Aly H, et al. Melatonin use for neuroprotection in perinatal asphyxia: a randomized controlled pilot study. J Perinatol. 2015;35(3):186-91. Thirty asphyxiated infants undergoing hypothermia were randomized to melatonin or not, in a study from Egypt. The melatonin was given enterally, and serum concentrations rose in the treated group. There were some potential benefits in the melatonin infants, with less seizures and improved MRI appearance. But this was a very small unblinded study, so a high risk of bias, but very interesting, suggestive results.
Livingston MH, et al. Glycerin Enemas and Suppositories in Premature Infants: A Meta-analysis. Pediatrics. 2015;135(6):1093-106. I must say I have never ordered a glycerin enema for a baby (or for anyone else for that matter), but I have occasionally given a suppository for a baby who has not stooled for a couple of days and appears distended. The three trials included in this meta-analysis are all of routine use of glycerine suppos or enemas. The trials all have some significant limitations, but they show, in general, that there may be a minor effect on the stool pattern, but no other clinical benefits, and there may be an increase in Necrotizing Enterocolitis. The relative risk for NEC was very high at 2.72, but with wide 95% confidence intervals which include the possibility of no effect.
I don’t really understand the rationale behind doing further trials of this subject, even though the authors of this review note that there are 3 that have been or are being done. With the data already in the literature, including the potential for an increase in NEC, I think that routine glycerine suppositories should be avoided, and even occasional intermittent use should be reconsidered or abandoned.
van Pul C, et al. Safe patient monitoring is challenging but still feasible in a neonatal intensive care unit with single family rooms. Acta Paediatrica. 2015;104(6):e247-e54. As many of us are moving toward single patient rooms, a common concern is how to provide alarm surveillance. If a nurse has two patients, as is usual in most places around the world for the more stable NICU patient, and is in a room suctioning a baby, for example, what happens when the other babies ventilator circuit comes apart? The problem is obviously compounded at break times. Many centers have adopted technological solutions which lead to distributed alarms, so the caregivers are supplied with wireless devices that receive alarms, with the primary nurse receiving alarms immediately for her/his patients, and a second nurse receiving the alarm if the first is not able to respond. One thing that I don’t see in the publication is how long it takes on a daily basis to log each primary or secondary nurse or other caregiver to their patient(s). We are expecting a substantial time commitment for that process when we move to our new unit, in about 18 months. This study is reassuring that a workable system can be developed which does not increase the alarm fatigue of the nurses. A system which includes important equipment alarms including the ventilator would be an improvement.