Author Archives: keithbarrington

About keithbarrington

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

More about Prebiotics

Posted on 6 January 2021 by keithbarrington

I don’t know if there is an “official” definition of prebiotics, but I think of them as molecules present in the diet that promote the growth of probiotic organisms. I believe that originally the term was applied only to molecules … Continue reading →

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When should we transfuse preterm babies, and why? Redux.

Posted on 5 January 2021 by keithbarrington

The TOP trial has just been published in the FPNEJM (Kirpalani H, et al. Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants. N Engl J Med. 2020;383(27):2639-51). It was a multicenter, non-masked RCT among 1800 babies of less than … Continue reading →

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Should all asphyxiated babies have MR spectroscopy?

Posted on 21 December 2020 by keithbarrington

MRI post-asphyxia, and post-rewarming, seems to be more predictive of long term outcomes than MRI at term for preterm infants. Imaging and analysis of the Apparent Diffusion Coefficient in the PLIC (posterior Limb of the Internal Capsule), for example, has … Continue reading →

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Diuretics as Anticonvulsants?

Posted on 16 December 2020 by keithbarrington

In recent years there has been a lot of interest in neonatal seizures and how to treat them. Older studies confirmed that phenobarbitone (or phenobarbital, I never know these days) appears effective, but with limits; many babies have a partial … Continue reading →

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Do Sub-Ependymal Haemorrhages cause cerebral palsy?

Posted on 15 December 2020 by keithbarrington

The germinal matrix is a region in the immature brain where a large proportion of cortical neurones are formed before they migrate out to form the neo-cortex. It is intensely metabolically active as it is producing hundreds of thousands of … Continue reading →

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Does intravitreal bevacizumab adversely affect long term development? Two simultaneous systematic reviews say yes, or no.

Posted on 14 December 2020 by keithbarrington

A reliable answer to the above question would require a large multicentre RCT comparing intravitreal bevacizumab (IVB) to laser, powered for long term outcomes. Such a trial does not currently exist. As a result, 2 groups have just published systematic … Continue reading →

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Three trials with null results, how should we respond?

Posted on 10 December 2020 by keithbarrington

These 3 articles have just been published, all show no difference in long term outcomes between the randomized groups. What does that mean for the impact on therapeutic decision-making? Natalucci G, et al. Neurodevelopmental Outcomes at Age 5 Years After … Continue reading →

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What role for High Flow Nasal Cannulae?

Posted on 4 December 2020 by keithbarrington

There are a few new publications which might help us to answer the question posed in the title of this post. When heated, humidified, high flow nasal cannulae were first being spoken about I remembered an old study using standard … Continue reading →

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Probiotics and NEC, the latest answer?

Posted on 30 October 2020 by keithbarrington

The updated Cochrane review of probiotics for prevention of NEC, sepsis and mortality has been published. Meta-analysis showed that probiotics may reduce the risk of NEC: RR 0.54, 95% CI 0.45 to 0.65 (54 trials, 10,604 infants; I2 = 17%); … Continue reading →

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Quality of life cannot be predicted from a brain scan

Posted on 23 September 2020 by keithbarrington

…either ultrasound or MRI, or by EEG, or neurological examination, or even during follow-up by screening for disabilities. That title is from a recently published editorial (Fayed N, et al. Quality of life cannot be predicted from a brain scan. … Continue reading →

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