Neonatal updates

Ong KK, et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatrica. 2015;104(10):974-86.

This interesting systematic review confirms that the observational studies are fairly consistent, improved growth, and improved head circumference growth are associated with improved outcomes. As for the interventional studies the evidence is much weaker. Of the small number of trials some were only performed after discharge from the NICU, a couple are quite old trials with control groups who received what would now be considered to be inadequate intakes.

I guess the problem now is that it would be difficult to justify a study where one group received recommended intakes, and the other received less nutrition. We know that if you get close to recommended intakes you can get close to intra-uterine growth rates, so randomizing babies to have sub-optimal growth would be problematic.

I think that all we can do is to keep trying to get to optimal growth, and keep an eye on our outcomes.

Jering K, et al. Parenteral Nutrition as an Unexpected and Preventable Source of Mercury Exposure in Preterm Infants. The Journal of pediatrics. 2015;166(6):1533-5. In other nutritional news, TPN can be source of evil as well as good. Aluminium, manganese, and now mercury can be found in it. Although the levels were low, there was detectable mercury in the TPN in this NICU, maybe from sharing equipment for preparation of TPN for adults.

Jary S, et al. Less severe cerebral palsy outcomes in infants treated with therapeutic hypothermia. Acta Paediatr. 2015. Some babies treated with therapeutic hypothermia still develop cerebral palsy. This cohort study shows that they are less severely affected than a historical comparison group before hypothermia.

Brock JW, et al. Bladder Function After Fetal Surgery for Myelomeningocele. Pediatrics. 2015.  Children from the MOMS trial of antenatal surgical closure for meningomyelocele were followed. The bladder function outcomes were all better in the antenatal surgery group. The proportion who were using intermittent catheterisation at 30 months of age was 38% vs 51%, which was not statistically significant, but is quite a substantial difference. The other outcomes showed significantly less trabeculation and less open bladder neck with antenatal surgery.

The authors give a summary of the other results of the MOMS trial.

 In summary, prenatal surgery was associated with less need for cerebrospinal fluid shunt at 12 months and a better composite score for mental development and motor function at 30 months. Prenatal surgery also revealed benefit in several key secondary outcomes including hindbrain herniation, ability to walk unaided, and a better score on the Bayley II Psychomotor Development Index. These results were tempered by an increase in preterm birth and the risk of uterine dehiscence in the prenatal surgery group

About Keith Barrington

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