Neonatal Updates

Kapadia VS, Chalak LF, Sparks JE, Allen JR, Savani RC, Wyckoff MH: Resuscitation of preterm neonates with limited versus high oxygen strategy. Pediatrics 2013. This trial randomized infants 24 to 34 weeks of age who needed to be resuscitated. Infants (44 per group) started on room air or on 100% oxygen and then were progressively changed, in order to progressively achieve reasonable saturation goals. The high oxygen babies only received extra oxygen, compared to the low oxygen babies for about 9 to 10 minutes, but they still had more signs of oxidative stress, and more respiratory problems after birth, they were more likely to get diagnosed with BPD. I think this was intended to be a pilot for a larger clinical trial, and was powered for the oxidative stress outcomes, rather than clinical. Nevertheless it does show that the impact of changing the initial FiO2 appears to be quite substantial. Certainly gives more reason for doing a larger trial with clinical primary outcomes.

Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE, Huskins WC, Livingston R, Saiman L, Smith PB et al: Catheter dwell time and CLABSIS in neonates with piccs: A multicenter cohort study. Pediatrics 2013. The longer you leave a central catheter the higher the total infection rate. That is obvious, what is not so obvious is if there is any sort of threshold after which infections increase, if so you could say that after 20 days (for example) the daily sepsis rate increases, so it is best to remove the catheter. This study showed the opposite, that after about 18 days of gradually increasing daily sepsis rate, the frequency levels off. So you should ensure every day that you really need the catheter, but there is no magic number of days at which the catheter starts to become more risky.

Westin V, Stoltz Sjöström E, Ahlsson F, Domellöf M, Norman M: Perioperative nutrition in extremely preterm infants undergoing surgical treatment for patent ductus arteriosus is suboptimal. Acta Paediatrica 2013. Most preterm infants receive less nutrition than they need. Tnis study shows that preterms needing PDA ligation in Sweden are among the most disadvantaged.

About Keith Barrington

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