April 2015

Longer and deeper cooling for hypoxic ischemic encephalopathy in neonates does not reduce mortality

HIE Hypoxic-Ischemic Encephalopathy is a common cause of disability or death among full term neonates who experienced perinatal asphyxia. This randomized control trial sought to determine the most effective temperature and duration of therapeutic hypothermia. The study found no reduction in mortality with either longer, deeper, or combined lengthened and deeper cooling. Though follow-up data remains to be collected, longer and deeper cooling cannot currently be recommended as therapies for HIE.

Twin birth – planned vaginal delivery still standard of care

TWINS Twin pregnancy accounts for 2-3% births and is associated with a higher risk for adverse perinatal outcome. Thus, this randomized controlled trial sought to determine whether planned cesarean section resulted in improved outcomes compared to planned vaginal delivery in twin pregnancy. The trial revealed no difference in outcomes for either mothers or infants in the planned cesarean section group. Though long-term follow-up studies are necessary, these data do not suggest that planned cesarean section is superior to vaginal delivery in twin pregnancy.

Delivering non-invasive positive pressure to prevent extubation failure in preterm infants: nasal CPAP remains the standard of care

CPAP Lowering extubation failures in very preterm infants remains an important goal. For this purpose and upon extubation, high-flow nasal cannulae (HFNC) and nasal CPAP were compared. Extubation failure occurred in 34% randomized to HFNC, and in 26% randomized to CPAP. Apnea was the most common cause of extubation failure in both groups. These data provide no compelling argument that HFNC should be considered as equivalent to nasal CPAP as the current standard of care to prevent extubation failure.

Sustained lung inflation in extreme preterm infants

SUSTAINED LUNG INFLATION Preventing CPAP failure remains an elusive goal. Providing prophylactic sustained lung inflation (SLI) in the delivery room is one potential intervention that may prevent CPAP failure, and ultimately improve both pulmonary and neurodevelopmental outcomes in the highest-risk infants. Thus, the ability of prophylactic SLI to prevent the need for mechanical ventilation in the first 3 days of life in infants born at 25-28 weeks was evaluated. This trial showed that use of SLI reduced the need for mechanical ventilation in the first 72 hours of life. However, there was a higher, non-statistically significant increased incidence in pneumothorax in the group randomized to receive SLI. These data show that prophylactic SLI can decrease rates of CPAP failure, but larger studies are necessary to demonstrate safety and the effecton long-term outcomes.