Weekly updates 15

Lacey DJ, Stolfi A, Pilati LE: Effects of hyperbaric oxygen on motor function in children with cerebral palsy. Annals of Neurology 2012  Hyperbaric oxygen really, really doesn’t work for treating cerebral palsy. This is the second good trial of hyperbaric oxygen (HBO) in CP, the previous having being performed in Montreal. What I find interesting about this is that the first trial was performed by a group which included one of the enthusiasts of HBO. Even after the first study was clearly negative, showing no benefit whatsoever (for infants with CP of being exposed to HBO treatment compared to controls who had pressurized air as the placebo therapy), Dr Marois participated in a movie trying to promote it. The movie was called ‘medicine under the influence’ (actually médecine sous influence’) an appalling piece of crap of movie making which berated doctors as being under the influence of some sort of malign force (it was never identified in the movie, but I think it could be called ‘science’) which stopped them from helping poor families who were suffering as a result of neonatal intensive care. The first study was an excellent trial published in the lancet, and clearly showed no effect of HBO. This new trial is also a very high quality trial, again published in a very high quality peer reviewed journal, and again shows no effect.

I guess there is one positive effect of HBO in cerebral palsy, it makes money for people running HBO services! Apart from that, there is no rational basis for using HBO for CP, and there should be no more studies.

Poets A, Urschitz MS, Steinfeldt R, Poets CF: Risk factors for early sudden deaths and severe apparent life-threatening events. Archives of Disease in Childhood – Fetal and Neonatal Edition 2012, 97(6):F395-F397. I have been very fortunate in my career to meet and become friends with a number of interesting people who have made great contributions to neonatal care. I often refer to them in posts on this blog, but one I don’t think I have mentioned before is Christian Poets. This is another of his important studies. There are several full term babies who die every year, suddenly and unexpectedly soon after a normal delivery. Annie and I have reported one case,  and there are now a few regional studies examining the incidence of this terrible disaster. This current study was by a team which examined a series of reported cases, and identified risk factors, specifically a primiparous mother, and the baby in a position which was potentially risky. This later factor was defined as ‘lying prone on the breast or abdomen of its mother or close to her in a side position’. Most of the babies were in such a position (25 of 29 cases) but these are commonly used positions anyway (67% of controls). It seems very likely to me, and our case would support this, that the majority of these occurrences are asphyxial events occurring when the mother is exhausted after her delivery (mothers were twice as likely to be asleep when the event occurred as controls), and the baby has a rebreathing and/or airway occlusion episode which is not recognized until the baby is severely ill. Preventing such cases is probably possible by making sure that the mother and baby are under observation whenever the baby is in such a position, and if ever she falls asleep to ensure that the baby is on their back on a firm surface.

Boland RA, Davis PG, Dawson JA, Doyle LW: Predicting death or major neurodevelopmental disability in extremely preterm infants born in Australia. Archives of Disease in Childhood – Fetal and Neonatal Edition 2012. Many of you will be aware of the ‘Tyson calculator’ which estimates mortality and survival without major disability with data that are readily available prior to extremely preterm delivery. The calculator was constructed with data from the NICHD network, and the Melbourne group (not them again!) have looked at whether the calculator is accurate for their patients also. The calculator was indeed accurate for estimating survival of inborn infants, but overestimated severe impairment.

Ang JY, Lua JL, Mathur A, Thomas R, Asmar BI, Savasan S, Buck S, Long M, Shankaran S: A Randomized Placebo-Controlled Trial of Massage Therapy on the Immune System of Preterm Infants. Pediatrics 2012. There are number of small randomized trials of massage of preterm infants. Most have shown some benefit, but the outcomes are different in each study, so it is difficult to be sure what the benefits in real life might be. One thing that seems a little more consistent is a increase in weight gain, which you could hypothesize a mechanism for, the movements might increase muscle mass, and there are also some suggestions that bone mass might increase, again a physical therapy with effects on body composition seems feasible. How on earth massage might have effects on the immune system I have no idea, and in fact the primary outcome of the proportion of NK cells was not affected. A secondary outcome of increased NK cell cytotoxicity was increased in the massage group, but as always, secondary outcomes should be treated with suspicion. Weight gain was also increased in the massage group, again a secondary outcome, but consistent with several other studies.

About Keith Barrington

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