Weekly Updates #21

Van Hus JW, Jeukens-Visser M, Koldewijn K, Geldof CJ, Kok JH, Nollet F, Van Wassenaer-Leemhuis AG: Sustained developmental effects of the infant behavioral assessment and intervention program in very low birth weight infants at 5.5 years corrected age. The Journal of pediatrics 2013(0). Long term follow up of an RCT of an early intervention program for preterm infants. about 180 infants were randomized to post-discharge intervention or control, which lasted for 6 months. At 5.5 years there appear to be significant benefits form the program among the 136 infants reviewed, fewer babies with an IQ below 85, as well as better motor skills. Most programs have not shown benefits persisting this long in the past.

Jiang P, Smith B, Qvist N, Nielsen C, Wan JM-F, Sit W-H, Jensen TK, Wang H, Sangild PT: Intestinal proteome changes during infant necrotizing enterocolitis. Pediatr Res 2013. This proteome analysis of parts of bowel from preterm infants with NEC which were necrotic and parts which were adjacent yet unaffected, showed expression of heat-shock proteins was enhanced, and several other proteins were also affected. This might be important, or it might not, I am not sure how the expression of such proteins in necrotic parts of bowel is affected just by them being necrotic… It would be nice to know how they were affected as the necrosis was progressing, but that of course is impossible.

Bharadwaj SK, Vishnu Bhat B: Therapeutic hypothermia using gel packs for term neonates with hypoxic ischaemic encephalopathy in resource-limited settings: A randomized controlled trial. Journal of Tropical Pediatrics 2012, 58(5):382-388. Therapeutic hypothermia for term infants with encephalopathy can be done cheaply and safely. This study shows that even using cheap simple methods it is still effective; in an RCT of 130 babies, survival without severe disability (at 6 months) was better when the babies where cooled with gel packs than the controls. Asphyxia is a major cause of death and disability in the developing world, this cheap intervention could make a big difference.

van den Broek MPH, Rademaker CMA, van Straaten HLM, Huitema ADR, Toet MC, de Vries LS, Egberts ACG, Groenendaal F: Anticonvulsant treatment of asphyxiated newborns under hypothermia with lidocaine: Efficacy, safety and dosing. Archives of Disease in Childhood – Fetal and Neonatal Edition 2013. Some centers use lidocaine frequently as an anticonvulsant in the newborn. This study documents the reduced clearance of lidocaine under hypothermia, and does suggest that it is effective. We really need better studies of comparative effectiveness of anticonvulsants and of long term outcomes.

About Keith Barrington

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