Weekly Updates #16

Sarajuuri A, Jokinen E, Mildh L, Tujulin A-M, Mattila I, Valanne L, Lönnqvist T: Neurodevelopmental burden at age 5 years in patients with univentricular heart. Pediatrics 2012. This study followed infants with univentricular lesions, both hypoplastic left heart syndrome and other single ventricles. about a quarter had major neurodevelopmental dysfunction in both groups, full-scale IQ was lower in patients with HLHS and with single ventricle than controls. One thing I found very interesting were the actual numbers, median IQ was 97 for HLHS, 112 for single ventricle and 121 for the controls. 121! I guess the Finns are very smart people.

Shin M, Kucik JE, Siffel C, Lu C, Shaw GM, Canfield MA, Correa A: Improved survival among children with spina bifida in the united states. The Journal of Pediatrics 2012, 161(6):1132-1137.e1133. Survival to one year of age of infants born with spina bifida continues to improve in the USA, up to 93% overall, there are unexplained ethnic differences in survival (it is over 96% in white families), and survival is lower if the baby also has a serious congenital heart disease, or a high lesion, cervical or thoracic, or if born with very low birth weight.

Lee SK, Ye XY, Singhal N, De La Rue S, Lodha A, Shah PS, for The Canadian Neonatal N: Higher altitude and risk of bronchopulmonary dysplasia among preterm infants. Amer J Perinatol 2012(EFirst). NICUs that were over 400m altitude had more babies with BPD after correcting for all the usual things than NICUs at less than 400m. I think the reliance on diagnosing BPD based on oxygen need is probably the issue here: you may also need more ventilation and O2 and therefore have more lung damage to keep the saturations at usual acceptable levels during the first days of life, but you will then also need some more oxygen to keep the alveolar PO2 at the same level as if you were at sea level. Don’t know what to do about this though, we should all move to the coast.

Natalucci G, Becker J, Becher K, Bickle GM, Landolt MA, Bucher HU. Self-perceived health status and mental health outcomes in young adults born with less than 1000 g. Acta Paediatrica. 2012 As Annie (Janvier) has said many times, we have thousands of publications detailing how screwed up preterm infants are (that is literally tue, there are thousands). In contrast very few studies of how to help them. This balance has changed in many fields, but not yet in neonatology. In contrast there is a growing recognition that most preterm infants turn out just fine! It is easier to write a paper saying that the proportions of preterm infants who have problems is increased by X%, but to recognize that most are functioning at a very acceptable to very high level is harder for people to state. The first sentence of the conclusions of this paper does have that balance, it starts, ‘Health status and mental health of former ELBW adults were overall satisfying. ‘

A similar comment starts ‘what does this mean’ section of the editorial by Michael Msall recently published in Acta. ‘First, the large majority of ELBW survivors (83%) are free of
neurosensory disability. Thus, unprecedented survival without major neurosensory disability can be expected.’ the editorial was commenting on the paper from Maureen Hack’s group, Litt JS, Taylor HG, Margevicius S, Schluchter M, Andreias L, Hack M: Academic achievement of adolescents born with extremely low birth weight. Acta Paediatrica 2012 which detailed the intellectual outcomes of 14 year olds who were babies born at less than 1 kg, that study noted yet again the specific difficulties with mathematics that are more frequent among former extremely preterm infants. They note that such infants might well benefit from specific interventions to improve these skills, but they don’t give any reference to such a program. It is about time we found ways to improve these outcomes, which are already very good, to further benefit our tiniest patients.

About Keith Barrington

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