Author Archives: Keith Barrington

About Keith Barrington

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

Making intubation safer for the most fragile babies

Posted on 31 October 2022 by Keith Barrington

Many, many years ago, when I was a young trainee physician, we learned almost everything “on the job”. I can’t remember the first patient I intubated, but there were no mannequins, and no simulations, the phrase “see one, do one, … Continue reading →

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Time to stop placebo injections in neonatal research projects

Posted on 27 October 2022 by Keith Barrington

Randomized controlled trials are the bedrock of evidence-based medicine. If a treatment has a good theoretical rationale, and preclinical data showing efficacy, the only way to prove efficacy in the human is to randomise patients to the treatment, compared to … Continue reading →

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Protein pump inhibitors cause coeliac disease and asthma, and they are unnecessary.

Posted on 24 October 2022 by Keith Barrington

OK, that title is perhaps slightly too definite, the publications that I wanted to discuss are observational studies, which can only prove associations, but it would be hard to perform the prospective controlled trials that would be necessary to prove … Continue reading →

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Reducing pain from retinopathy screening

Posted on 3 October 2022 by Keith Barrington

Retinopathy screening is undoubtedly painful for preterm babies, formal evaluation with PIPP scores routinely exceed 10 during screening, and may exceed 14, meaning moderate to severe pain. As a planned procedure there is always opportunity for pre-emptive analgesia prior to … Continue reading →

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What dose of caffeine to use?

Posted on 9 September 2022 by Keith Barrington

The dose of caffeine that we used for the CAP trial was the dose that was being widely used at the time. It seemed to be a safe dose, that did not require serum concentration surveillance, but was not based … Continue reading →

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Toxicity of antenatal steroids on the developing brain.

Posted on 4 September 2022 by Keith Barrington

A new study from Finland this time, raises similar concerns to those from a Canadian study. (Raikkonen K, et al. Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children. JAMA Netw Open. 2022;5(8):e2228518). It is … Continue reading →

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Cord milking and resuscitation, an alternative?

Posted on 2 September 2022 by Keith Barrington

My recent posts about resuscitation with an intact cord were rapidly followed by a publication of another multicentre randomized controlled trial, this time a cluster randomized crossover trial, of cord milking in babies who needed intervention. (Katheria AC, et al. … Continue reading →

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Resuscitation before clamping the cord, some physiologic considerations

Posted on 30 August 2022 by Keith Barrington

Delaying cord clamping until respiration is well established is a physiologically pleasing approach, and avoids the dramatic decrease in left ventricular preload, simultaneously with an increase in afterload that occurs with early clamping. But does delaying clamping during positive pressure … Continue reading →

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Is glucose gel safe? Is it necessary?

Posted on 25 August 2022 by Keith Barrington

The Auckland group has been studying the treatment and implications of neonatal hypoglycaemia for many years now, with unique high quality studies. Two of their recent publications have addressed the safety of glucose gel for hypoglycaemia, the first (St Clair … Continue reading →

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Anti VEGF treatment of retinopathy: and the long term?

Posted on 9 August 2022 by Keith Barrington

There remains some doubt about the impacts on cerebral development, and thus on developmental progress of anti-VEGF treated babies. It is possible that there are cerebral effects of VEGF inhibition (or interception) and it isn’t clear what the exposure of … Continue reading →

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