Author: GS

Heart rate at birth measured by pulse oximetry versus electrocardiography

Concurrent readings of heart rate immediately after birth as detected by pulse oximetry and EKG electrodes were compared in 53 neonates (both term and preterm infants were included). The leads or sensor were applied as soon as possible after birth…

Impact of routine surveillance for MRSA

A single-center study reported the results two years before and two years after routine MRSA surveillance was introduced. The rate of MRSA blood-stream infection was 3.8 per 1000 neonates in the pre-surveillance period and 5.3 per 1000 neonates during the…

Suprapubic aspiration versus urethral catheterization

A randomized trial in 80 preterm newborn infants compared two methods of obtaining urine specimens – suprapubic aspiration and urethral catheterization. Only uncircumcised boys were studied. Each infant’s face and upper body were videotaped for five minutes before and five minutes…

Tongue color during resuscitation

An observational study from Australia tried to determine whether the color of an infant’s tongue predicted the need for supplemental oxygen during neonatal resuscitation. The tongue color was visually assessed by midwives and pediatric trainees at one to seven minutes…

Cooling for HIE – longer and deeper is not better

A randomized factorial-design trial from the Neonatal Research Network compared the effects of cooling babies with HIE to lower levels than  usual (32 degrees C instead of 33.5 degrees C) and for longer than usual (120 hours instead of 72…

Location of birth and outcomes of extremely preterm infants

The EPICURE 2 study from the UK of babies born at 22 – 26 weeks gestation in 2006 found that only 56% of such infants were born in centers with level 3 NICUs. Ten percent were born in level 1…

Gastric residuals in preterm infants

A randomized trial in preterm infants compared outcomes in infants 24 – 32 weeks gestation in whom gastric residuals were routinely checked prior to every feed versus those in whom residuals were not checked. An algorithm guided all other aspects…

Occlusive wrap to prevent heat loss at birth

A multicenter randomized study in 39 NICUs (the largest trial of its kind) compared the effects of applying polyethylene occlusive wrap to preterm infants between 24 – 27 weeks gestation immediately after birth. The study was stopped early when 50%…

Antenatal magnesium sulfate and school-age outcomes

ACTOMgSO4 was a randomized multicenter trial from Australia and New Zealand, comparing magnesium sulfate with placebo given to pregnant women expected to deliver before 30 weeks gestation. Early-childhood outcomes of this trial showed a reduction in cerebral palsy with magnesium…

Outbreak investigation and control of SSSS

A report from the UK describes how an outbreak of Staphylococcal scalded skin syndrome was investigated and managed. Eight neonates were affected over a period of three months. Clinical and microbiologic investigation was performed of affected infants, unaffected infants, the…

The unborn smoker

A large retrospective population-based cohort study from Canada compared pregnancy outcomes in pregnant women who smoked to those who did not. Active smokers had a significantly higher rate of preterm delivery (almost double) and intrauterine fetal demise (almost five times).…

Facial recognition software to detect neonatal pain

To study whether computerized recognition of facial expressions can accurately detect neonatal pain, researchers from Brazil obtained nearly 6000 facial images from 30 neonates in the resting state and when undergoing painful procedures. These images were then analyzed by computer…

Structured ethical decision-making in a NICU

A study from the Netherlands describes how a NICU implemented a structured approach to multidisciplinary discussions and decisions for difficult ethical decisions. Meetings were chaired by an ethicist and a special online form was used to guide the discussions and summarize…

Benefits of umbilical cord milking

A systematic review and meta-analysis of seven randomized trials of umbilical cord milking compared to control conditions found the following benefits in preterm infants less than 33 weeks gestation – a higher hemoglobin and hematocrit, reduction in oxygen requirement at…

Infusion of TPN into the liver from malpositioned umbilical venous catheters

A case series from a single center describes five neonates who had parenteral nutrition inadvertently infused into the liver from malpositioned umbilical venous catheters. Presenting features were abdominal distension, hemodynamic instability and anemia. Diagnosis was confirmed by ultrasound which showed…

Spontaneous intestinal perforation, prophylactic indomethacin and early feeds

An observational study of nearly 16,000 extremely-low-birth-weight infants analyzed the rates of spontaneous intestinal perforation in extremely-low-birth-weight infants, some of whom were exposed to prophylactic indomethacin or early feedings, or both. In those treated with prophylactic indomethacin, the risk of SIP…

RBC transfusion variability in NICUs

A retrospective analysis of data from four NICUs that were following the same RBC transfusion guidelines showed wide variability in the number of RBC transfusions administered, from 5 per 1000 NICU days to 22 per 1000 NICU days. NICUs with…

Do term infants with bilious vomiting require urgent referral?

A retrospective analysis of 163 term infants who had bilious emesis in the first week of life found that 14% had a surgical condition that required immediate management. Overall, approximately half of these infants had a surgical condition. Abnormal abdominal…

Grief reactions of fathers of NICU babies

A study from Iran assessed 120 fathers of preterm babies who were hospitalized in the NICU. These fathers were administered an anticipatory grief scale. All reported anticipatory grief reactions, the most common being unremitting mental engagement with the infant and…

Long-term outcomes of total body hypothermia

The Total Body Hypothermia for Neonatal Encephalopathy (TOBY) randomized trial previously showed beneficial effects with therapeutic hypothermia at 18 months follow-up. The infants in these trial were followed until 6 – 7 years of age. Infants undergoing hypothermia treatment were…

Lung ultrasound findings in meconium aspiration syndrome

In the first published description of lung ultrasound findings in meconium aspiration syndrome, a series of six neonates with meconium aspiration syndrome underwent lung ultrasound in the first few hours after birth. Dynamic findings noted on ultrasound were: B-pattern (interstitial)…

Umbilical venous catheters – often misplaced

A retrospective analysis of 51 neonates with an umbilical venous catheter in place compared the location of the catheter tip as assessed on radiographs with assessment by targeted neonatal echocardiography (TNE). Almost 40% of the UVCs were inside the heart…

Vancomycin dosing regimens – validation needed

A prospective observational study of vancomycin trough levels using two different dosing regimens in over 200 neonates found that vancomycin trough levels of less than 10 mg/L were quite common (70% of trough levels were below this level). These suboptimal…

Fentanyl – a review

A review article on fentanyl summarizes the literature on this drug in neonates. Fentanyl, a synthetic opioid, acts by agonist binding to the mu and kappa opiod receptors. It is metabolized by CYP3A4 in the liver. It provides rapid analgesia,…

The first Cesarean section ever?

A woodcut image from 1549 depicts how the god Apollo performed a post-mortem Cesarean section (perhaps the first-ever) on a nymph called Coronis to deliver a baby who would be named Asclepius and would become the god of medicine. The birth…

Ten tips for interacting with parents of NICU babies

The emotional and psychological needs of parents of NICU babies are often not addressed by NICU health professionals, even when the medical care of the infants is optimal. A checklist of ten items is offered in  a special article that…

Lung-protective respiratory support in preterm infants

Lung injury in preterm infants receiving respiratory support can be decreased by avoiding: (1) Atelectrauma by promoting alveolar stability, (2) Volutrauma by limiting tidal volume to prevent alveolar overdistension, and (3) Oxitrauma by minimizing oxygen toxicity by improving ventilation-perfusion matching.…

Outcome of infants less than 500 grams birth weight

A retrospective review of admissions to a NICU with a birthweight of less than 500 grams found that that proportion of liveborn infants weighing less than 500 grams increased from 0.1% to 0.2% over the years. These infants (n =…

The birth of gossip

In the early days the word ‘gossip’ referred to women who were present with a woman in labor. An image from a 17th century midwifery book depicts a scene with such women. Eventually the meaning of the word ‘gossip’ appears…

On being present, not perfect

A TED talk “On Being Present, Not Perfect” by Elaine Meyer, PhD addresses difficult conversations in healthcare such as conveying serious diagnoses, disclosing medical errors, and ethical quandaries at the end-of-life care. These conversations are the bedrock of the patient-health professional relationship.  When they go poorly, patients’ outcomes, trust, and satisfaction can suffer. Dr. Meyer illustrates the profound gaps in healthcare communication and how to close them. She introduces their Institute’s educational philosophy of the “one room schoolhouse” and shares the Wizard of Oz metaphor to describe the key ingredients of honest, direct, and genuine conversations.

https://www.youtube.com/watch?v=phUUjk_btiY

Severe hyperbilirubinemia and its effects

A retrospective review of over half a million births at a gestation of 35 weeks or greater over a 16-year period found that the incidence of severe hyperbilirubinemia (total serum bilirubin 30 mg/dl or higher) was 9 per 100,000 births. The…

Incidental discovery of nonparentage – to disclose or not?

When newborns and children undergo laboratory tests, the results occasionally indicate that one of the supposed parents cannot be the genetic parent that he or she is supposed to be. Such incidental findings of nonparentage can cause considerable distress to…

Infant stool color cards to screen for biliary atresia

Late diagnosis of biliary atresia, which presents with jaundice and acholic stools, can lead to liver failure and liver transplantation. The use of an infant stool color card that can be used by the parents to detect acholic stools at…

Better documentation in the inpatient medical record

An expert group recently issued recommendations on documentation in the inpatient electronic health record. They acknowledge common problems with the note such as ‘note-bloat’ (increased length and complexity of a note with a decrease in the meaningful content and decrease…

Amino acid intake in extremely preterm infants

A randomized trial from Italy in extremely preterm infants receiving TPN compared the routine use of 2.5 grams per kg per day of amino acids to 4 grams per kg per day, with equal non-protein energy. Each group had almost…

Initial treatment of hydrocephalus: shunt versus third ventriculostomy

A retrospective analysis of over five thousand infants treated for hydrocephalus across multiple institutions compared the results of endoscopic third ventriculostomy (ETV) versus shunt therapy. Infants undergoing ETV had a higher rate of operative failure at one year of age…

Adenovirus infections in neonates

A retrospective cohort study of 26 neonates with adenoviral infection (over a 17 year period) found that the most common presentations were respiratory signs and temperature instability. Treatment with ribavirin, cidofovir or intravenous immune globulin did not appear to improve…

The costs of prematurity

A review of published literature since 1990 summarized the results of eighteen studies reporting the costs of prematurity. These studies varied in methodology and in the types of subjects included. There was considerable variability across studies in costs within the…

MRSA colonization and risk of infection

A systematic review of studies that reported the prevalence of MRSA colonization on admission to the NICU and PICU, and of MRSA infection, found that the overall prevalence of colonization on admission was 2%. In the NICU, around 6% of…

Nasal trauma from nasal cannulae versus CPAP

A randomized trial compared the incidence and severity of nasal trauma in preterm infants less than 32 weeks gestation managed with either nasal CPAP or with heated humidified high-flow nasal cannulae in the seven days after extubation. Nasal trauma was…