Weekly updates #10

Vanderbilt DL, Schrager SM, Llanes A, Chmait RH: Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome. American Journal of Obstetrics and Gynecology 2012, 207(4):320.e321-320.e326. The authors followed children born after laser surgery, but only performed CNS imaging in those born before 32 weeks, and those more mature who had symptoms. So although described as a study of prevalence it is only a partial prevalence. There also wasn’t a standard protocol for imaging, so a 36 week infant with an cerebral infarct, who would be unlikely to have symptoms, which is not necessarily the case at all, might only have had an ultrasound, with a poor sensitivity for this kind of lesion. So not surprisingly the major risk factor for a cerebral lesion was prematurity.

Wheeler B, Broadbent R, Reith D: Premedication for neonatal intubation in Australia and New Zealand: A survey of current practice. Journal of Paediatrics and Child Health 2012:online. All Australian NICUs and transport teams give premedication prior to endotracheal intubation. Hooray! 80% of them have a written protocol. Hooray! More than half of them use morphine. Boo! (Morphine is the one opiate shown to not improve physiologic stability during intubation, its onset of action is 10 to 15 minutes, too slow for an acute procedure.)  Come on Aussies, you need to switch to something that works fast enough to reduce pain and improve stability during intubation.

Slater L, Asmerom Y, Boskovic DS, Bahjri K, Plank MS, Angeles KR, Phillips R, Deming D, Ashwal S, Hougland K et al: Procedural Pain and Oxidative Stress in Premature Neonates. The Journal of Pain 2012, 13(6):590-597. The authors measured indicators of oxidative stress before and after removing tape securing a dressing of a central line or arterial catheter. Signs of pain correlated significantly with indicators of oxidative stress.

Mann PC, Cooper ME, Ryckman KK, Comas B, Gili J, Crumley S, Bream EN, Byers HM, Piester T, Schaefer A et al: Polymorphisms in the fetal progesterone receptor and a calcium-activated potassium channel isoform are associated with preterm birth in an Argentinian population. J Perinatol 2012. We know that progesterone therapy reduces recurrence of preterm birth, this study suggests that prematurity is associated with an increased risk of having particular isoforms of the progesterone receptor, as well as a potassium channel. Also ethnic differences in these associations.

Grobman WA, Thom EA, Spong CY, Iams JD, Saade GR, Mercer BM, Tita ATN, Rouse DJ, Sorokin Y, Wapner RJ et al: 17 alpha-hydroxyprogesterone caproate to prevent prematurity in nulliparas with cervical length less than 30 mm. American journal of obstetrics and gynecology 2012. In this particular high-risk group without a previous delivery, (placebo controlled randomized trial in 660 pregnant women) progesterone didn’t work. About 25% had a preterm delivery in each group, confirming that they were indeed high risk.

About Keith Barrington

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