Hartling L, et al. Benefits and Harms of Treating Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2013 (open access). A very comprehensive review, as is usual from this source, I can’t pretend to have read it all in detail, but the conclusions are: Treating GDM reduces macrosomia (which in turn leads to less shoulder dystocia), but not neonatal hypoglycemia, there is no real evidence of harm.
Ishii N, Kono Y, Yonemoto N, Kusuda S, Fujimura M, for the Neonatal Research Network J. Outcomes of Infants Born at 22 and 23 Weeks’ Gestation. Pediatrics. 2013. 36% of the infants born alive at 22 to 22 weeks 6 days survived to 3 years of age, and 63% of those born at 23 weeks. The rates of severe CP and moderate to severe developmental delay at 3 years were high among the 22 and 23 week infants. The survival rates are very impressive, we need to find ways to reduce impairments. They also present outcomes for more mature infants up to 25 weeks, and some summary data about in-hospital complications. The rates of BPD are incredibly low, only 30% at 23 weeks, severe intracranial hemorrhage was common at 22 and 23 weeks, over 20%, and a very high proportion had RoP requiring therapy, 30% right up to 25 weeks. This suggests some ways to reduce impairments, I don’t know if they use prophylactic indomethacin, but that intervention reduces severe hemorrhage, and PDA ligation without adverse effects, in a population with such a high risk of severe bleeds, that would be worth considering. Secondary analysis of the TIPP data showed in one high risk group (boys) that developmental outcomes were better with indomethacin treatment. Overall, it is true there was no effect on developmental delay, but the incidence of severe bleeds in the controls was much lower than this, 13%.
Corvaglia L, Aceti A, Mariani E, Legnani E, Ferlini M, Raffaeli G, et al. Lack of efficacy of a starch-thickened preterm formula on gastro-oesophageal reflux in preterm infants: a pilot study. The journal of maternal-fetal & neonatal medicine. 2012;25(12):2735-8. A cross-over study of a new formula with amylopectin. There were fewer reflux episodes, but no difference in total acid exposure of the lower esophagus, and no effect on non-acid reflux. One could ask ‘why bother?’ They start the article stating
Gastro-oesophageal reflux (GOR) is commonly diagnosed in preterm infants in neonatal intensive care units (NICUs); it is known to cause morbidity, prolong hospital stay and is associated with some relevant complications, such as aspiration of gastric content and oesophagitis.
I beg to differ. GOR is commonly diagnosed, yes: ‘known to cause morbidity’, little or no evidence. The authors state that they enrolled infants with ‘symptomatic’ reflux; the list of symptoms they give ’frequent regurgitations, post-prandial desaturations, chewing, hiccupping and back arching’ are not statistically more frequent in infants with more frequent GOR on esophageal impedance/pH monitoring than in infants with less frequent reflux.