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The midwife calls you to assess a newborn in the delivery room. The pregnancy was uneventful, but the mother's serology results show the following: hepatitis B surface antigen (HBsAg) negative, antibodies against hepatitis B surface antigen (anti-HBs) negative, but antibodies against hepatitis B core antigen (anti-HBc) positive. You wonder if the baby is at risk for perinatal transmission of hepatitis B virus (HBV) requiring preventive measures at this time. Does a newborn of a mother with isolated antibodies against hepatitis B core antigen need immunisation (intervention) to prevent perinatal infection with HBV (outcome)? If yes, what type and timing of immunisation? We searched MEDLINE via PubMed (January 1950 to November 2013) for the following terms: “anti-HBc AND vertical transmission”, “anti-HBc AND vaccination AND newborn”, “vaccination AND newborn AND perinatal transmission AND hepatitis B”, “isolated antibody AND hepatitis B AND pregnancy/pregnant”. Two hundred and forty-three abstracts were screened, 11 were considered for full text review. Of those, four were eligible and seven were excluded: four did not address the main question, two provided no follow-up …

Background: Bronchopulmonary dysplasia (BPD) is a common complication in preterm infants. Clinical prediction of BPD at an early stage in life is difficult. Plasma proendothelin-1 (CT-proET-1) is a lung injury biomarker in pulmonary hypertension and respiratory distress. Objective: To assess the prognostic ability of CT-proET-1 in BPD. Methods: In 227 prospectively enrolled preterm infants born at Results: The predictive ability of CT-proET-1 for any BPD was poor at birth [area under the ROC curve (AUC) 0.654, 95% CI 0.494-0.814], moderate at DOL 2 and 3 (AUC 0.769, 95% CI 0.666-0.872) and excellent at DOL 6 (AUC 0.918, 95% CI 0.840-0.995). Multivariable regression analysis revealed that CT-proET-1 levels at DOL 2, 3, 6 and 28 were strongly related to the duration of oxygen supplementation, independently of GA and the duration of respiratory support. Conclusions: CT-proET-1 is a novel promising biomarker for predicting the development of BPD in preterm infants when measured at the end of the first week of life.

Objective While respiratory symptoms in the first year of life are relatively well described for term infants, data for preterm infants are scarce. We aimed to describe the burden of respiratory disease in a group of preterm infants with and without bronchopulmonary dysplasia (BPD) and to assess the association of respiratory symptoms with perinatal, genetic and environmental risk factors. Methods Single centre birth cohort study: prospective recording of perinatal risk factors and retrospective assessment of respiratory symptoms during the first year of life by standardised questionnaires. Main outcome measures: Cough and wheeze (common symptoms), re-hospitalisation and need for inhalation therapy (severe outcomes). Patients: 126 preterms (median gestational age 28.7 weeks; 78 with, 48 without BPD) hospitalised at the University Children's Hospital of Bern, Switzerland 1999-2006. Results Cough occurred in 80%, wheeze in 44%, rehospitalisation in 25% and long term inhalation therapy in wheezers in 13% of the preterm infants. Using logistic regression, the main risk factor for common symptoms was frequent contact with other children. Severe outcomes were associated with maximal peak inspiratory pressure, arterial cord blood pH, APGAR and CRIB-Score. Conclusions Cough in preterm infants is as common as in term infants, whereas wheeze, inhalation therapy and re-hospitalisations occur more often. Severe outcomes are associated with perinatal risk factors. Preterm infants who did not qualify for BPD according to latest guidelines also showed a significant burden of respiratory disease in the first year of life.

Background and Aim In patients with cystic fibrosis (CF) the architecture of the developing lungs and the ventilation of lung units are progressively affected, influencing intrapulmonary gas mixing and gas exchange. We examined the long-term course of blood gas measurements in relation to characteristics of lung function and the influence of different CFTR genotype upon this process. Methods Serial annual measurements of PaO2 and PaCO2 assessed in relation to lung function, providing functional residual capacity (FRCpleth), lung clearance index (LCI), trapped gas (VTG), airway resistance (sReff), and forced expiratory indices (FEV1, FEF50), were collected in 178 children (88 males; 90 females) with CF, over an age range of 5 to 18 years. Linear mixed model analysis and binary logistic regression analysis were used to define predominant lung function parameters influencing oxygenation and carbon dioxide elimination. Results PaO2 decreased linearly from age 5 to 18 years, and was mainly associated with FRCpleth, (p < 0.0001), FEV1 (p < 0.001), FEF50 (p < 0.002), and LCI (p < 0.002), indicating that oxygenation was associated with the degree of pulmonary hyperinflation, ventilation inhomogeneities and impeded airway function. PaCO2 showed a transitory phase of low PaCO2 values, mainly during the age range of 5 to 12 years. Both PaO2 and PaCO2 presented with different progression slopes within specific CFTR genotypes. Conclusion In the long-term evaluation of gas exchange characteristics, an association with different lung function patterns was found and was closely related to specific genotypes. Early examination of blood gases may reveal hypocarbia, presumably reflecting compensatory mechanisms to improve oxygenation.

Background Endothelin-1 (ET-1) is a potent pulmonary vasoconstrictor, involved in lung injury and remodelling. ET-1 can be estimated by measuring its stable by-product, C-terminal pro-ET-1 (CT-proET-1), in plasma. Aims To investigate CT-proET-1 values in very preterm infants (gestational age Methods Prospective cross-sectional study of 391 CT-proET-1 measurements (fully automated immunoflorescent assay) from 267 very preterm infants. Measurements were performed at birth (n = 72 infants), on day of life (DOL) 2 (n = 89), on DOL 6 (n = 49), on DOL 28 (n = 106), and at PMA 36 (n = 75). Trial registration: ClinicalTrials.gov NCT01644981. Results CT-proET-1 values were (median) 151 pmol/L (IQR 118–186) at birth, peaked on DOL 2 (319 pmol/L (235–382)), and declined thereafter to 214 pmol/L (148–293) on DOL 6, 184 pmol/L (149–233) on DOL 28, and 150 pmol/L (118–188) at PMA 36. Infants with BPD had higher CT-proET-1 values on DOL 2 (p = 0.001), DOL 6 (p Conclusions The levels and the pattern of CT-proET-1 increase during the first week of life might serve as an early marker of BPD.

BackgroundMorphological changes in preterm infants with bronchopulmonary dysplasia (BPD) have functional consequences on lung volume, ventilation inhomogeneity and respiratory mechanics. Although some studies have shown lower lung volumes and increased ventilation inhomogeneity in BPD infants, conflicting results exist possibly due to differences in sedation and measurement techniques.Methodology/principal findingsWe studied 127 infants with BPD, 58 preterm infants without BPD and 239 healthy term-born infants, at a matched post-conceptional age of 44 weeks during quiet natural sleep according to ATS/ERS standards. Lung function parameters measured were functional residual capacity (FRC) and ventilation inhomogeneity by multiple breath washout as well as tidal breathing parameters. Preterm infants with BPD had only marginally lower FRC (21.4 mL/kg) than preterm infants without BPD (23.4 mL/kg) and term-born infants (22.6 mL/kg), though there was no trend with disease severity. They also showed higher respiratory rates and lower ratios of time to peak expiratory flow and expiratory time (t(PTEF)/t(E)) than healthy preterm and term controls. These changes were related to disease severity. No differences were found for ventilation inhomogeneity.ConclusionsOur results suggest that preterm infants with BPD have a high capacity to maintain functional lung volume during natural sleep. The alterations in breathing pattern with disease severity may reflect presence of adaptive mechanisms to cope with the disease process.