Category: All articles

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…

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…

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…

Racial disparity in previable birth

A population-based retrospective cohort study of over a million live births in Ohio from 2006 to 2012 found that 0.25% of births occurred between 16 – 22 weeks (previable births). Compared to white mothers, black mothers had a three to…

Zinc deficiency in neonates and their mothers

Maternal zinc supplementation is associated with a decreased frequency of infections in infants in the first six months of life, and in low-income women it may reduce the risk of preterm birth. Neonates who are preterm, small for gestational age…

Heart rate assessment immediately after birth

A systematic review that included eighteen studies of heart rate assessment after birth found that palpation and auscultation were the least accurate methods of heart rate detection during resuscitation, that pulse oximetry was superior, and that the electrocardiogram was the…

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…

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…