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OBJECTIVE: The purpose of this study was to assess the incidence and outcome of managing a pneumothorax without tube thoracostomy and to determine the clinical and laboratory characteristics that distinguish infants with a pneumothorax who can be treated without chest-tube insertion. METHODS: A retrospective study was performed of neonates who were admitted to the neonatal intensive care unit at the University at Alabama at Birmingham from 1992 to 2005 and had a pneumothorax while on mechanical ventilation. Infant characteristics, respiratory and radiologic diagnoses, and respiratory management data (ventilator settings and blood gases) were compared between infants who initially were treated with a chest tube versus those initially treated without a chest tube. RESULTS: A total of 136 ventilated infants with pneumothorax while on a ventilator were included in the final analysis; 101 (74%) were treated initially with a chest tube and 35 (26%) without a chest tube. Of those who did not receive a chest tube initially, 14 were treated with needle aspiration and 21 with expectant treatment. Infants who were treated initially without a chest tube were on a lower ventilator settings (mean airway pressure and fraction of inspired oxygen) and had better blood gases (arterial oxygen saturation, Pco(2), and pH) compared with infants who were treated with a chest tube. Infants who were treated initially with needle aspiration were more likely to require subsequent chest-tube insertion than infants who had expectant treatment (43% vs 10%). CONCLUSIONS: It is possible to treat expectantly without initial chest-tube placement a select group of ventilated neonates with pneumothorax. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of early range-of-motion intervention on bone strength and bone turnover in very low birth weight infants., Methods: Twenty-four infants (mean birth weight: 1135 +/- 247 g; mean gestational age: 28.5 +/- 2.3 weeks) were matched for gestational age and birth weight and then randomly assigned into exercise (n = 12) and control (n = 12) groups. Exercise protocol started at the first week of life and involved daily extension and flexion range of motion against passive resistance of the upper and lower extremities (5 minutes per day, 5 days per week, 4 weeks). Growth parameters, bone strength, and biochemical markers of bone homeostasis were measured at enrollment and after 4 weeks. Bone strength was determined using quantitative ultrasound measurement of bone speed of sound (SOS) at the middle left tibial shaft., Results: Bone SOS decreased significantly in the control group during the study period (from 2892 +/- 30 m/sec to 2799 +/- 26), whereas bone SOS of the exercise group remained stable (2825 +/- 32 m/sec and 2827 +/- 26 m/sec at baseline and 4 weeks, respectively). This significant difference in bone SOS was not expressed in the biochemical markers of bone homeostasis., Conclusions: There is a significant postnatal decrease in the bone SOS of very low birth weight infants. A brief range-of-motion exercise attenuates the decrease in bone strength and may decrease the risk of osteopenia.