Category: Neurology

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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,…

Variation in the management of post-hemorrhagic hydrocephalus

In a survey of pediatric neurosurgical units and pediatric surgery units in Germany, surgeons were asked about their management of preterm infants with post-hemorrhagic hydrocephalus. Many of the units treated less than ten such infants each year. There was wide…

Maternal-child interaction and developmental outcome

A prospective study of 48 babies born before 28 weeks gestation assessed the association of maternal-child interactions with neurodevelopmental outcome. The maternal-infant interaction was assessed when the infants were two years of corrected age, in a structured play situation using…

How much evidence exists about neonatal seizure management?

A systematic review of all articles listed in Pubmed upto 2011 describing treatment of neonatal seizures (only studies with seizures confirmed electrographically were included) found there was scant evidence to support choice of treatments for neonatal seizures. Only two randomized…

Acidemia plus hypercapnia increases the risk of IVH

An observational study of extremely low birth weight babies looked at the association between acidemia, hypercapnia and severe intraventricular hemorrhage. Rates of severe IVH were higher in infants with a high base deficit (defined as a median base deficit of…

MRI after hypothermia treatment

A case series of neonates with hypoxic-ischemic encephalopathy who underwent a cranial MRI between 5 – 14 days of life reports test accuracy characteristics of MRI scans with minor or no brain injury detected on imaging. Of 52 infants who…

High sound levels inside incubators

A simulation study assessed the sound levels in a Giraffe Omnibed incubator using a dummy infant and advanced sound assessment equipment. Various conditions that NICU infants might be exposed to when on a high frequency jet ventilator were simulated (incubator…

NIDCAP in preterm infants

A review summarizes the results of nine randomized controlled trials comparing the Newborn Individualized Development Care and Assessment Program (NIDCAP) to standard care in preterm infants less than 33 weeks gestation. A total of 503 infants were included in the…

Dexamethasone and brain volume in extremely preterm infants

A geographic cohort of babies born at less than 28 weeks in 1991-1992 in Australia was assessed at age 18. Brain volume was calculated using T1 weighted magnetic resonance imaging. Around one-third of these infants had received postnatal dexamethasone for…

Neurodevelopmental outcome after intraventricular hemorrhage

An Australian regional cohort study of nearly 1500 babies born at 23 – 28 weeks gestation reports the rates of moderate to severe neurosensory impairment in babies with intraventricular hemorrhage. After multivariate analysis, compared to babies without IVH, the rates…

Prognostic tests in HIE

A systematic review of prognostic tests in term infants with hypoxic ischemic encephalopathy included 29 studies of 13 different tests to predict long-term neurologic sequelae or death. Amplitude-integrated EEG and visual evoked potentials had the best sensitivity and specificity (around…

Neonatal hypocalcemia: presentation and outcomes

A case series of 78 term infants with an ionized calcium of less than 1 mmol per liter found that their median age was eight days, and they consisted of disproportionately more males and Hispanic babies. Most presented with seizure-like…

Newborn odor and maternal-infant bonding

Using fMRI, investigators measured the brain responses of women when exposed to newborn infants’ body odors. The newborn odors were presented to the women using cotton undershirts worn by newborn infants for the first two days after birth. The odors…

Japanese outcome data for babies born at 22 – 23 weeks gestation

A study from the Japanese Neonatal Research Network, from 48 NICUs, reports the rates of death and neurodevelopmental outcomes (at age three) of infants between 22 – 26 weeks of gestation. Survival without neurodevelopmental impairment or only mild impairment at…

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…

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…

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…

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…

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…