On 10/12/2006, at 21:55, Nikki Lee wrote:

> In a message dated 12/9/2006 7:53:10 PM Eastern Standard Time,
> [log in to unmask] writes:
>> There has been some amnotic fluid around the baby's face on noted on
>> ultasound, but there is great concern that the baby's lungs may be
>> underdeveloped.

> Dear Friends:
>     Now as the baby is floating in amniotic fluid until it is born,  
> why is
> amniotic fluid around the baby's face anything  to even mention?  
> And wouldn't we
> expect a 26-weeker to have immature lungs?

Re-reading the original post, the mother had rupture of the membranes  
at 19 weeks. The note of some amniotic fluid present in the baby's  
face region would be a hopeful prognostic sign, not a negative one. I  
believe there are better prognostic indicators (this paper explains  
some: http://pediatrics.aappublications.org/cgi/content/full/ 
109/2/250 ). PROM before 20 weeks with oligohydramnios is associated  
with particularly bad outcomes, so preparing this mother for full  
NICU care including milk expression would be entirely appropriate, I  
believe.

Perhaps one of the neonatologists will explain further and correct my  
misunderstandings. My understanding is that one of the primary  
concerns with such early PROM and subsequent oligohydramnios is not  
that the lungs will be age-appropriately immature, but that they will  
not develop along normal lines at all - neonatal pulmonary  
hypoplasia. There is really no cure for severe pulmonary hypoplasia.  
No matter how much you ventilate a hypoplastic lung, you can't make  
lung tissue materialise from nowhere for gas exchange. One can only  
hope that this baby has escaped that fate, or has a very mild version.

Lara Hopkins

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