Author Archives: Keith Barrington

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About Keith Barrington

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

Is there any indication to close the PDA?

Posted on 26 January 2024 by Keith Barrington

Yet another trial of PDA treatment and attempted closure with a null result. Baby-OSCAR was a UK multi-center masked RCT of ibuprofen treatment of 23 to <29 week infants who were screened with echocardiogram within the first 72 hours of … Continue reading →

Posted in Neonatal Research | Tagged , , | 3 Comments

Time to open the DOOR

Posted on 17 January 2024 by Keith Barrington

I have written many times about the problems with classical composite outcomes in neonatal research. “Death or BPD”, “death or NDI”, or sometimes “death or NEC or Sepsis or BPD or severe IVH” have been used as a way of … Continue reading →

Posted in Neonatal Research | Tagged , , | 1 Comment

To bolus or not to bolus? Not really a question…

Posted on 19 December 2023 by Keith Barrington

Many preterm babies receive boluses of normal saline, often during the first 24 hours when their blood pressure is lower than desired. I have 3 serious questions about this. The rationale for giving a fluid bolus is that the infant … Continue reading →

Posted in Neonatal Research | Tagged , | 3 Comments

Early routine surfactant, method and outcomes

Posted on 13 December 2023 by Keith Barrington

Two important new studies of the use of very early routine surfactant, compared to later selective surfactant if necessary. The first I will discuss is the one that didn’t seem to improve any important clinical outcomes (Murphy MC, et al. … Continue reading →

Posted in Neonatal Research | 1 Comment

Umbilical cord management at birth for preterm infants

Posted on 24 November 2023 by Keith Barrington

The Lancet just published back-to-back articles from the iCOMP collaborative reporting the results of the Individual Patient Data Meta-analysis of trials of differing cord management techniques in preterm infants. There were 48 trials with a total of 7000 patients in … Continue reading →

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Which Probiotic is Preferable?

Posted on 21 November 2023 by Keith Barrington

The word “probiotic” is defined rather vaguely as a micro-organism which has beneficial health impacts. I think it is obvious that there is a huge difference between fungi that are found in the intestinal microbiome of adults, and the lactic … Continue reading →

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Do probiotics only work in bigger babies? What is the risk-benefit of routine probiotics in the extremely preterm?

Posted on 13 November 2023 by Keith Barrington

The recent statement from the AAP and a recent review article both state that probiotics only appear to be effective in babies over 1000g birthweight. This would be remarkable if it were true. I am trying to think of another … Continue reading →

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More thoughts about the “toxicity” of donor milk, a case of Reverse Causation

Posted on 6 November 2023 by Keith Barrington

After my recent post, about the study which suggested that donor milk was killing babies, I have been taking a deeper dive into the article, as I prepare a letter to the editor. Only 2 small subsets of the infants … Continue reading →

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Manipulating the Microbiome

Posted on 2 November 2023 by Keith Barrington

Not with human milk based fortifier, but with probiotics. This post is a sort of intersection between some of my recent posts, human-milk based fortifier does not appear to have a positive effect on the intestinal microbiome. But exogenous probiotics … Continue reading →

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Interesting study, impossible results. Donor breast milk is not toxic.

Posted on 29 October 2023 by Keith Barrington

Is it possible that giving artificial formula to babies will prevent 90% of the deaths of very preterm babies, compared to using donor human milk? (Chehrazi M, et al. Outcomes in very preterm infants receiving an exclusive human milk diet, … Continue reading →

Posted in Neonatal Research | Tagged , , , | 6 Comments