Neonatal Updates #33

McElroy SJ, Underwood MA, Sherman MP: Paneth Cells and Necrotizing Enterocolitis: A Novel Hypothesis for Disease Pathogenesis. Neonatology 2013, 103(1):10-20. (free access)I think this is an interesting idea that might be fruitful for the future. If the hypothesis is correct, it might explain some of the efficacy of probiotics and of lactoferrin. And it might give a target for future preventive therapies. This is not one of those Monty Python type theories, but seems to have significant evidence to support it.

Thayyil S, Sebire NJ, Chitty LS, Wade A, Chong W, Olsen O, Gunny RS, Offiah AC, Owens CM, Saunders DE et al: Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 2013(0). Study which compared autopsy findings to findings on what was called minimally invasive autopsy. This consisted of a whole body MRI with some needle sampling to obtain cultures. The minimally invasive method was quite accurate for the fetus, and the newborn (less so for older children). Autopsy rates have been declining, often leaving us with many unanswered questions. This might be a good alternative if we can’t get consent for full autopsy, which seems to be more and more difficult.

Jenke AC, Zilbauer M, Postberg J, Wirth S: Human beta-defensin 2 expression in ELBW infants with severe necrotizing enterocolitis. Pediatr Res 2012, 72(5):513-520. This molecule, Hbd2, is part of the innate immune system of the neonate. Levels were high in chorio-amnionitis, and were also high in most cases of NEC, in the most severe cases the levels were low, suggesting maybe a failure of immune defenses in the worst cases.

Rios DR, Welty SE, Gunn JK, Beca J, Minard CG, Goldsworthy M, Coleman L, Hunter JV, Andropoulos DB, Shekerdemian LS: Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease. Pediatrics 2013. Evidence that supports what many of us have long thought, that head ultrasounds are useless for screening for congenital CNS anomalies. They are OK for finding central cerebral hemorrhagic lesions, but for trying to see if there are CNS malformations, or subtle white matter abnormalities, don’t bother. Get an MRI instead… if you need to know.

The following series of articles are from a new issue of Seminars of Fetal and Neonatel Medicine, all about perinatal palliative care, and all interesting, and generally well written.

Mancini A, Kelly P, Bluebond-Langner M: Training neonatal staff for the future in neonatal palliative care. Seminars in Fetal and Neonatal Medicine 2013, 18(2):111-115.

Larcher V: Ethical considerations in neonatal end-of-life care. Seminars in Fetal and Neonatal Medicine 2013, 18(2):105-110.

Woodroffe I: Supporting bereaved families through neonatal death and beyond. Seminars in Fetal and Neonatal Medicine 2013, 18(2):99-104.

Craig F, Mancini A: Can we truly offer a choice of place of death in neonatal palliative care? Seminars in Fetal and Neonatal Medicine 2013, 18(2):93-98.

Carter BS, Jones PM: Evidence-based comfort care for neonates towards the end of life. Seminars in Fetal and Neonatal Medicine 2013, 18(2):88-92.

Laing IA: Conflict resolution in end-of-life decisions in the neonatal unit. Seminars in Fetal and Neonatal Medicine 2013, 18(2):83-87.

Cacciatore J: Psychological effects of stillbirth. Seminars in Fetal and Neonatal Medicine 2013, 18(2):76-82.

Breeze ACG, Lees CC: Antenatal diagnosis and management of life-limiting conditions. Seminars in Fetal and Neonatal Medicine 2013, 18(2):68-75.

About Keith Barrington

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