Category: Uncategorized

Human milk intake not associated with better developmental outcomes

Data from over 600 preterm infants who were 33 weeks gestation or less from five Australian perinatal centers were analyzed to identify association between exposure to human milk and neurodevelopmental outcomes. In multivariate analyses, neither the volume nor the duration…

RSV in the NICU

A prospective observational study from Australia used PCR to detect the presence of respiratory syncytial virus in specimens obtained from swabs of the nose, hands and personal clothing of visitors and healthcare workers in the NICU. These swabs were obtained…

Natriuretic peptides to diagnose significant PDA

A systematic review was performed of the diagnostic test accuracy of brain natriuretic peptide (BNP) or amino-terminal pro-B-type natriuretic peptide (NT-proBNP) for the diagnosis of hemodynamically significant patent ductus arteriosus. Ten studies were included for BNP. The summary estimate for sensitivity…

Pressure ulcers in the NICU

A prospective observational study from a level III NICU determined the incidence of pressure ulcers in NICU patients. Designated nursing staff (skin champions) examined the skin of all NICU patients from head to toe on admission and then once in…

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…

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 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…

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

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…

Time to culture positivity in infants less than 90 days

A retrospective study of infants aged 0 to 90 days who were evaluated for serious bacterial infection looked at the time to detection of positive blood, urine and cerebrospinal fluid cultures. Positive cultures were identified in less than 36 hours…

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…

Do single room NICUs cause sensory deprivation?

A prospective cohort study compared infants assigned to be managed within single rooms versus an open ward within the same hospital. Infants were assigned based on availability of staff and space and remained in their assigned space from admission until…

Early TPN in VLBW infants

A randomized trial compared three parenteral nutritional regimens in VLBW infants that were all started at birth. The control group received amino acid alone (2.4 grams per kg per day of AA). One intervention group received the same amount of…

Endotracheal intubation in NICUs: room for improvement

An observational study of endotracheal (oral) intubations from five US NICUs found that of 450 intubation attempts, only 37% were successful on the first attempt. The majority (83%) of successful intubations were accomplished by the third attempt. Success rate was…

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…

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…

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.…

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…