March 2015

Establishing ventilation in the delivery room: T-piece resuscitator versus self-inflating bag

RESUSCITATION There are different devices for neonatal ventilation. Newborn infants ventilated with a facemask at birth were randomized to use of self-inflating bag (SIB) or T-piece. There was no difference between SIB and T-piece in establishing ventilation, as assessed by heart rate. However, T-piece was associated with lower rates of DR-intubations and BPD. The T-piece resuscitator is less injurious to the lung than the SIB. Future studies should define relations between pressures & volumes during neonatal resuscitation, and respiratory outcomes in preterm infants.

Does fluconazole prophylaxis reduce the incidence of death or invasive candida infection in extremely preterm infants?

CANDIDA Invasive candidiasis remains relatively common and is frequently deadly among extremely low birthweight infants. Thus, strategies to prevent invasive disease are needed. For this purpose, the effectiveness of prophylactic fluconazole to prevent invasive candidiasis in infants born at <750 g was evaluated. The combined outcome of death or invasive candidiasis was not different between treatment and control groups. These data provide no compelling argument that prophylactic fluconazole should be used routinely to prevent invasive candidiasis in infants weighing <750 g at birth.

A randomized blinded trial to assess whether near infrared spectroscopy measures of cerebral saturation in infants

NIRS Cerebral oxygenation after extremely preterm birth may be unstable. Extremely preterm infants (<28 wks) were randomized to NIRS for 3-72 hours after birth and an algorithm to stabilize it, or not (NIRS-data blinded). NIRS-monitoring resulted in longer periods of cerebral oxygen saturation on target (55-85%), but did not significantly reduce IVH or mortality. This report found no significant difference in clinical outcomes. Further validation and clinical demonstration must be provided before NIRS-monitors become standard of care.