Author: GS

BOOST II trials results

The short-term outcomes of the BOOST II trials have been published. BOOST II consisted of three international randomized trials of over 2000 infants born before 28 weeks of gestation, in which the effects of targeting an oxygen saturation of 85 to…

SUPPORT and informed consent

The SUPPORT study has been criticized for not obtaining adequate informed consent. A defense of the informed consent consent obtained during SUPPORT emphasizes the clinical uncertainty and equipoise that existed at the onset of the trial (both of which justify the…

Complications of mechanical ventilation: new paradigm

The CDC has released a new set of definitions to allow hospitals to track complications related to mechanical ventilation, and to replace existing definitions of ventilator associated pneumonia. This change was meant to broaden the focus to all complications of…

Sudden unexpected postnatal collapse of healthy newborns

A study from Sweden reviewed all cases from five delivery units of late preterm and term infants who appeared to be healthy but collapsed within 24 hours of birth. Data from two and a half years were analyzed. The incidence of…

SUPPORT study: neurodevelopmental outcomes

Infants (24 – 27 weeks gestation) enrolled in the SUPPORT study were followed up. The composite outcome of death or neurodevelopmental impairment was assessed at 18 – 22 months corrected age. This study had a factorial design that compared early…

Supraglottic airway devices in resuscitation

A systematic review of studies of laryngeal masks and oropharyngeal airways during neonatal resuscitation found no studies about oropharyngeal airways. There were four studies of the use of laryngeal masks. Compared to bag and mask ventilation, infants given positive pressure…

Which formula you use for ultrasound estimation of fetal gestation matters

In a Swedish study three different formulae were applied to mid-trimester ultrasound measurements of fetal biparietal diameter and femur length in order to calculate gestational age in infants less than 27 weeks gestation. These estimates were compared to gestation determined…

Outcome of fetal echogenic bowel

A retrospective review from a single center was performed of all fetal ultrasounds that showed a fetal echogenic bowel. If the finding was an isolated one (around 40% of cases) then the outcome was uneventful. If it was associated with…

Pulse oximetry screening in the well-baby nursery

Pulse oximetry screening for the detection of critical congenital heart disease was implemented in a community hospital. Infants admitted to the well-baby nursery were screened with pulse oximetry at the time of newborn metabolic screening. Oxygen saturation readings in the…

Treating Coagulase-negative Staph – is a three-day course enough?

In a NICU in the Netherlands the duration of treatment for Coagulase-negative Staphylococcal sepsis was changed from seven days to three days, provided that there was clinical improvement within 48 h, the CRP value decreased, the platelet count was normal, and…

Self-reported health of ELBW infants in adolescence

Extremely low birth weight children born in the early 90’s were evaluated at age 14 and compared to normal birth weight controls. The ELBW adolescents rated their (self-reported) health similar to that of normal birth weight controls in areas such…

Shortage of doctors expected in the US

An article from the New York Times reports that, partly due to President Obama’s health care law, the US will have a shortage of over 60,000 doctors by 2015. This number will more than double by 2025. There is little…

Does PRBC transfusion increase the risk of NEC?

A systematic review with a meta-analysis of eleven observational studies evaluated whether PRBC transfusions were associated with an increased risk of NEC in the 48 hours following the transfusion. Most of these studies had a low or moderate risk of…

How dangerous is neonatal hyperbilirubinemia?

From a national cohort of Danish children, infants 35 weeks or greater gestation with a serum bilirubin of 25 mg/dl or higher in the first three weeks of life were studied, and compared with a matched control group. Infants with intermediate or…

Hyperglycemia in preterm infants: should we use insulin for tighter glucose control?

A randomized study from New Zealand of hyperglycemic preterm infants compared the use of insulin to achieve tight glycemic control (blood glucose target 72 – 108 mg/dl, 4 – 6 mmol/L)  to more restrictive usage of insulin (target blood glucose range  144…

Neonatal abstinence syndrome: health-care expenditures

Data from large national US databases showed that neonatal abstinence syndrome increased almost three-fold between 2000 and 2009. The mean hospital charge per infant increased from $39,000 to $53,000 over this time. More than three-quarters of the charges were attributed…

MRSA and MSSA in preterm infants

A study from the NICHD Neonatal Research Network describes the frequency and impact of infections with MRSA and with methicillin-sensitve staph aureus (MSSA) in VLBW infants. One percent of all infants had a MRSA infection. MRSA infections varied across centers…

The fetal smile

Fetuses smile, even though they have no social reason to. A case series from Japan describes 31 fetuses between 22 to 30 weeks of gestation who were noted to have smiles during four-dimensional ultrasonography. There were 51 smiles noted. The…

Surfactant administration with a thin catheter inserted into the trachea

A randomized trial tested a new method of administering surfactant to preterm infants that avoids positive pressure ventilation. In spontaneously breathing infants surfactant was administered through a thin catheter is inserted into the trachea under laryngoscopy. Infants treated this way had…

Caffeine for apnea of prematurity: five-year outcomes

Does caffeine therapy for apnea of prematurity improve long-term neurodevelopmental outcome? In a study reporting the five-year follow up results of the randomized placebo-controlled Caffeine for Apnea of Prematurity (CAP) trial in babies 500 – 1250 grams, the combined outcome…

Do preterm infants get enough iodine in the NICU?

How much iodine does a preterm infant receive during  a typical NICU stay? To estimate this, investigators from Boston measured the iodine content of preterm formulas, donor breast milk, human milk fortifiers, and parenteral nutrition solutions. Using these measurements they…

Hypertension during follow-up of extremely preterm infants

Blood pressure data from a Swedish national population-based cohort of extremely preterm infants who survived were analyzed. At the age of 2.5 years 44% of the 68 extremely preterm infants had a systolic blood pressure at or above the 90th…

Posthemorrhagic hydrocephalus: management patterns

In this study from the Hydrocephalus Clinical Research Network, data were analyzed from 110 neonates consecutively treated for post-hemorrhagic hydrocephalus in preterm infants. Almost two-thirds of the patients underwent a temporizing procedure such as a ventricular reservoir or a subgaleal…

Catheter-related sepsis in ELBW infants

In a retrospective cohort study from Canadian NICUs of babies less than 29 weeks gestation or less than 1000 grams birth weight who had a percutaneously placed central venous catheter, around 20% of babies developed catheter-related sepsis. The rate of…

Hypoglycemia in at-risk babies

In this study from New Zealand, low glucose levels developed in over half of babies > 35 weeks gestation who had risk factors for hypoglycemia. Almost 20% had severe hypoglycemia and almost 20% had more than one episode of hypoglycemia.…

Presenting information to help parents decide: how much detail and what order ?

When volunteers were presented a hypothetical scenario of a 23 week gestation infant and asked to choose either intensive care or comfort care, they chose similarly, irrespective of whether they were presented information in more detail or less, and whether…

Early feeding of preterm growth-restricted infants

A randomized trial from the UK found that, compared to delayed initiation of enteral feeds (on day 6), early initiation (on day 2), lead to infants achieving full enteral feeds sooner, shorter duration of parenteral nutrition, less cholestasis. There was…

Nursing excellence and outcomes of VLBW infants

Hospitals that had received recognition for nursing excellence (RNE) had better outcomes in VLBW infants (lower mortality, lower infection rates, lower severe intraventricular hemorrhage) in an analysis of data from the Vermont Oxford Network. Association between hospital recognition of nursing…

Long-term outcomes after whole-body hypothermia

Outcomes were assessed at 6 – 7 years. There was no significant difference in the composite outcome of death or IQ < 70. Death rates were lower with hypothermia and disability rates were not increased in survivors. Childhood outcomes after…