Neonatal Updates

Garel C, Moutard ML. Main congenital cerebral anomalies: how prenatal imaging aids counseling. Fetal diagnosis and therapy. 2014;35(4):229-39. An excellent review article that can assist in prenatal counselling if you have a mother whose fetus has a CNS anomaly.

Baylis R, Ewald U, Gradin M, Nyqvist KH, Rubertsson C, Blomqvist YT. First time events between parents and preterm infants are affected by the designs and routines of neonatal intensive care units. Acta Paediatrica. 2014. How your unit is designed and organized affects the first interactions between parents and their preterm babies.

Finn D, Collins A, Murphy B, Dempsey E. Mode of neonatal death in an Irish maternity centre. Eur J Pediatr. 2014:1-5. A study which points out how different certain countries might be, the persistent influence of the Catholic church in Ireland makes pregnancy termination for any indication very rare, and largely impossible for fetal malformations. The babies who die in an Irish neonatal unit are therefore much more commonly babies with extremely high risk congenital anomalies, who receive comfort care. A much higher proportion of neonatal deaths being in this category than in our NICU, or others which have reported their experience. However there are also similarities, most deaths in the NICU occur after a decision to limit intensive care efforts, and only just over 10% occurred despite on-going full intensive attempts at life-sustaining efforts.

Niemarkt HJ, Kuypers E, Jellema R, Ophelders D, Hutten M, Nikiforou M, Kribs A, Kramer BW: Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs. Pediatr Res 2014.In this study the clinical effects (on oxygenation) of surfactant therapy delivered via a thin catheter passed through the larynx were smiliar to the effects of standard intubation and surfactant, even though much less surfactant was delivered to the lungs, and the compliance was not as good in the thin catheter group.

Vasudevan C, Johnson K, Miall LS, Thompson D, Puntis J: The Effect of Parenteral Lipid Emulsions on Pulmonary Hemodynamics and Eicosanoid Metabolites in Preterm Infants: A Pilot Study. Nutrition in Clinical Practice 2013, 28(6):753-757. 5 preterm infants received a lipd emulsion based on olive oil, 10 others received standard soy-based emulsion. I don’t know why they weren’t randomized, even in a small pilot study, and no indication is given why some babies received the one oil or the other. Echocardiography was performed and eicosanoid analysis. Estimated pulmonary artery pressures fell faster in the olive oil group, the ratio between urinary thromboxane B2 and 6-keto-PGF1-alpha fell in the olive oil group and remained unchanged in the soy group. Interesting if limited data, confirming that we need to do a good clinical trial of fat emulsions from different sources.




About Keith Barrington

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