Weekly Updates #20

My endnote database got corrupted partway through the week, I nearly had a “crise de nerfs” and it took most of a day to put right… the final solution wasn’t that difficult, but I tried about 15 other things first. I think having a huge database and a synchronisation program between 3 different computers may be the problem. All of this to say that when the database was fixed the last few additions were out of order, so I might have missed some good stuff this week.

Bekhof J, Reitsma JB, Kok JH, Van Straaten IH: Clinical signs to identify late-onset sepsis in preterm infants. Eur J Pediatr 2012:1-8. The authors studied 187 episodes of possible sepsis, and evaluated 21 clinical signs.   They then went back to see which kids actually were septic (including some culture-negative sepsis) and compared the signs between septic and non-septic babies.   Increased respiratory support, capillary refill, grey skin and central venous catheter were the most important signs associated with sepsis. Clinical signs that were too non-specific to be useful were temperature instability, apnoea, tachycardia, dyspnoea, hyper- and hypothermia, feeding difficulties and irritability. They produce an algorithm that allows you to calculate the possibility of sepsis. There are not many good studies that have done anything like this before.

Ceelie I, de Wildt SN, van Dijk M, van den Berg MM, van den Bosch GE, Duivenvoorden HJ, de Leeuw TG, Mathot R, Knibbe CA, Tibboel D: Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery: A randomized controlled trial. JAMA 2013, 309(2):149-154. Babies randomized to intravenous paracetamol (that’s acetaminophen to the N Americans) needed a lot less morphine that the controls, about 1/3 as much. we need a preparation available in Canada.

Moran PM, Hawkes CP, Dempsey EM, Ryan CA: T-piece gas flow palpation as a clinical indicator of endotracheal intubation in neonates. Eur J Pediatr 2012:1-4. The neonatal group in Cork keep doing very interesting studies which may change how we do resuscitations, (conflict of interest alert, 2 of the authors are my very good friends!) in this study they showed that when there is a tidal volume of 5 mL or more, just by holding you wrist next the exhalation flow of the Neopuff you can usually tell if there is a breath, and it is more obvious at 10 mL, so one way to tell if you think the baby is intubated in the right place.

Romero R, Korzeniewski SJ: Is there a long-term price to pay for infants not exposed to the stress of labor? How the microbiome and the immune system can affect our lives. Am J Obstet Gynecol 2012(0). This is an editorial accompanying a review article Cho CE, Norman M: Cesarean section and development of the immune system in the offspring. American Journal of Obstetrics and Gynecology 2012 (0). which both suggest that being born by C section isn’t so benign after all. It may increase the risk of developing immune diseases such as asthma, allergies, type 1 diabetes, and celiac disease. Some of this may be due to abnormal neonatal microbiome development. Maybe all babies born by C-section should get probiotics too!

About Keith Barrington

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