June 2018

Is paracetamol as effective as indomethacin or ibuprofen in closing a hemodynamically significant patent ductus arteriosus in preterm infants?

PDA Indomethacin and Ibuprofen, two effective and commonly-used treatments for hemodynamically significant patent ductus arteriosus (hs-PDA), are associated with adverse clinical events, poor neurodevelopmental outcome, and BPD. This trial assessed the effectiveness of paracetamol as an alternative to indomethacin or ibuprofen in closing a hs-PDA in neonates born at <28 weeks gestation or <1500 grams, and found that paracetamol is equally as effective in inducing PDA closure and was associated with fewer GI bleeding events and renal effects. This EBNEO review comments on the role of CONSORT reporting guidelines in interpreting the results of RCTs.

Quality-Improvement Effort to Reduce Hypothermia Among High- Risk Infants on a Mother-Infant Unit

HYPOTHERMIA Hypothermia is associated with increased morbidity and mortality among preterm infants. This quality improvement study sought to address rates of hypothermia and demonstrated that a combination of simple thermoregulation strategies, including thoroughly drying infants after birth and delaying baths for the first 12 hours of life, reduced hypothermic events among VLBW and late preterm infants. Although further study is needed to determine the generalizability of these results, employing a combination of simple perinatal thermoregulation strategies may improve rates of neonatal hypothermia.

A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis

Early Onset Sepsis Early-onset sepsis (EOS) is a leading cause of neonatal death, but limited tools exist to accurately identify neonates with EOS and prevent those at low risk of EOS from unnecessary antibiotic exposure. This observational study assessed the use of an EOS calculator to modify antibiotic use and EOS workup in neonates > 35 weeks’ gestation at trial centers. The study demonstrated that use of the EOS calculator was associated with reduced evaluation for sepsis and reduced antibiotic use without increases in illness severity. Thus, use of the EOS calculator may be appropriate in the NICU.

Late Neuroimaging Predicts Neurodevelopmental Outcomes in Preterm Infants

NEUROIMAGING Much effort has been devoted to developing accurate neurodevelopmental prognostic assessments for extremely preterm neonates. This prospective cohort study compared different types and timing of neuroimaging with accurate predictions of poor neurodevelopmental outcome or death in neonates born at 24-27 weeks’ gestational age, and found that cranial ultrasound performed at 35-42 weeks postmenstrual age was more accurate than CUS performed at 4-14 days of life and comparable to MRI at 35-42 weeks PMA for predicting neurodevelopmental impairment. Although significant additional follow-up study is needed, CUS performed at near-term corrected gestational age may be a useful prognostic tool for neurodevelopmental outcome in extremely preterm neonates