Author: GS

Inhaled budesonide for bronchopulmonary dysplasia

In a multi center randomized trial from Europe in infants born at 23 – 27 weeks gestation, the effects of inhaled budesonide given prophylactically were compared with those of placebo. The inhalations were started before 24 hours of life and…

Diazoxide for hyperinsulinemic hypoglycemia

A single-center randomized trial in small-for gestational age infants with a gestation of 32 weeks or greater who had hyperinsulinemic hypoglycemia compared the effects of diazoxide with placebo. Infants treated with diazoxide had a lower: median time to achieve hypoglycemia control…

Testing for CMV in neonates who fail hearing screening

In a single-center study, all 171 neonates with a failed hearing screen (out of nearly 11,000 infants screened) were tested for congenital CMV infection with a salivary polymerase chain reaction (PCR) assay. Such testing was mandated by state law. If the…

Is a VCUG required after every neonatal UTI?

A retrospective three-center study of 126 NICU infants diagnosed with urinary tract infection (UTI) found that 60% of infants that underwent renal ultrasonography had abnormal renal ultrasound findings (hydronephrosis or pelvicaliectasis), with 12% having severe abnormalities. Vesico ureteric reflux (VUR)…

Cardiopulmonary resuscitation in the Level 4 NICU

A single center retrospective review of over 5000 infants from a quaternary neonatal intensive care unit found that 2% of infants received cardiopulmonary resuscitation (CPR) and the median duration of chest compression was 2 minutes. Adrenaline was administered in 30%…

Is a routine MRI in preterm infants useful?

A multicenter randomized trial compared preterm infants less than 33 weeks at birth for whom results of both cranial ultrasound and cranial MRI at term gestation were available, to similar infants for whom only ultrasound results were available. Each group…

MRI score to predict poor outcome after perinatal asphyxia

Investigators from the Netherlands and Sweden developed a scoring system for brain injury using MRI images (including diffusion weighted imaging) from neonates 36 weeks gestation or greater with hypoxic ischemic encephalopathy treated with total body hypothermia. The scoring system allocated…

Continuous glucose monitoring – better glucose control?

A single center randomized trial from Italy in very-low-birth-weight infants compared the titration of the glucose infusion rate using continuous glucose monitoring versus periodic glucose measurement using bedside glucometers (with the continuous values hidden from clinicians). In both arms of…

Post-immunization cardiorespiratory events in preterm infants

A randomized trial in infants less than 32 weeks gestation at birth compared changes in levels of C-reactive protein, prostaglanding E2 (PGE2) and the frequency of cardio-respiratory events after the infants received the two-month vaccinations. The intervention group received ibuprofen…

T-piece versus self inflating bag for resuscitation of VLBW infants

In a prospective multi-center observational study from Brazil of almost 2000 infants with a birth weight less than 1500 grams, compared to infants who received positive pressure at birth with a self-inflating bag (with no PEEP valve), those who received…

WWLST in VLBW Neonates

A retrospective 18-center analysis of data on very low birth weight infants found that discussions about withholding or withdrawal of life-sustaining therapy (WWLST) occurred more often in infants 22 – 24 weeks gestation (27%) than in those 27-28 weeks (6%). There…

Venous thrombosis in neonates

Venous thromboembolism is being increasingly diagnosed in neonates and is the result of a disturbance of the delicate balance between procoagulant and anticoagulant factors in neonatal blood. The primary risk factors are the use of central venous catheters, and prematurity.…

Buprenorphine for neonatal abstinence syndrome

In a single-center randomized trial of term infants with neonatal abstinence syndrome, compared with infants who were managed with oral morphine, those who were managed with sublingual buprenorphine had a shorter duration of treatment (median of 15 vs 28 days),…

Recorded maternal voice reduces pain

In a single-center randomized trial in preterm infants undergoing a heel lance, infants who were exposed to a recording of their mother’s voice during the procedure had lower pain scores (using the Premature Infant Pain Profile) and less of a…

Placental transfusion in newborns needing resuscitation

A narrative review summarizes the current evidence on three different methods of placental transfusion in preterm and term infants who need resuscitation – delayed cord clamping, milking of the uncut umbilical cord, and milking of the cut umbilical cord. The…

Review – congenital diaphragmatic hernia

In a comprehensive, well-illustrated review the authors summarize the current literature on congenital diaphragmatic hernia (CDH). Prenatally, severity can be assessed by the lung to head ratio (LHR) and position of the liver. Delivery at term is preferred, and management at birth includes…

Donor breast milk vs formula – a randomized trial

In a double-blind multicenter trial very-low birth weight infants with inadequate supply of their mother’s own milk were randomly assigned to receive either donor breast milk with bovine fortifier or formula (for 90 days or until discharge). There were no…

Higher mortality in Medicaid infants with birth defects

An observational study from the CDC using birth certificate data analyzed infant mortality rate attributable to major birth defects (nearly 12 per 10,000 live births overall). Compared to infants covered by private insurance, deaths due to birth defects in Medicaid infants…

Medically complex children and transition to home

In a qualitative study from one tertiary center, 23 family members of children with complex medical conditions and 16 health professionals were interviewed to identify needs when transitioning such children from hospital to home. Families had needs in 7 domains…

Does early intervention for preterm infants work?

A randomized trial from Australia of 120 children born less than 30 weeks gestation compared the long-term effects (at age eight years) of early intervention versus standard care. The early intervention group received nine home visits over the first year of life…

Early low-dose hydrocortisone to prevent BPD

A multicenter double-blind randomized study from France of over 500 infants less than 28 weeks gestation compared the use of a ten-day course of intravenous hydrocortisone started by 24 hours after birth to placebo. Infants receiving hydrocortisone had a higher…

Dextrose gel to manage hypoglycemia

A single-center observational (pre-post) study reported outcomes of treatment of neonatal hypoglycemia before and after a practice change was implemented. Compared to hypoglycemic infants treated with feed supplementation alone (prior to the practice change), infants treated with dextrose gel in addition to feed supplementation…

High-flow nasal cannula for initial respiratory support

A multicenter randomized trial compared the use of high-flow nasal cannula (HFNC) versus nasal CPAP for respiratory support in preterm infants greater than 28 weeks gestation with respiratory distress who had not received surfactant. Treatment failure was defined as an…

Antenatal steroids for late preterm and early term gestations

A systematic review with meta-analysis was performed of randomized clinical trials in singleton pregnancies 34 weeks gestation or greater, that compared the use of antenatal corticosteroids versus placebo or no treatment. Six trials with nearly 6000 women were included, including women at 37…

Good neurodevelopmental outcome – associated factors

An observational study from Canada of over 2000 preterm infants less than 29 weeks gestation found that good neurodevelopmental outcomes on the Bayley III (composite score of 100 or more) were associated with the absence of three major morbidities –…

Zika virus guideline

Updated guidelines from the CDC recommend Zika virus testing for infants born to mothers who have laboratory features of  exposure to Zika virus and to infants who have clinical features of infection (microcephaly, intracranial calcifications, eye anomalies and other neurologic…

Multiple intubation attempts and IVH

A single-center retrospective study of over 300 infants less than 1500 grams birth weight found that infants with severe IVH had a higher number of intubation attempts in the first four days of life than infants with mild or no…

Human milk intake not associated with better developmental outcomes

Data from over 600 preterm infants who were 33 weeks gestation or less from five Australian perinatal centers were analyzed to identify association between exposure to human milk and neurodevelopmental outcomes. In multivariate analyses, neither the volume nor the duration…

Improving the care of neonatal abstinence syndrome

A single-center study reported the results of a coordinated program for neonatal abstinence syndrome, including standardized protocols for scoring, medications and weaning, and a calm rooming-in environment. Otherwise healthy infants were treated on the inpatient pediatric unit instead of in…

Delayed cord clamping improves motor function

A randomized trial of women delivering singleton fetuses before 32 weeks gestation compared the effects of delayed cord clamping (30-45 seconds) versus immediate (less than ten seconds) cord clamping. There were no differences in rates of intraventricular hemorrhage or late-onset…

Antenatal betamethasone for late preterm delivery

A multicenter randomized trial of singleton pregnancies at 34 – 36 week gestation compared placebo versus betamethasone (two doses, 24 hours apart). There were around 1400 infants in each group. In the betamethasone group fewer infants developed respiratory problems than…

Burden of venipuncture pain in the NICU

A prospective study of 495 neonates from 16 NICUs in France showed that the mean (SD) number of venipunctures was 3.8 (2.8) for all neonates, and 4.1 (2.9) for neonates less than 33 weeks. The range was 1-19 for all neonates…

Filtered sunlight to treat hyperbilirubinemia

A randomized controlled noninferiority trial from a single center in Nigeria compared, in infants with hyperbilirubinemia, the use of conventional phototherapy against filtered sunlight. Over two hundred infants were assigned to each group. Efficacy was defined as a slowing of…

Do transfusions cause NEC? Or is it the anemia?

A prospective multicenter cohort study of 600 VLBW infants studied the effect of RBC transfusions and anemia on the development of necrotizing enterocolitis and mortality. In a multivariable analysis, the rate of NEC was associated with severe anemia, but not…

Signs of CPAP failure after birth

An observational study from one center used the results of pulmonary function testing in 32 preterm infants stabilized on CPAP immediately after birth to compare patterns in infants who failed CPAP versus those who succeeded. Respiratory interventions were recorded starting…

Poor repeatability of echo findings of PDA

In a prospective observational study very low birth weight preterm infants clinically suspected to have a patent ductus were subjected to echocardiography. Two different observers each performed an echocardiographic and Doppler ultrasound examination within 30 minutes of the other. There…

Upper GI contrast for malrotation

A retrospective review of 166 neonates with bilious vomiting who underwent an upper gastrointestinal contrast study showed that only 14 (9%) had malrotation (confirmed at laparotomy). Of infants referred in the first three days of life, less than 1% had…

Moral distress in intensive care

Moral distress is anguish experienced when an individual makes a clear moral judgment about an action to take but is unable to act accordingly due to societal, institutional or contextual constraints. A systematic review of 13 studies on moral distress…

A summary of evidence on nutrition

An expert group has published a summary of the existing evidence on multiple aspects of neonatal nutrition and identified research priorities in this field. A couple of excerpts from this summary: “Current nutrient recommendations for preterm infants are based on…

LISA for RDS

A multicenter randomized controlled trial from Germany in infants 23 – 26 weeks with respiratory distress syndrome compared traditional surfactant administration following endotracheal intubation and positive pressure ventilation, versus less invasive surfactant administration (LISA) where surfactant was administered through a thin…