A premature baby born at 24 weeks gestational age is admitted to the neonatal unit having been born in poor condition and receiving cardio-pulmonary resuscitation (CPR) with adrenaline in the delivery room. Considering the available evidence, is the use of CPR at delivery of extremely premature infants associated with very poor outcomes such that CPR in these infants may be inappropriate? Does the administration of CPR provide these infants with a chance of survival free of disability?

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Is the frequency of recurrent chest infections, in children with chronic neurological problems, reduced by prophylactic Azithromycin?
You see Jonny, an 8 yr old boy with severe dystonic CP as a result of his premature birth at 26 wks gestation with another chest infection. He is mainly gastrostomy fed and had a Nissen’s fundoplication 5 yrs ago at the same time his gastrostomy was inserted. He has copious secretions and a poor cough reflex; these are made worse by Nitrazepam he requires for his dystonia. Evidence from previous barium studies and swallow assessments show that he chronically aspirates his secretions. He has no symptoms of upper airway obstruction. He has had increasingly frequent lower respiratory tract infections over the last year, requiring admission and intra-venous antibiotics (a total of four times in 2006). His weight and height have fallen from the 10th to the 3rd percentile. A chest x-ray shows chronic changes suggestive of underlying bronchiectasis. Immune function and Sweat test are normal. He awaits a CT scan. He has daily physiotherapy and regular suction and usually produces copious muco-purulent secretions. He is on maximal anti-reflux medication already. Would prophylactic Azithromycin reduce his risk of further LRTI? Or might it increase growth of multi resistant organisms within his sputum?

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