May 2015

Late Neuroimaging Predicts Neurodevelopmental Impairment at 18-22 Months in Preterm Infants Born at 24-27 Completed Weeks’ Gestation

CRANIAL ULTRASOUND Neurodevelopmental impairment is a common morbidity of preterm birth. This prospective cohort study sought to determine the accuracy of cranial ultrasound (CUS) and/or MRI in predicting NDI at 18-22 months of age. Near-term CUS was the most effective predictor of NDI, however likelihood ratios show that no imaging study provides overwhelming predictive power. Thus, the limitations of these studies must be understood before they are widely used as a useful prognostic tool.

Repeat doses of antenatal betamethasone and risk factors for cardio-metabolic disease at early school age

GLUCOCORTICOIDS The long-term cardiovascular and metabolic outcomes of repeated doses of antenatal glucocorticoids are not known. This randomized controlled trial studied the long-term cardiovascular and metabolic outcomes of school-aged individuals who received multiple doses of glucocorticoids during gestation. The trial revealed no significant difference in cardiometabolic disease between recipients of single-dose or multiple-dose antenatal glucocorticoids. Thus, this trial provides important evidence that multiple antenatal glucocorticoid doses may be safe.

Re-feeding gastric residuals in extremely preterm infants

ENTERAL FEEDING Establishment of enteral feeding is associated with positive outcomes in preterm infants. This randomized controlled trial studied the effectiveness of re-feeding gastric residuals to reduce the time to establish full enteral feeds in extremely preterm neonates. The trial revealed no significant difference in time to full enteral feeds using gastric residual re-feeding; however, the data suggest that re-feeding of gastric residuals may be safe.

Hypertension at late preterm gestation: deliver immediately or watch and wait?

HYPERTENSION Gestational hypertension causes significant maternal and neonatal morbidity, and few evidence-based guidelines exist for delivery in non-severe late preterm gestational hypertension. This randomized controlled trial evaluated the safety of immediate delivery or expectant management in mothers with gestational hypertension at 34-36 weeks of gestation. The investigation suggested that while there was no significant difference in maternal outcome depending on strategy, immediate delivery significantly increases the risk of neonatal respiratory distress syndrome. Thus, pending collection of additional follow-up data, expectant management can be considered an appropriate strategy for non-severe late gestation hypertension.