Neonatal Updates

Corvaglia L, Martini S, Battistini B, Rucci P, Aceti A, Faldella G. Bolus versus continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants. Pediatr Res. 2014. During a 6 hour period, preterm infants had either a bolus feed an a 3 hour infusion of milk. Bolus feeding led to an increase in the intestinal NIRS signal.  A 3 hour infusion led to a decrease. I’m not sure what this means, Randomized comparisons of clinical outcomes generally show now substantial difference between bolus and continuous feeding. So if the oxygenation is lower but the clinical function is OK, do we need to worry?

Fox LM, Choo P, Rogerson SR, Spittle AJ, Anderson PJ, Doyle L, et al. The relationship between ventricular size at 1 month and outcome at 2 years in infants less than 30 weeks’ gestation. Archives of Disease in Childhood – Fetal and Neonatal Edition. 2014;99(3):F209-F14. If you have bigger ventricles, and therefore, on average, less brain, your outcome is worse. That is a facetious comment on an interesting paper, which confirms that one of the better predictors of outcome is ventricular enlargement.

Wang D, Aubertin C, Barrowman N, Moreau K, Dunn S, Harrold J. Examining the effects of a targeted noise reduction program in a neonatal intensive care unit. Archives of Disease in Childhood – Fetal and Neonatal Edition. 2014;99(3):F203-F8. The NICU is a noisy place, especially if you have fragile preterm baby ears. Reducing noise intensity is not very easy, and may even have contrary effects to those that you desire.

Emond A, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, et al. Randomised controlled trial of early frenotomy in breastfed infants with mild–moderate tongue-tie. Archives of Disease in Childhood – Fetal and Neonatal Edition. 2014;99(3):F189-F95. Tongue-tie has always been rather controversial, but I think overall the evidence shows that cutting a severe tongue-tie has short term benefits in breast feeding success. This new RCT investigated immediate frenotomy in moderate cases compared to breast feeding support. The primary outcome was the LATCH score of breast-feeding efficacy at 5 days of age, and it was not different between groups: but the proportions of mothers who gave up breast-feeding (a secondary outcome) was substantially lower in the frenotomy group than in the controls. There were no adverse effects noted. So with the usual proviso about secondary outcomes, this appears modestly successful.

About Keith Barrington

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