Neonatal Updates #32

Cevey-Macherel M, Forcada Guex M, Bickle Graz M, Truttmann AC: Neurodevelopment outcome of newborns with cerebral subependymal pseudocysts at 18 and 46 months: A prospective study. Archives of Disease in Childhood 2013. It is not rare to find these cysts. They are found where the germinal matrix used to be, and I thought they were probably of no consequence. This follow up of 74 infants with the cysts is reassuring. But they did find more associated diseases than I would have expected, 8 with congenital CMV, and 9 with other conditions. That is probably more than you would expect for a group of randomly selected infants without the cysts, so a careful evaluation and maybe a routine urine (or saliva) CMV is probably warranted.

Payne AH, Hintz SR, Hibbs AM, Walsh MC, Vohr BR, Bann CM, Wilson-Costello DE, Eunice Kennedy Shriver National Institute of Child H, Human Development Neonatal Research N: Neurodevelopmental outcomes of extremely low-gestational-age neonates with low-grade periventricular-intraventricular hemorrhage. JAMA Pediatr 2013, 167(5):451-459. NICHD network follow up of 270 preterm VLBW infants with grade 1 or grade 2 hemorrhages. Compared to preterm controls with no hemorrhage the low grade hemorrhage had no effect on 18 to 20 month outcomes. That is what we have said to parents for along time, even though there have been some intermittent suggestions that there might be minor effects of these small hemorrhages. this looks like very reliable data. The authors do state that they think that later outcomes should be examined, which is always the right thing to say, but to be honest if the Bayley at 18 months doesn’t show a difference, its very unlikely that later more appropriate tests of cognition are going to show anything.

Rogowski JA, Staiger D, Patrick T, Horbar J, Kenny M, Lake ET: Nurse staffing and nicu infection rates. JAMA Pediatr 2013, 167(5):444-450. The authors tried to examine something which is very difficult to have a good scientific study, but I think they did a really good job. comparing staffing levels to guielines, then measuring the incidence of infection.  I will quote their results ‘Hospitals understaffed 31% of their NICU infants and 68% of high-acuity infants relative to guidelines. To meet minimum staffing guidelines on average would require an additional 0.11 of a nurse per infant overall and 0.34 of a nurse per high-acuity infant. Very low-birth-weight infant infection rates were 16.4% in 2008 and 13.9% in 2009. A 1 standard deviation-higher understaffing level (SD, 0.11 in 2008 and 0.08 in 2009) was associated with adjusted odds ratios of 1.39 (95% CI, 1.19-1.62; P< .001) in 2008 and 1.40 (95% CI, 1.19-1.65; P <.001) in 2009.’

So not enough nurses, more infections.

About keithbarrington

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