Neonatal Updates

Bilgin A, Wolke D. Maternal Sensitivity in Parenting Preterm Children: A Meta-analysis. Pediatrics. 2015. “Mothers of preterm children were not found to be less sensitive or responsive toward their children than mothers of full-term children.” Quite.

Boss RD, et al. Decisions regarding resuscitation of extremely premature infants: Should social context matter? JAMA Pediatrics. 2015;169(6):521-2.
This is a discussion of two cases of extremely preterm infants, and the decision-making surrounding them in 2 different social contexts. An interesting article, and I don’t agree with everything they say, but I certainly do agree with this statement:

Delivering a monologue of medical detail and a menu of treatment options can seem a simpler path…… Yet allowing the delivery of medical information to monopolize conversations with families, even in urgent situations, rarely affects parents’ immediate decisions

Harris DL, et al. Lactate, rather than ketones, may provide alternative cerebral fuel in hypoglycaemic newborns. Archives of disease in childhood Fetal and neonatal edition. 2015;100(2):F161-4. The authors measured a ketone (beta-hydroxybutyrate) and lactate in the blood of infants with hypoglycemia. The ketone was very low, and the lactate much higher in most, although low in 17%. They didn’t actually measure whether the brains of the babies were using the lactate, but they note that there is good evidence that brains can use lactate, and will do so if the levels are high enough (including a study in adults where they made them hypoglycemic enough to have symptoms and then infused lactate, showing an improvement in symptoms. Which sounds like a very scary thing to volunteer for!) and that when ketone concentrations are low the brain doesn’t use them much. The supposition that the brain can use the increased lactates found in this study, and wouldn’t get much from the ketones,  seems reasonable.

Mian Q, et al. Spontaneously Breathing Preterm Infants Change in Tidal Volume to Improve Lung Aeration Immediately after Birth. The Journal of pediatrics. 2015. 30 preterm infants receiving face mask CPAP had measurement of tidal volume and CO2 excretion over the first 100 breaths. ETCO2 was at first low, with tidal volumes of 5 to 6 mL/kg. Vt then increased over 30 breaths to 7-8 mL/kg and ETCO2 increased also, then the tidal volumes fell back to 4-6, but ETCO2 continued to increase. Which seems to mean that the babies are initially clearing their lung fluid and establishing an FRC and good aeration, then they can eliminate CO2 with smaller tidal volumes.

Baserga MC, et al. Darbepoetin Administration to Neonates Undergoing Cooling for Encephalopathy (DANCE): A Safety and Pharmacokinetic Trial. Pediatr Res. 2015.30 babies being cooled fro HIE were randomized to darbepoetin, the long acting erythropoietin analogue, or placebo. No adverse effects were noted, and the elimination was very long, meaning you could give a weekly dose, if we can show it actually helps. Maybe a couple or 3 weekly doses might help in cerebral repair, we need to know!

About Keith Barrington

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