Weekly Updates #2

Recent things that I have noted:

Dennington D, Vali P, Finer NN, Kim JH: Ultrasound confirmation of endotracheal tube position in neonates. Neonatology 2012, 102(3):185-189. Bed-side ultrasound by the NICU team can confirm ETT position quickly and without radiation. This could be done out on transport, or in the delivery room as well as in the NICU, using handheld equipment with instant results.

Berry CA, Suki B, Polglase GR, Jane Pillow J: Variable ventilation enhances ventilation without exacerbating injury in preterm lambs with respiratory distress syndrome. Pediatr Res 2012. This confirms work in adult dogs, and shows less lung injury if you allow tidal volume to vary around an average value rather than keeping it identical for each breath. I thought of looking at this in babies a long time ago, but I realized that tidal volume already varies a lot, unless you have the baby paralyzed.

Newburger JW, Sleeper LA, Bellinger DC, Goldberg CS, Tabbutt S, Lu M, Mussatto KA, Williams IA, Gustafson KE, Mital S et al: Early developmental outcome in children with hypoplastic left heart syndrome and related anomalies: The single ventricle reconstruction trial. Circulation 2012, 125(17):2081-2091. 14 month follow up of an RCT comparing 2 different ways of doing the Norwood procedure. Bayley scores were not affected very much by how the procedure was done, or by other intra-operative management variables. They were mostly affected by innate patient variables (such as syndromes) and by patient morbidity over the first year of life. Bayley 2 MDI scores at 14 months averaged about 90, with 16% being below 70.

Beal J, Silverman B, Bellant J, Young TE, Klontz K: Late Onset Necrotizing Enterocolitis in Infants following Use of a Xanthan Gum-Containing Thickening Agent. J Pediatr 2012, 161(2):354-356. Even things that you think should be innocuous may be dangerous for preterm babies. This report documents a possible association between NEC and a milk thickening agent used for reflux. As previously noted, very few babies who have reflux need any treatment at all. Please don’t use something that might be toxic.

Parker M, Kamholz K, Brodsky D, Zuckerman B: Neonatal Intensive Care Unit Graduate Home Visit: A Learning Opportunity for Pediatric Interns. The Journal of Pediatrics 2012, 161(2):177-178.e171. What a good idea. Send pediatric residents to do home visits with families who have an ex-preterm infant to see what the home life of such a family is really like. We should do the same thing with families coping with children with impairments as well.

About keithbarrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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