Neonatal Updates

Gephart SM, Spitzer AR, Effken JA, Dodd E, Halpern M, McGrath JM. Discrimination of GutCheckNEC: a clinical risk index for necrotizing enterocolitis. J Perinatol. 2014. The Pediatrix group have developed a scoring system for predicting the risk of NEC; points are given for a number of different items, and then added. The process of developing it is well described, it took me a while to find where is the cut off for the score, but in figure 3 it is noted that the threshold is 32. If you have a score more than that you at increased risk, less than that you are at decreased risk. Interestingly, the positive risk factors, which reduce the risk, include probiotics! Also interestingly the background incidence of NEC in the individual NICU is by far the most important risk factor. Human milk feeding on both days 7 and 14 was another protective factor. Many of the risk factors are not modifiable, but those 2 certainly are.

van Ganzewinkel C, Derijks L, Anand KJS, van Lingen RA, Neef C, Kramer BW, et al. Multiple intravenous doses of paracetamol result in a predictable pharmacokinetic profile in very preterm infants. Acta Paediatrica. 2014. In much of the world, intravenous paracetamol (acetaminophen) is available. This study gives important pharmacokinetic data.

Hitzert MM, Van Braeckel KNJA, de Bok M, Maathuis CGB, Roze E, Bos AF. Functional outcome at school age of preterm-born children treated with high-dose dexamethasone. Early Human Development. 2014;90(5):253-8. Arie Bos is one of those exceptionally productive but self-effacing individuals who drive a large body of neonatal research. In this study the group he works with have analyzed outcomes of very preterm babies who received dexamethasone, compared to control infants. Overall cognitive and motor development were worse, with less effect on language skills. As always from observational data, it is not certain whether this is causative or not, but it is certainly biologically feasible.

Rollo DE, Radmacher PG, Turcu RM, Myers SR, Adamkin DH. Stability of lactoferrin in stored human milk. J Perinatol. 2014;34(4):284-6. Refrigerating breast milk decreases lactoferrin concentrations, but not by much. Freezing it has more of an effect, prolonged freezing at -20  reduces levels by half. The fresher the better, at least for lactoferrin.

Pathak G, Upadhyay A, Pathak U, Chawla D, Goel SP. Phenobarbitone versus phenytoin for treatment of neonatal seizures: an open-label randomized controlled trial. Indian pediatrics. 2013;50(8):753-7. An RCT in about 110 babies with seizures. Clinical seizure control was better with phenobarb. Unfortunately no EEG data.

Wilson-Ching M, Pascoe L, Doyle LW, Anderson PJ. Effects of correcting for prematurity on cognitive test scores in childhood. Journal of Paediatrics and Child Health. 2014. I think that you should always correct for prematurity. It just has less and less impact as the child ages. 3 months of correction makes a big difference to a 2 year old, and not much for a 10 year old. But at least we all then talk about the same thing.

About keithbarrington

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