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Objective Both high altitude and trisomy 21 (T21) status can negatively impact respiratory outcomes. The objective of this study was to examine the association between altitude and perinatal respiratory support in neonates with T21 compared with those without T21. Study Design This retrospective cohort study used the United States all-county natality files that included live, singleton, in-hospital births from 2015 to 2019. Descriptive statistics for neonates with and without the primary outcome of sustained assisted ventilation (>6 hours) were compared using t -tests and Chi-squared analyses. Multivariable logistic regression was used to determine the association between respiratory support and the presence of T21, and included an interaction term to determine whether the association between respiratory support and the presence of T21 was modified by elevation at delivery. Results A total of 17,939,006 neonates, 4,059 (0.02%) with T21 and 17,934,947 (99.98%) without, were included in the study. The odds of requiring sustained respiratory support following delivery were 5.95 (95% confidence interval [CI]: 5.31, 6.66), 4.06 (95% CI: 2.39, 6.89), 2.36 (95% CI: 1.64, 3.40), and 5.04 (95% CI: 1.54, 16.54) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevations, respectively. The odds of requiring immediate ventilation support following delivery were 5.01 (95% CI: 4.59, 5.46), 5.90 (95% CI: 4.16, 8.36), 2.86 (95% CI: 2.15, 3.80), and 12.08 (95% CI: 6.78, 21.51) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevation, respectively. Conclusion Neonates with T21 have increased odds of requiring respiratory support following delivery when compared with neonates without T21 at all categories of altitude. However, the odds ratios did not increase monotonically with altitude which indicates additional research is critical in understanding the effects of altitude on neonates with T21. Key Points Neonates with T21 have an increased need for perinatal respiratory support at all altitudes. The odds of needing perinatal respiratory support did not increase monotonically with elevation. Additional research is critical to understanding the effects of altitude on neonates with T21. [ABSTRACT FROM AUTHOR]

Respiratory distress syndrome (RDS) is a major contributor to neonatal mortality worldwide. However, little information is available regarding rates of RDS-specific mortality in low-income countries, and technologies for RDS treatment are used inconsistently in different health care settings. Our objective was to better understand the interventions that have decreased the rates of RDS-specific mortality in high-income countries over the past 60 years. We then estimated the effects on RDS-specific mortality in low-resource settings. Of the sequential introduction of technologies and therapies for RDS, widespread use of oxygen and continuous positive airway pressure were associated with the time periods that demonstrated the greatest decline in RDS-specific mortality. We argue that these 2 interventions applied widely in low-resource settings, with appropriate supportive infrastructure and general newborn care, will have the greatest impact on decreasing neonatal mortality. This historical perspective can inform policymakers for the prioritization of scarce resources to improve survival rates for newborns worldwide. [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that in volume targeted ventilation modes, ventilator performance would vary according to ventilator type.Methods: Four neonatal ventilators: Draeger Babylog 8000 (Draeger Medical, Germany), SLE 5000 infant ventilator (SLE systems, UK), Stephanie paediatric ventilator (F. Stephan Biomedical, German) and V.I.P. Bird gold (Viasys Healthcare, USA) were assessed using a lung model. Delivered peak pressure, inflation time, mean airway pressure (MAP) and volume were measured.Results: At the same preset ventilator settings, the Stephanie and V.I.P. Bird ventilators delivered significantly lower peak pressures and tended to deliver lower MAPs than the other two ventilators. At a volume targeted ventilation level of 5 mL, the SLE and the V.I.P. Bird delivered significantly shorter inflation times. The above differences related to differences in the airway pressure waveforms delivered by the four ventilators. The V.I.P. Bird had a less variable volume delivery, but this was always significantly lower than the preset volume guarantee level but higher than the volume displayed by the ventilator.Conclusion: In volume targeted ventilation modes, performance differs between neonatal ventilator types; these results may have implications for clinical practise. [ABSTRACT FROM AUTHOR]

Presents information on the responses of pediatricians from the United States regarding several medical topics. Position on male circumcision; Remarks about the definition of last sleeping position of infants; Response to a study on high-frequency oscillation for the treatment of respiratory distress syndrome.

The article offers updates concerning drug development and approval in the U.S. The Surfaxin drug from Discovery Laboratories Inc. was given an approval designation for the prevention of respiratory distress syndrome in premature infants. The Fentanyl buccal tablet Fentora from Cephalon Inc. was not given approval for the management of pain in opioid-tolerant patient with chronic pain conditions. Resveratrol has received an orphan drug designation for the treatment of mitochondrial myopathy.

The article focuses on Pennsylvania-based firm Discovery Labs which seeks regulatory approval from the U.S. Food and Drug Administration (FDA for its Surfaxin (lucinactant), a drug used to treat respiratory distress syndrome in premature infants. It notes that Surfaxin was rejected four times by FDA due to its manufacturing procedures. Rusty Clayton, the head of research and development of Discovery Labs reveals that the company has already addressed the concerns and has resolved the problem.

The article focuses on the issue of clinical trial design and patient safety in a study for the treatment of acute respiratory distress syndrome (ARDS) patient, by the use of mechanical ventilation. The U.S. National Heart, Lung, and Blood Institute (NHLBI) announced in March 1999 that it had stopped a multicenter clinical trial, conducted by the Acute Respiratory Distress Syndrome (ARDS) Network, of the use of mechanical ventilation in patients with the acute respiratory distress syndrome because the group receiving a lower tidal volume than had substantially fewer deaths. It was argued that the participants in the study were subjected to unnecessary risks, and the researchers could have erroneously concluded that the use of lower tidal volumes can save lives.

Reports developments in medical care as of December 1990 in the U.S. Benefits of giving patients with non-rheumatic atrial fibrillation anticoagulants; Treatment of respiratory distress syndrome inneonates; Mobility improvement in children with cerebral palsy.

Presents news briefs related to actions of the U.S. Food and Drug Administration on various pharmaceutical products. Approval of a surfactant product for neonatal respiratory distress syndrome therapy; Order to stop the distribution of Cal-Ban 3000 diet tablets and capsules.

Reports that the U.S. Food and Drug Administration has authorized the use of the bovine lung surfactant Survanta under a Treatment IND, a procedure that allows treatment use under certain circumstances of an investigational therapy for serious diseases. Use of the drug for the treatment of respiratory distress syndrome; Increase in the incidence of apnea.