Weekly updates #4

Ok not even nearly weekly, but I am now back from vacation, and after clearing though my inbox pressing the delete button several hundred times, I am ready to start posting again.

van der Ham DP, Vijgen SM, Nijhuis JG, van Beek JJ, Opmeer BC, Mulder AL, Moonen R, Groenewout M, van Pampus MG, Mantel GD et al: Induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks: A randomized controlled trial. PLoS Med 2012, 9(4):e1001208.
536 women with ruptured membranes at 34 to 37 weeks were randomized. In many hospitals currently labour is induced in these circumstances. This study found no advantage of induction compared to expectant management.

Weisman LE, Leeming AH, Kong L: Approriate antibiotic therapy improves ureaplasma sepsis outcome in the neonatal mouse. Pediatr Res 2012.
As study in a neonatal mouse model of ureaplasma sepsis. Azithromycin was much more successful than erythromycin for eliminating ureaplasma, and this improved survival. I rarely treat ETT ureaplasma infections, and when I do it seems to be very difficult to eliminate them, maybe I have been using the wrong antibiotic!

Choi WW, McBride CA, Bourke C, Borzi P, Choo K, Walker R, Nguyen T, Davies M, Donovan T, Cartwright D et al: Long-term review of sutureless ward reduction in neonates with gastroschisis in the neonatal unit. Journal of Pediatric Surgery 2012, 47(8):1516-1520. This technique I think has been a major advance, what we call here umbilical flap closure, and this article calls sutureless ward reduction. This article shows that about 50% can be reduced using this method, and that the babies do very well. They do it mostly on non-intubated patients, and 3/4 remain extubated after the procedure. We are more ‘aggressive’ I think, with many of our babies requiring ventilation after the procedure, but we are able to reduce a larger proportion of the cases without going to the OR. Recovery times appear to be shorter, but maybe they are the less severe lesions…

Petraglia AL, Moravan MJ, Dimopoulos VG, Silberstein HJ: Ventriculosubgaleal shunting – a strategy to reduce the incidence of shunt revisions and slit ventricles: An institutional experience and review of the literature. Pediatric Neurosurgery 2011, 47(2):99-107. There is enormous variation between institutions in the frequency and indications for shunts for post hemorrhagic hydrocephalus. Part of this may be because of varying frequencies of complications, and how the individual surgeon weighs the balance between complications and benefits.  A new-ish technique which shunts to the subgaleal space appears to be a good temporizing measure, and has low complication and infection rates.

About Keith Barrington

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