Weekly updates #6

van der Ham DP, van der Heyden JL, Opmeer BC, Mulder AL, Moonen RM, van Beek JH, Franssen MT, Bloemenkamp KW, Sikkema JM, de Groot CJ et al: Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol 2012(0). This is a follow-on to the trial I mentioned a few weeks ago, another  cohort of 200 women were randomized using the same protocol as PPROMEXIL, that is they were eligible if they had ruptured membranes, they were between 34 and 37 weeks and did not go into labour within 24 hours of membrane rupture (so some 17% of them ruptured before 34 weeks then were randomized when they passed 33 6/7. The were either induced or allocated to expectant management. They confirmed no differences in any outcome between groups. The expectant managament group only gained about 3.5 days of pregnancy on average. The authors also updated a meta-analysis of all similar trials in the discussion section (a practice that should be encouraged) which confirms no differences in neonatal sepsis or other outcomes.

Medeiros LF, Souza ACd, Souza Ad, Cioato SG, Scarabelot VL, Caumo W, Fernandes LC, Torres ILS: Fentanyl administration in infant rats produces long-term behavioral responses. International Journal of Developmental Neuroscience 2012, 30(1):25-30.
This is a bit concerning. 1 dose of fentanyl or ketamine to rats on day 14 of life led to behavioural changes that persisted into adulthood. Don’t know what that means for our babies, but we need to continue collecting data.

The latest issue of the Australian pediatric journal Paediatrics and Child Health has a number of interesting and well written pieces. (I am glad the Aussies know how to spell, unfortunately I keep forgetting, too long in North America I guess…must remember…oedema… haemoglobin…paediatrics….)  Nick Evans’ review of the therapy of PDA, Peter Dargaville and David Tingay’s review of lung protective ventilation, and Colm O’Donnel (who has outdone himself with the title of his review of neonatal resuscitation, I don’t know any other quotes of David Bowie songs in the neonatal literature)  Turn and face the strange – ch..Ch..Ch..Changes to neonatal resuscitation guidelines in the past decade are all to be particularly recommended.

About Keith Barrington

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