrence of hyaline membrane disease in full-term neonates.

The association between hyaline membrane disease and preeclampsia

The purpose of this study was to determine whether hyaline membrane disease is increased in newborn infants who are born to women with preeclampsia compared with control subjects. This was a historic cohort study of deliveries between 24 and 37 weeks of gestation at the Medical University of South Carolina from 1996 through 2002. Singleton infants who were born to women with preeclampsia were compared with nonpreeclamptic control subjects. The incidence of hyaline membrane disease was compared by chi 2 analysis and Fisher exact test, with significance at a probability value of <.05. Logistic regression analysis was performed to address potential confounders. There were 814 women with preeclampsia and 3021 control subjects. When we controlled for confounding factors, there was a significant increase in the incidence of hyaline membrane disease in the preeclamptic group overall (odds ratio, 1.35; 95% CI, 1.03-1.78). The risk was more pronounced in neonates who were born at 32 weeks of gestation (odds ratio, 1.93; 95% CI, 1.28-2.91). The risk of hyaline membrane disease in neonates at < 32 weeks of gestation is increased in patients with preeclampsia. This supports the contention that fetal lung maturity is not accelerated in preeclampsia.

High viscosity of newborn extracellular matrix is the etiology of erythema toxicum neonatorum: Neonatal jaundice?: Hyaline membrane disease?

At the time of birth, the fetal ground substance is under the influence of maternal and placental hormones. Hormones are known to exert significant effect on ground substance. The ground substance viscosity that is ideal for intrauterine life is too viscous for the newborn. Sites of minor skin trauma develop swelling, inflammation and pustules. Dilution of tissue fluids causes formation of some of the mediators of inflammation including those responsible for intraepidermal pustule formation. The newborn responds to inflammation with eosinophilic granulocyte. The clinical lesions referred to as erythema toxicum neonatorum are known to localize at pressure sites. The skin lesions correct as maternal and placental hormone influence weakens. The entity occurs in 31 to 72% of white infants. The hormone induced viscosity changes may aid in better understanding some aspects of neonatal physiology; such as jaundice of the neonatal period, the eosinophilic granulocyte inflammatory response of the neonatal period and hyaline membrane disease.

Noninvasive prediction of hyaline membrane disease: An optimized classification of sonographic placental maturation

Accurate prediction of fetal pulmonary maturity by means of a less invasive procedure than amniocentesis would be desirable. Sonographic diagnosis of a Grade III placenta has been reported to be an excellent predictor of fetal lung maturity. The standard classification of placental grading assigns grade according to the most advanced portion of the placenta. Using this classification, we studied 230 patients. In 80 pregnancies with Grade III placenta, three of the neonates developed respiratory distress syndrome. With reclassification of the placentas as immature, (no Grade III areas), intermediate, (only a portion of the placenta being Grade III), or mature, (Grade III placenta throughout), it was found that no neonatal hyaline membrane disease occurred in the 41 pregnancies with mature placentas, whereas 12% of the neonates in the immature group and 8% in the intermediate group developed hyaline membrane disease. These findings suggest that when sonographic examination of the placenta shows both Grade III and non-Grade III sections, there is still a risk for an immature amniotic fluid lecithin/sphingomyelin ratio and neonatal hyaline membrane disease. The placentas should be considered mature only when Grade III changes are present in all sections examined by ultrasound.

Pulmonary epithelial permeability in hyaline-membrane disease.

Neonatal hyaline-membrane disease is complicated by pulmonary edema, yet left atrial pressures are normal. Alveolar-capillary-membrane permeability may therefore be increased. To assess pulmonary epithelial permeability, we measured the pulmonary clearance and half-life of aerosolized 99mTc-diethylenetriamine pentacetate (99mTc-DTPA) on 31 occasions in 15 intubated premature infants with hyaline-membrane disease. Three infants with respiratory failure due to other diseases were studied on four occasions. All studies of infants with hyaline-membrane disease that were performed in the first 72 hours of life demonstrated a biphasic clearance curve with a rapid-phase half-life of 1.6 +/- 0.6 minutes (mean +/- S.D.). As these infants recovered, the curve became monophasic with a half-life of 56.0 +/- 32.1 minutes. Two infants remained dependent on oxygen and ventilator support and had persistent biphasic curves with a rapid-phase half-life of 1.5 +/- 0.7 minutes. All infants without hyaline-membrane disease had monophasic curves with a half-life of 65.4 +/- 33.6 minutes. Using a similar technique, we observed that newborn lambs and piglets have a monophasic pulmonary clearance of 99mTc-DTPA (114 +/- 59 minutes in lambs and 52.5 +/- 16.3 minutes in piglets). We conclude that the lungs of neonates with hyaline-membrane disease are abnormally permeable to small solutes and that this abnormality persists in infants with subsequent chronic lung disease.

A Ten-Year Retrospective Study of Pink and Yellow Neonatal Hyaline Membrane Disease

Department of Pathology, University of Southern California School of Medicine, Los Angeles County-USC Medical Center, Los Angeles, California

The relationship of placental grade, fetal lung maturity, and neonatal outcome in normal and complicated pregnancies

Ultrasonically diagnosed maturity changes in the placenta, Grades 0 to III, have been previously shown to correlate with fetal lung maturity. In a prospective study of 230 term and preterm complicated pregnancies, we compared the relationship between sonographic placental grading, amniotic fluid phospholipids, and neonatal outcome. The frequencies of gestational age less than 38 weeks, lecithin/sphingomyelin (L/S) ratio less than 2.0, negative phosphatidylglycerol, and neonatal hyaline membrane disease were found to decrease as placental grade advanced from 0 to III. Patients were divided into subgroups on the basis of maternal complications. In patients with Grade III placentas, the frequencies of gestational age less than 38 weeks and L/S ratio less than 2.0 were significantly increased when the subgroup of patients with chronic hypertension was compared individually to both of the subgroups, repeat cesarean section deliveries, and Classes A, B, and C diabetes mellitus (both with p less than 0.05) All three infants who developed hyaline membrane disease in association with Grade III placentas were from pregnancies of less than 38 weeks complicated by chronic hypertension. These findings suggest that the presence of a Grade III placenta is affected by both gestational age and pregnancy complications. Hence, when an elective cesarean section delivery is being planned near term gestation, a Grade III placenta is a reliable predictor of lung maturity. In preterm complicated pregnancies, an ultrasound-diagnosed Grade III placenta may still be associated with hyaline membrane disease.

A Ten-Year Retrospective Study of Pink and Yellow Neonatal Hyaline Membrane Disease

Since it was first described several years ago, yellow bilirubin staining of the pulmonary membranes in neonatal hyaline membrane disease has apparently become more common. In a retrospective study of neonatal autopsy experience, it was found that as more of the premature infants survived longer, yellow hyaline membrane disease was a more frequent finding, increasing from 7% of all newborns having hyaline membrane disease at autopsy in 1970 to 50% in 1980. In comparing 499 cases with eosinophilic hyaline membranes with 168 cases of yellow membranes, newborns with bilirubin staining of the pulmonary membranes were found to be more premature (P less than .02), had smaller autopsy weight (P less than .002), and survived longer (P less than .00001). When multiple clinical parameters were compared between a group of infants with yellow membranes and a group of infants with pink membranes who were matched for gestational age, year of birth, and length of survival, no differences were found between the two groups. No correlation was found between kernicterus and yellow staining of the pulmonary hyaline membranes in the first years of the study, but there was a strong correlation in the last 5 years, coincident with the increase in the rate of yellow hyaline membrane disease found at autopsy. The gross bilirubin staining of the brain was the secondary type of kernicterus, not toxic bilirubin encephalopathy. The observation of bilirubin staining in the lung and in the brain correlates with prolonged survival in some very small premature infants. This does not appear to be a manifestation of bilirubin toxicity, but rather a marker of prior tissue damage.

Yellow hyaline membrane disease in neonates: clinical diagnosis by tracheal aspiration cytology.

Yellow hyaline membrane disease (YMH) of the neonate may be diagnosed clinically by tracheal aspiration cytology, an easily accessible, noninvasive, and safe technique. Since the frequent association of yellow membranes and kernicterus in premature infants at relatively low levels of serum bilirubin is significant, this means of diagnosis during life may be useful in identifying infants at risk for kernicterus. We also suggest use of this technique in evaluating the role of possible factors in the pathophysiology of yellow hyaline membranes.

Perinatal death and respiratory apparatus dysgenesis due to a bis (dichloroacetyl) diamine.

N, N1-bis (dichloroacetyl) diamine 1, 8-octomethylenediamine (WIN 18,446) is an experimental drug which was first investigated as a male contraceptive. It is soluble in lipid solvents but not in water. The administration of 1,200 to 1,600 mg/kg to pregnant rats on the tenth day of gestation produced multiorgan fetal malformations. Smaller doses, 400 to 800 mg/kg, especially if divided over 2 or 3 days, caused perinatal death. Thus, 60 to 100% of offspring of rats given WIN 18,446 on the tenth and 11th days of gestation died at birth or within 4 days (Taleporos et al., 78). The present study investigated such deaths. At doses of 200 mg/kg on day 10 or 50 mg/kg on days 10 and 11, 67% of offspring had defective or absent diaphragms, 48% had tracheobronchiomegaly with cystic lungs, and 67% had pleural hemorrhage. At doses of 100 mg/kg given on 1 day or 25 mg/kg each day for 2 days, 50% had tracheobronchiomegaly with cystic lungs and rudimentary acini. At lower doses (18.8 mg/kg X 2 or 12.4 mg/kg X 3), a majority of fetal lungs had rudimentary acini, thick septa, few capillaries, and wide cuffs of perivascular connective tissue. Thus, a chemical given during organogenesis produced dysgenesis of the respiratory apparatus. Varying the dose produced malformed lungs with persistently deficient acini which model such human lung faults as tracheobronchiomegaly (Mournier-Kuhn Syndrome; Mounier-Kuhn, '32), bronchiolar dysplasia (Wilson-Mikity Syndrome), and perinatal death with acinar failure resembling neonatal hyaline membrane disease.

Bronchiolar epithelial lesions induced in the premature rabbit neonate by short periods of artificial ventilation.

Premature newborn rabbits were ventilated with standardized tidal volume (10 ml/kg) or standardized insufflation pressure (35 cm H2O) for 1--30 min. The lungs of the experimental fetuses were fixed by perfusion of the pulmonary artery and examined by light and electron microscopy, with particular reference to the prevalence and ultrastructure of bronchiolar epithelial lesions. Necrosis and desquamation of bronchiolar epithelium were constant findings in fetuses ventilated for 5 min. or more, and were also present in some of the fetuses ventilated for only 1 min. Since the light microscopic and ultrastructural appearance of these bronchiolar lesions is similar to early stages of human neonatal hyaline membrane disease, we conclude that artificially ventilated pre-term newborn rabbits might serve as a useful model of this disease.

Performance of the amniotic fluid foam stability—50 percent test: A bedside precedure for the prenatal detection of hyaline membrane disease

A study was conducted on 394 patients in order to evaluate a modified foam stability (FS) test for the prenatal evaluation of fetal oulmonary maturity. We termed the assay the “FS-50 test” because of its dependence upon the maintenance of a 50% ethanol concentration in the final assay mixture. The FS-50 test was regarded as “positive” when an uninterrupted ring of stable bubbles formed around the meniscus of the tube at the air-fluid interface, following vigorous shaking. Anything less was regarded as a “negative” result. Neonatal hyaline membrane disease (HMD) did not occur in association with a “positive” FS-50 test result. However, when the FS-50 test was “negative,” 35.8% of the neonates developed HMD. In 164 of the 394 patients studied, sufficient amniotic fluid was available so as to enable us to perform the FS-50 and the lecithin/sphingomyelin (LS) ratio assay concurrently. LS ratio values of greater than 2.0 correctly predicted a sufficient degree of fetal pulmonary maturity so as to protect against the subsequent development of HMD in 97.8% of the cases. LS ratio values of less than 2.0 were predictive of HMD in 28.4% of the cases studied, while a “negative” FS-50 test correctly predicted that HMD would subsequently occur in 46.9% of the cases. The FS-50 test promises to provide a reliable screening method for the prenatal detection of HMD. The practicability and sensitivity of this simple assay makes it a potentially valuable addition to our diagnostic armamentarium.

Hyaline membrane disease in neonates treated with artificial ventilation: neurological and intellectual sequelae at two to five years of age.

Of 99 infants treated for hyaline membrane disease (HMD) by artificial ventilation during the period of 1967 to 1970 in the neonatal ICU: six died during the follow-up period, four of whom had severe neurological damage; 13 were lost to follow-up examinations; 80 were followed for two to five years. Of the 80 who were followed; 39 (48%) developed normally, 29 (36%) had problems of moderate severity with acceptable handicaps; 12 (15%) had severe neurological damage. There was a good correlation between neonatal neurological status and subsequent clinical outcome. The correlation between the neonatal EEG and clinical outcome was also good. Babies with severe neurological abnormalities during the neonatal period were found to have a high incidence of late sequelae.