Neonatal Updates

Alderliesten T, Lemmers PMA, van Haastert IC, de Vries LS, Bonestroo HJC, Baerts W, van Bel F: Hypotension in Preterm Neonates: Low Blood Pressure Alone Does Not Affect Neurodevelopmental Outcome. The Journal of pediatrics 2014. In this observational study of very preterm infants who had recording of blood pressure and of cerebral oxygenation by NIRS, having a low BP was not related to poorer long term outcome, but having a reduced cerebral oxygenation was, regardless of the blood pressure. Should NIRS be routine in the NICU? Perhaps we should have a prospective randomized trial (Gorn Griesen has already suggested this), the big problem is, when the cerebral oxygenation is low, what should we do about it? Do we have an intervention that will reliably increase cerebral oxygen delivery?

Peterson C, Ailes E, Riehle-Colarusso T, et al.: Late detection of critical congenital heart disease among us infants: Estimation of the potential impact of proposed universal screening using pulse oximetry. JAMA Pediatrics 2014. This study estimates the number of babies that are diagnosed with critical congenital heart disease after 3 days of age, and therefore potentially could have earlier diagnosis from universal screening. Using data from the National Birth Defects Prevention Study database, they found that about 30% of such babies are not diagnosed before 3 days, in the USA.

Aliaga S, Clark RH, Laughon M, Walsh TJ, Hope WW, Benjamin DK, Kaufman D, Arrieta A, Benjamin DK, Smith PB: Changes in the Incidence of Candidiasis in Neonatal Intensive Care Units. Pediatrics 2014, 133(2):236-242. Invasive Candidiasis appears to be getting less frequent in the Pediatrix NICUs. The reason may be related to their other findings, the increased use of fluconazole prophylaxis, and the reduced use of broad spectrum antibiotics in at risk patients.

Tracy MB, Shah D, Hinder M, Klimek J, Marceau J, Wright A: Mask leak increases and minute ventilation decreases when chest compressions are added to bag ventilation in a neonatal manikin model. Acta Paediatrica 2014 It is difficult to maintain adequate ventilation by face mask once you start doing cardiac massage. Facemask leaks increase and ventilation falls substantially. What to do? Maybe we should always intubate if we do cardiac massage, or find other ways to maintain ventilation.

About Keith Barrington

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