Paracetamol is increasingly used for the treatment of a haemodynamically significant patent ductus arteriosus (hsPDA) and is touted as a better alternative to ibuprofen, the current drug of choice in the UK. This review examines the evidence from randomised controlled trials (RCT) comparing paracetamol with ibuprofen, in terms of dose and pharmacokinetic and pharmacodynamic profiles. It appears that there is a lot to ascertain before paracetamol can be confidently used over ibuprofen for management of hsPDA in preterm infants.

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We describe a case of nocardial pneumonia due to Nocardia farcinica in a preterm infant of 25 weeks’ gestation, which is an extremely rare diagnosis in this age group. The infant was subsequently diagnosed with possible chronic granulomatous disease, a known risk factor for this infection. To our knowledge, this case represents the first report of an in-hospital presentation of nocardial pneumonia in an extremely low birthweight neonate.

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This survey reviews current cooling practice of level 3 neonatal units (NNUs) in the UK with regard to treatment of babies who do not fulfil the existing cooling entry criteria. We collected replies from 78% of tertiary NNUs. More than 80% of tertiary units consider cooling or have cooled babies from at least one of the ‘outside the entry criteria’ categories. An analysis of the replies is discussed.

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Advances in neonatal care have led to increased survival of the extreme preterm infant, yet bronchopulmonary dysplasia (BPD) as a comorbidity has shown an increasing trend. A major proportion of preterm infants who remain invasively ventilated at term-corrected gestational age go on to require long-term respiratory support yet the management and prognosis for severe BPD shows wide regional variation depending on availability of resources. This article addresses conundrums regarding the management of severe BPD and the care pathway, including a survey of practice to give a UK regional perspective.

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