Neonatal updates

Potijk MR, Kerstjens JM, Bos AF, Reijneveld SA, de Winter AF: Developmental Delay in Moderately Preterm-Born Children with Low Socioeconomic Status: Risks Multiply. The Journal of pediatrics 2013, 163(5):1289-1295. The team in Groningen have been publishing fascinating data about the outcomes of moderately preterm infants for a while. This new article points out the importance of social circumstances in determining outcomes of these infants born at 32 to 36 weeks. Developmental delay at 4 years of age was a frequent as 12.6% among the infants with low socio-economic status, compared to only 5.6% among those with a high status.

Koroglu OA, Yalaz M, Levent E, Akisu M, Kultursay N: Cardiovascular Consequences of Bronchopulmonary Dysplasia in Prematurely Born Preschool Children. Neonatology 2013, 104(4):283-289. At 2 to 4 years of age, there were still abnormalities of function of both ventricles, and increased pulmonary artery pressures in babies who had BPD.

Cristea AI, Carroll AE, Davis SD, Swigonski NL, Ackerman VL: Outcomes of Children With Severe Bronchopulmonary Dysplasia Who Were Ventilator Dependent at Home. Pediatrics 2013, 132(3):e727-e734. I have never sent a baby home on a ventilator because of BPD, I guess things are different in some parts of the world. Over 27 years 102 babies with BPD went home in Indiana in their home ventilation program. 81% of them survived, 2/3 were weaned from their ventilator, almost all of those being weaned before 5 years of age. The children were frequently in and out of hospital. The prevalence of home ventilation for BPD has been increasing in that state.

Govande VP, Brasel KJ, Das UG, Koop JI, Lagatta J, Basir MA: Prenatal counseling beyond the threshold of viability. J Perinatol 2013, 33(5):358-362. This study reviewed how much parents understood once they had received their antenatal counselling. The more mature the babies were, the less parents knew about the potential for long term problems. Nice to see a study that doesn’t just look at the extremely immature infant. But I am not sure what to do with this information, should we try and make sure that all families are worried about something that happens less and less frequently, or, better, find a way to inform them without causing more stress. And how do we do that when the understanding of proportions and percentages is so poor? We need some education aids to make this process work better. They could (should) be designed by parent groups!

Verhagen AA, Janvier A: The Continuing Importance of How Neonates Die. JAMA Pediatr 2013:-. A brief viewpoint article from Eduard Verhagen and Annie, which points out that most deaths of neonates in the developed world occur in NICUs, and that the mode of death (that is whether a decision about LSI withdrawal or withholding precedes the death) is an important issue when mortality is reported or compared.

About Keith Barrington

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