Neonatal Updates #37

Hough JL, Johnston L, Brauer S, Woodgate PF, Schibler AF: Effect of body position on ventilation distribution in ventilated preterm infants. Pediatric Critical Care Medicine 2013, 14(2):171-177. Regional ventilation was measured using computed impedance tomography. The researchers found no effect of gravity on the distribution of ventilation, consistent with their previous work in infants on CPAP or health term babies. The babies were not very sick, with mean O2 requirements of 26%, and no difference in oxygen needs when they were placed prone or supine. It is frequent in babies with sick lungs to find that their oxygen needs a reduced in prone position, perhaps gravity has an effect on the distribution of perfusion, which becomes important in improving VQ matching when the lungs are sick. There are also fewer desaturation events in prone position.

Kidokoro H, Neil JJ, Inder TE: New mr imaging assessment tool to define brain abnormalities in very preterm infants at term. American Journal of Neuroradiology 2013. One of the difficulties in assessing the literature regarding MRI imaging in the preterm infant is that everyone reports them differently, so it is difficult or impossible to compare them. What we need is some sort of standardized reporting system. Behold! Terrie Inder and her group have come up with just that. Lets hope it catches on.

Filippa M, Devouche E, Arioni C, Imberty M, Gratier M: Live maternal speech and singing have beneficial effects on hospitalized preterm infants. Acta Paediatrica 2013, 102(10):1017-1020. Cool: Sick preterm babies have fewer apneas and hypoxic events when their mothers sing to them or talk to them.

Serce O, Benzer D, Gursoy T, Karatekin G, Ovali F: Efficacy of saccharomyces boulardii on necrotizing enterocolitis or sepsis in very low birth weight infants: A randomised controlled trial. Early Human Development 2013 Just over 200 VLBW babies were randomized to a probiotic fungus or control. No benefits were shown, either in reduction of NEC or in sepsis or mortality.

Ruano R, da Silva MM, Campos JA, et al: Fetal pulmonary response after fetoscopic tracheal occlusion for severe isolated congenital diaphragmatic hernia. Obstetrics & Gynecology 2012, 119(1):93-101 It is starting to look like this might actually work. The group in Sao Paolo are now reporting some outcomes from two small randomized trials, with a total of  just over 70 patients randomized. Fetuses had very severe pulmonary hypoplasia, with an observed to expected Lung/Head ratio below 25% and the liver herniated. Only 5% of the controls survived, and over 50% of the intervention group. The particular technique used requires a fetoscopic laryngoscopy, with occlusion of the trachea by balloon, followed, usually by an EXIT procedure, although they have sometimes done a second fetoscopy to remove the balloon. The report of the second trial is free access and has neat pictures. The same group has also done some earlier procedures also with some success. With this approach the gestational age at delivery was pretty close to term on average at 35 + weeks, which is also better than previous reports. If other centers can replicate this success, then we are on our way.

About Keith Barrington

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