Author: GS

Inhaled budesonide to prevent BPD

A multicenter randomized trial from Europe in infants 23 – 27 weeks tested the efficacy of inhaled budesonide compared to placebo. The medication was initiated within 24 hours of birth and continued until 32 weeks post-menstrual age or until discontinuation…

Treatment of hypoglycemia with dextrose gel

A single-center randomized trial of babies greater than 35 weeks gestation at high risk for hypoglycemia, who had blood glucose less than 47 mg/dl in the first 48 hours of life compared treatment with 40% dextrose gel massaged into the…

Cortisol levels in septic shock

The levels of serum cortisol and cortisol precursors in 30 term or near-term infants with blood-stream infection and refractory shock were compared with levels in 30 similar infected infants without shock. Compared to the control infants, infants with shock had…

Maternal vitamin D supplementation to protect against infant deficiency

  A randomized trial evaluated the effect of 3 dosage levels of vitamin D supplementation in pregnant women from 13 – 24 weeks gestation until eight weeks postpartum with no infant supplementation. Infant serum 25(OH)D levels were evaluated at eight weeks…

Videolaryngoscopy for intubation

A single-center randomized trial compared intubation of neonates (in the delivery room or in the NICU) by trainees using a videolaryngoscope where the screen was visible to the instructor in the intervention group and invisible in the control group. The…

Strategies to wean off nasal CPAP

A pilot randomized study compared four methods of weaning a baby off nasal CPAP – abruptly taking a baby off CPAP and placing on high-flow nasal cannula at 6 lpm (Group 1); abruptly taking a baby off CPAP to either…

The Apgar Score

A recent statement by the AAP and ACOG emphasizes the following about the Apgar score: It does not predict mortality or neurologic outcome in an individual infant. It alone should not be used to diagnose asphyxia – it is not…

Interventions to reduce neonatal and child mortality

A comprehensive overview of nearly 150 published systematic reviews of experimental and observational studies assessed interventions to prevent perinatal/neonatal and child mortality and classified them as effective, promising or ineffective. Effective interventions were: antenatal corticosteroids to prevent neonatal respiratory distress syndrome in…

Music therapy in the NICU

The acoustic environment of the NICU can be very stressful to neonates, especially preterm infants. However reduction of noise alone is not sufficient. Provision of the right acoustic and auditory environment is required. Music therapy offers considerable promise to improve…

Is resuscitation of preterm infants with room air risky?

In a retrospective cohort study of infants less than 27 weeks gestation from 17 Canadian NICUs, when compared to infants resuscitated with 100% oxygen, infants resuscitated with less than 100% (typically 21-40%) oxygen had a higher rate of severe neurologic injury or death (adjusted…

Vindication for the SUPPORT trial

Investigators of the SUPPORT trial have been criticized and accused (by parents and by the Office of Human Research Protection) of causing harm to babies enrolled in the trial even though this study was approved by multiple institutional review boards.…

Measuring heart rate during resuscitation

A simulation study compared the accuracy and time to detection of various heart rates detected either by umbilical palpation, listening to tapping of heart rate, or auscultation. While these methods were fairly accurate and timely in detection of heart rates…

Effects of hypoxemia or bradycardia in extremely preterm infants

An analysis of data from the multicenter (25 centers) Canadian Oxygen Trial of over 1000 infants 23 to 27 weeks gestation looked at the association between episodes of hypoxemia (oxygen saturation <80%) or bradycardia (pulse rate <80/min) for 10 seconds…

Inserting umbilical catheters: birth weight vs body measurement

A randomized trial from one center compared the percentage of umbilical catheters that were accurately placed when the catheter was placed using a birth-weight based formula for calculating the insertion depth versus using a graph based on shoulder-umbilicus length. There was…

The effect of rudeness on team performance

A randomized trial in a simulated setting assessed the effects of rudeness on performance of a NICU team that had to respond to a case scenario of a preterm infant with acute deterioration due to necrotizing enterocolitis. A putative external…

Outcomes of pregnancies delivered at 23 weeks

A prospective cohort study of pregnancies delivered at 23 weeks gestation from women admitted to one of sixteen Canadian tertiary perinatal units included 248 women and 287 infants. The rate of Cesarean section was 11%, and 40% of women had…

RSV in the NICU

A prospective observational study from Australia used PCR to detect the presence of respiratory syncytial virus in specimens obtained from swabs of the nose, hands and personal clothing of visitors and healthcare workers in the NICU. These swabs were obtained…

Bi-PAP vs CPAP

Low birth-weight nfants (n = 22) recovering from respiratory distress syndrome and requiring CPAP for greater than 24 hours were randomized to receiving CPAP either with bi-level nasal CPAP or conventional nasal CPAP (there was no blinding of interventions). Their…

Home influences on child development

The PHIME project (Public health impact of long-term, low-level, mixed element exposure in susceptible population strata) evaluated the association between low-level prenatal mercury (Hg) exposure through maternal fish consumption and child neurodevelopment in a coastal area of the north east…

Ventilatory control in chronic lung disease

In a prospective observational study of preterm infants less than 29 weeks gestation (part of the prematurity and respiratory outcomes project, PROP), infants who were either on supplemental oxygen or room air through a nasal cannula were subjected to a…

EEG characteristics that predict outcome in HIE

A systematic review of studies in term neonates with hypoxic-ischemic encephalopathy assessed the diagnostic accuracy of background features of the EEG in identifying future neurodevelopmental outcome. Data were extracted from 31 eligible studies and meta-analyzed. Definitions for burst suppression, low…

Status of screening for critical congenital heart disease

Critical congenital heart defects (CCHD) occur in approximately two of every 1000 live births. Screening with pulse oximetry can help in early detection and treatment of CCHD. All 50 US state CCHD newborn screening programs were surveyed on CCHD newborn…

Relationship between maternal and neonatal creatinine

A retrospective study of 157 neonates less than 30 weeks gestation from one center compared the first neonatal serum creatinine level with the maternal creatinine in the 48 hours prior to delivery. The mean first neonatal creatinine level (0.9 mg/dl) was significantly higher…

Accuracy of transcutaneous bilirubin measurement

A cross-sectional study from 27 newborn nurseries over two 2-week periods compared transcutaneous bilirubin values to serum bilirubin values obtained within two hours of the transcutaneous value. Only 11% of all transcutaneous values had a concurrent serum bilirubin value available. The mean difference between…

Heparin flushes prolonged peripheral IV catheter patency

A randomized trial compared the use of flushes with 1 ml of heparinized saline (10 U of heparin per ml) versus 1 ml of normal saline in maintaining the patency of peripheral intravenous catheters in neonates > 32 weeks gestation…

CPAP for Preterm Infants

A review article summarizes the available evidence on nasal CPAP and discusses implications for developing countries. Key points of this review are: In preterm infants less than 28 weeks gestation whose mothers have received antenatal steroids, CPAP is the preferred…

Neonatal arterial stroke

A prospective cohort study of 100 full-term neonates with neonatal arterial ischemic stroke from Switzerland found the incidence of this condition to be 13 per 100,000 live births. Most (80%) were unilateral strokes and most occurred on the left side.…

Morphine vs clonidine for neonatal abstinence syndrome

A small randomized trial compared the use of morphine versus clonidine for the treatment of neonatal abstinence syndrome. Compared to infants randomized to morphine (n = 15), infants treated with clonidine (n =16) had a shorter duration of treatment (median of…

Does the RAM cannula deliver adequate CPAP?

An in-vitro study using an artificial airway model compared the mean airway pressure delivered by two types of devices, each attached to a ventilator – a standard nasal CPAP interface with the nares fully occluded, and RAM cannulae. The RAM…

The ideal admission temperature in preterm infants < 33 weeks of gestation

Submitted by: Krithika Lingappan, MD A retrospective observational study of nearly 10,000 neonates neonates  <33 weeks of gestation from 29 NICUs in the Canadian Neonatal Network sought to estimate the admission temperature associated with lowest rates of adverse outcomes. The…

Delay in increase of delivered oxygen during resuscitation

During neonatal resuscitation, when positive pressure ventilation is delivered through a T-piece resuscitator and the fraction of inspired oxygen is increased at the oxygen blender, it may take some time before the infant actually receives the increased FiO2.  In a…

How long should we treat for CMV infection?

A randomized trial in almost 100 infants with symptomatic congenital cytomegalovirus infection compared the effects of treatment with valganciclovir for six months versus six weeks. The primary outcome of hearing in the better ear did not change significantly from baseline…

Routine glycerine suppositories in preterm infants

A single-center randomized trial evaluated the effect of daily (from day 2 – 14) glycerin suppositories in infants with a birth weight of 1000 – 1500 grams compared to similar infants receiving no intervention. Each arm had 25 infants. The time…

Prediction of respiratory morbidity in BPD

A cohort study of preterm infants 23 – 28 weeks gestation from the UK studied the ability of three methods to predict respiratory outcomes at 24 months corrected age as assessed by respiratory health questionnaires. The three methods were: A BPD…

Changes in intestinal microbiome prior to onset of NEC

A case control study evaluated the patterns of the intestinal microbiome prior to the development of NEC in 12 infants and compared these with the patterns in 26 control infants without NEC. Fecal samples were collected from all these infants…

Sustained lung inflation at birth

A randomized trial of babies 25 – 28 weeks gestation compared two methods of initial stabilization after birth – nasal CPAP alone versus sustained lung inflation followed by nasal CPAP. Infants receiving the sustained lung inflation had a lower incidence of mechanical…

Increased protein intake and neurodevelopmental outcomes

A prospective cohort study compared neurodevelopmental outcomes in extremely-low-birth-weight infants (less than 1000 grams birth weight), before and after a regimen of increased protein intake (according to international consensus recommendations) was introduced. The Bayley-III was used for assessment. A significant improvement in early growth…

Risk factors for morbidity in term neonates

A prospective two-year cohort study of term neonates without major congenital anomalies determined the antepartum and intrapartum factors associated with a composite measure of neonatal morbidity, defined as one or more of the following: hypoxic ischemic encephalopathy, meconium aspiration with pulmonary…

Natriuretic peptides to diagnose significant PDA

A systematic review was performed of the diagnostic test accuracy of brain natriuretic peptide (BNP) or amino-terminal pro-B-type natriuretic peptide (NT-proBNP) for the diagnosis of hemodynamically significant patent ductus arteriosus. Ten studies were included for BNP. The summary estimate for sensitivity…

Pressure ulcers in the NICU

A prospective observational study from a level III NICU determined the incidence of pressure ulcers in NICU patients. Designated nursing staff (skin champions) examined the skin of all NICU patients from head to toe on admission and then once in…