Non-invasive versus invasive respiratory support in preterm infants

Respiratory insufficiency is almost ubiquitous in infants born preterm, with its incidence increasing with lower gestational age. A wide range of respiratory support management strategies are available for these infants, separable into non-invasive and invasive forms of respiratory support. Here we review the history and evolution of respiratory care for the preterm infant and then examine evidence that has emerged to support a non-invasive approach to respiratory management where able. Continuous positive airway pressure (CPAP) is the non-invasive respiratory support mode currently with the most evidence for benefit. CPAP can be delivered safely and effectively and can commence in the delivery room. Particularly in early life, time spent on non-invasive respiratory support, avoiding intubation and mechanical ventilation, affords benefit for the preterm infant by virtue of a lessening of lung injury and hence a reduction in incidence of bronchopulmonary dysplasia. In recent years, enthusiasm for application of non-invasive support has been further bolstered by new techniques for administration of exogenous surfactant. Methods of less invasive surfactant delivery, in particular with a thin catheter, have allowed neonatologists to administer surfactant without resort to endotracheal intubation. The benefits of this approach appear to be sustained, even in those infants subsequently requiring mechanical ventilation. This cements the notion that any reduction in exposure to mechanical ventilation leads to alleviation of injury to the vulnerable preterm lung, with a long-lasting effect. Despite the clear advantages of non-invasive respiratory support, there will continue to be a role for intubation and mechanical ventilation in some preterm infants, particularly for those born <25 weeks' gestation. It is currently unclear what role early non-invasive support has in this special population, with more studies required.

Development of a Measure of Egodystonicity

The term egodystonicity is a distinguishing feature of obsessional thoughts (American Psychiatric Association, 2000) but has not been consistently nor comprehensively defined. These two studies present the development and initial validation of the Ego-Dystonicity Questionnaire (EDQ). A definition of the term egodystonicity was developed, drawing from existing definitions and theoretical models of obsessive-compulsive disorder (OCD). An item pool was developed and refined through initial testing, the product of which was a 37-item self-report measure. Respondents identify a specific type of thought (e.g., their most upsetting obsession, most upsetting worry) and then answer each item with respect to that thought. In study 1, two nonclinical samples (N = 278) and one sample of individuals with OCD (N = 17) were administered the EDQ along with self-report measures of mood, personality, OCD symptoms, and appraisal of obsessional thoughts. A principal components analysis of the nonclinical sample yielded four factors. Scales based on these factors had acceptable internal reliability. The EDQ distinguished between obsessional thoughts and common worries, and individuals in the clinical sample had higher scores than the nonclinical sample. The EDQ showed low to moderate correlations with OCD symptoms, mood, and appraisal of obsessions but was not associated with personality traits such as neuroticism. In study 2, individuals with OCD (N = 28) completed the EDQ in reference to their most or least upsetting obsession. As predicted, egodystonicity varied according to obsession type. These data indicate that the EDQ is a valid measure with potential for use in understanding and treating obsessional problems.

Protective effect of drugs on bronchoconstriction induced by sulphur dioxide

The response to inhaled sulphur dioxide in eight normal, seven atopic, and 22 asthmatic subjects was studied by measuring thoracic gas volume and airway resistance in a whole-body plethysmograph. The fall in specific airway conductance in relation to the concentration of sulphur dioxide inhaled (0-20 ppm) was determined in all three groups. The specific airway conductance fell significantly in the atopic and asthmatic subjects but not in the normal group. In a double-blind study prior inhalation of disodium cromoglycate caused a significant reduction in the response to sulphur dioxide inhalation in atopic and asthmatic subjects. Prior treatment with inhaled ipratropium bromide blocked the response in the atopic subjects, but the effect was variable in the patients with asthma. Previous treatment with inhaled clemastine also reduced the response in patients with asthma, without causing a change in baseline specific conductance. We conclude that non-allergic bronchial hyperreactivity was increased in the atopic and the asthmatic subjects and that mediator release, in addition to a vagal reflex, has a role in such bronchoconstriction.