Category: Outcomes

T-piece versus self inflating bag for resuscitation of VLBW infants

In a prospective multi-center observational study from Brazil of almost 2000 infants with a birth weight less than 1500 grams, compared to infants who received positive pressure at birth with a self-inflating bag (with no PEEP valve), those who received…

WWLST in VLBW Neonates

A retrospective 18-center analysis of data on very low birth weight infants found that discussions about withholding or withdrawal of life-sustaining therapy (WWLST) occurred more often in infants 22 – 24 weeks gestation (27%) than in those 27-28 weeks (6%). There…

Donor breast milk vs formula – a randomized trial

In a double-blind multicenter trial very-low birth weight infants with inadequate supply of their mother’s own milk were randomly assigned to receive either donor breast milk with bovine fortifier or formula (for 90 days or until discharge). There were no…

Higher mortality in Medicaid infants with birth defects

An observational study from the CDC using birth certificate data analyzed infant mortality rate attributable to major birth defects (nearly 12 per 10,000 live births overall). Compared to infants covered by private insurance, deaths due to birth defects in Medicaid infants…

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…

Early low-dose hydrocortisone to prevent BPD

A multicenter double-blind randomized study from France of over 500 infants less than 28 weeks gestation compared the use of a ten-day course of intravenous hydrocortisone started by 24 hours after birth to placebo. Infants receiving hydrocortisone had a higher…

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…

Good neurodevelopmental outcome – associated factors

An observational study from Canada of over 2000 preterm infants less than 29 weeks gestation found that good neurodevelopmental outcomes on the Bayley III (composite score of 100 or more) were associated with the absence of three major morbidities –…

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…

Delayed cord clamping improves motor function

A randomized trial of women delivering singleton fetuses before 32 weeks gestation compared the effects of delayed cord clamping (30-45 seconds) versus immediate (less than ten seconds) cord clamping. There were no differences in rates of intraventricular hemorrhage or late-onset…

Antenatal betamethasone for late preterm delivery

A multicenter randomized trial of singleton pregnancies at 34 – 36 week gestation compared placebo versus betamethasone (two doses, 24 hours apart). There were around 1400 infants in each group. In the betamethasone group fewer infants developed respiratory problems than…

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…

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…

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…

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…

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…

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…

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…

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…

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.…

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…

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…

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…

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…

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…

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).…

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…

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-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 =…

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…

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…

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…

Fluconazole prophylaxis: a randomized trial

A randomized blinded multicenter trial studied the effects of prophylactic fluconazole in babies less than 750 grams birth weight. Fluconazole (6 mg/kg/day) was given twice a week for 42 days. Control infants received placebo. The composite primary end point of…

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…