Glasson EJ, et al. Improved Survival in Down Syndrome over the Last 60 Years and the Impact of Perinatal Factors in Recent Decades. The Journal of pediatrics. 2016;169:214-20.e1. This is a fascinating study, showing dramatic improvements in the survival of persons born with Down syndrome (trisomy 21) over the last 60 years with data from a linked western Australia database. Infants with Down syndrome are much more likely to be born preterm, and the survival disadvantage of having T21 is much greater for very premature babies with the diagnosis. Although the survival disadvantage of Down syndrome has diminished over the years, such that they know are 93% as likely to survive to 30 years of age as the general population, the same is not true of premature babies with T21, who still have a major survival disadvantage. Of course this kind of study can’t say why that is, are premature babies with T21 more fragile? Do they have more serious complications of prematurity? Or are attitudes still a problem, with less intensive care given to these babies, with a greater willingness to limit care?
Schwarz CE, et al. Repeatability of echocardiographic parameters to evaluate the hemodynamic relevance of patent ductus arteriosus in preterm infants: a prospective observational study. BMC Pediatrics. 2016;16(1):1-5. This also I found a little surprising, but maybe I shouldn’t have, measuring things with ultrasound in tiny preterm babies often approaches the limits of resolution of the technology. For example a study which tells you that the diameter of the PDA is 1.8 mm, if your cutoff for treatment is 1.6mm, should probably be repeated, by another person, who doesn’t know the results of the first study. The second study might give you such a different answer that you would change your treatment decision, and the same is true for all the indices of whether a PDA is significant or not.
Baxter B, et al. Neonatal lumbar puncture: are clinical landmarks accurate? Archives of Disease in Childhood – Fetal and Neonatal Edition. 2016. This study also makes me question what I do, the usual landmark for doing an LP, the line between the 2 iliac crests, is a very poor indicator of the lumbar segment, and a worryingly poor indicator of the end of the spinal cord. Makes me wonder if we should find another anatomic landmark, or whether we should routinely do a spinal ultrasound to find the right point.
Shetty S, et al. Work of breathing during CPAP and heated humidified high-flow nasal cannula. Archives of Disease in Childhood – Fetal and Neonatal Edition. 2016. High flow cannulae at 8 litres per minute, or 6 litres for babies less than 1 kg, were compared with CPAP at 6 cmH2O. There were no differences in calculated work of breathing, or in thoracic/abdominal asynchrony, or in saturations.
The Schwarz study is really important. I’m actually surprised the variability wasn’t more. A real eye opener that in only 6 of 15 cases could both investigators trace the length of the PDA. PDA diameter really is a very weak measurement, both for clinical assessments and trial inclusion. I continue to advocate for the presence or absence of diastolic descending aortic flow reversal as the best marker of high volume PDA shunt, as shown in our MRI work – http://www.ncbi.nlm.nih.gov/pubmed/23412748