Neonatal Updates #40

Oops, the last one was #40, except it wasn’t, this is the real #40, as we are heading to a big blog threshold soon, I will probably stop numbering these!

Field D: Neonatal ECMO Study of Temperature (NEST): A Randomized Controlled Trial. Pediatrics 2013. This was a UK multi-centre randomized trial of controlled hypothermia during ECMO, with just over 100 babies randomized, the 2 year outcomes showed that somewhat more babies died in the cooling arm, and the developmental scores were slightly lower with cooling than normothermia. Although none of the differences were significant, there is no evidence of benefit. I certainly thought this was worth studying, and that it might well be beneficial, it just shows again how important it is to do good trials like this one.

Wadhawan R, Oh W, Hintz SR, Blakely ML, Das A, Bell EF, Saha S, Laptook AR, Shankaran S, Stoll BJ et al: Neurodevelopmental outcomes of extremely low birth weight infants with spontaneous intestinal perforation or surgical necrotizing enterocolitis. J Perinatol 2013. We have known for a while that NEC is bad for your long term outcome, and that surgical NEC is worse; the data regarding spontaneous intestinal perforations  (SIP) has been less consistent, but worrying. This is probably the largest follow up study of SIP with nearly 300 cases, and nearly 500 surgical NEC. Both were bad, the SIP babies were a little less mature than the surgical NEC, but their long term outcomes were similarly worse than controls without SIP or NEC. The plot of the Odds ratios for neurological impairment or developmental delay on multiple logistic regression are revealing, SIP and surgical NEC are both serious risk factors for poor outcomes, with Odds similar to postnatal steroids, BPD, severe IVH and PVL.

Infantino BJ, Mercer DF, Hobson BD, Fischer RT, Gerhardt BK, Grant WJ, Langnas AN, Quiros-Tejeira RE: Successful Rehabilitation in Pediatric Ultrashort Small Bowel Syndrome. The Journal of pediatrics 2013, 163(5):1361-1366. If after a case of NEC (or for any other reason) you end up losing your bowel, make sure you are looked after by a multi-disciplinary intestinal rehabilitation team like this one. These authors report that after very prolonged intensive therapy they were able to get half of their babies, who had less than 20 cm of small bowel left, off TPN. It took up to 4 years, and many of the babies had surgery, sometimes more than once, but succesful TPN weaning, when the remaining bowel is this short, is a real success.

Konduri GG, Sokol GM, Van Meurs KP, Singer J, Ambalavanan N, Lee T, Solimano A: Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure. J Perinatol 2013. This is a secondary analysis of the early versus late iNO therapy. The original analysis showed no major difference between the groups. This analysis suggests that starting treatment earlier leads to improved outcomes.

About Keith Barrington

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