Weekly Updates #19

Scattolin S, Gaio P, Betto M, Palatron S, De Terlizzi F, Intini F, Visintin G, Verlato G: Parenteral amino acid intakes: Possible influences of higher intakes on growth and bone status in preterm infants. J Perinatol 2013, 33(1):33-39. This was an RCT in 115 babies less than 1250 grams birth weight enrolled in the 1st 3 days of life to receive a standard of 3 g/kg compared to 4 g/kg per day. There was no overall difference in non-protein energy intake, the actual eventual intakes were quite a bit lower than the 3 or 4 grams planned. Even so the high protein group had more weight gain, grew more in length and had better bone mineralization. This is more evidence that we are not giving enough protein to our preterm infants (see previous blog post here ), and that giving more protein might be a safe way to improve growth outcomes.

Thankavel PP, Rosenfeld CR, Christie L, Ramaciotti C: Early echocardiographic prediction of ductal closure in neonates <30 weeks gestation. J Perinatol 2013, 33(1):45-51. This seems sort of self-evident, but its nice to have some actual figures to confirm. Bigger PDAs are less likely to close than smaller ones. The way the authors evaluated size is not, I think, standard, but makes a lot of sense, rather than a measure in millimeters, they compared the size of the PDA to the Left pulmonary artery.  So if you are less than 28 weeks and the PDA is more than half the size of the LPA, only 9% are closed without therapy at 10 days. Now we could do with an RCT in this high risk group to see if earlier attempted closure with ibuprofen improves any clinical outcomes.

Le Compte AJ, Lynn AM, Lin J, Pretty CG, Shaw GM, Chase JG: Pilot study of a model-based approach to blood glucose control in very-low-birthweight neonates. BMC Pediatr 2012, 12(1):117. I was thinking of doing this myself, so it must have been a good idea. There are data in older ICU kids that using a computer algorithm to decide on changes in insulin therapy for hyperglycemia can be safer and lead to more normal sugar values (I have blogged about this before) This new publication shows that after introducing a computer based algorithm for extremely immature babies with hyperglycemia, there was no hypoglycemia, and more nomoglycemia.

Bissuel M, Deguines C, Tourneux P: [a national survey on pain management before tracheal intubation in neonates in french type iii maternity units.]. Arch Pediatr 2012(0). Thsi survey shows that many units in France are still not premedicating before routine endotracheal intubations, and even those that are are largely using medications that have either never been studied, have been inadequately studied, or are ineffective! (sufentanil, ketamine, midazolam, and propofol). A few years the French were ahead of other countries in premedication practice, but the situation appears to have stagnated.

About Keith Barrington

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