Neonatal Updates

Dardas M, Gill SR, Grier A, Pryhuber GS, Gill AL, Lee Y-H, et al. The Impact of Postnatal Antibiotics on the Preterm Intestinal Microbiome. Pediatr Res. 2014. It will be no surprise to readers of this blog that antibiotics are bad for your bugs, and not just the ones that you don’t want. This study of postnatal development of the intestinal microbiome took samples at 10 days and 30 days in very preterm infants. They show that babies that received more than 7 days of antibiotics, compared to those who received only 2 days, had reduced diversity in their intestinal flora. Reduced diversity has been linked to the development of NEC in some studies.

Victor S, McKeering CM, Roberts SA, Fullwood C, Gaydecki PA. Effect of permissive hypercapnia on background cerebral electrical activity in premature babies. Pediatr Res. 2014. Higher CO2 had little effect on EEG activity in this study, there may have been an increase in delta activity with higher CO2, but as the authors tested many correlations of different aspects of the EEG, his may have been spurious, as they acknowledge.

Czaba-Hnizdo C, Olischar M, Rona Z, Weninger M, Berger A, Klebermass-Schrehof K. Amplitude-integrated electroencephalography shows that doxapram influences the brain activity of preterm infants. Acta Paediatrica. 2014. As I started my research career studying doxapram I have stayed interested, even though it is no longer available in Canada. The results of this study are quite are concerning, an increase in continuous background activity, and a major increase in seizure like episodes was seen on aEEG monitoring of preterm babies receiving doxapram. Both compared to the same babies when not receiving doxapram, and compared to similar control babies. At first I wondered if they had used a high dose, as we used to think that low doses affect the peripheral chemoreceptor and higher doses had a direct CNS stimulant effect, but the dose they used, of 0.5 to 1 mg/kg/h was what we devised from pharmacokinetic studies years ago. So it doesn’t seem too high. The electrical seizure like activity disappeared after the doxapram was stopped. You can’t be 100% definite about seizures from an aEEG it is possible, I guess, that doxapram induces EEG changes that look like seizures on the EEG but are really some other phenomenon, but maybe its a good thing that I can’t prescribe it any more!

Vendettuoli V, Bellù R, Zanini R, Mosca F, Gagliardi L, Italian Neonatal Network. Changes in ventilator strategies and outcomes in preterm infants. Archives of Disease in Childhood – Fetal and Neonatal Edition. 2014. This study of data from the Italian database compared interventions and outcomes in 2006 and 2010. Despite similar babies, fewer babies had invasive ventilation, more received non-invasive ventilation, and the outcomes of mortality and combined mortality and BPD were reduced.

Chollat C, Enser M, Houivet E, Provost D, Bénichou J, Marpeau L, et al. School-Age Outcomes following a Randomized Controlled Trial of Magnesium Sulfate for Neuroprotection of Preterm Infants. The Journal of pediatrics. 2014. Follow up to an average of 11 years of children who had been enrolled in the French antenatal magnesium for neuroprotection study. About 73% of the surviving subjects were seen in follow-up, n=431. Most of the outcomes were a little better in the magnesium exposed group, although there was nothing that could not easily have been due to chance. I think this is re-assuring.

About Keith Barrington

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