Reviews

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BPD While the incidence of BPD continues to rise, little is known about the most effective, least injurious forms of ventilation in the most critically ill premature neonates. This prospective cohort study assessed the long-term pulmonary outcomes of ELBW infants born during three epochs (1991-92, 1997, and 2005), and found that at 8 years of age, ELBWs born in the 2005 epoch had worse pulmonary function outcomes than ELBWs born in the two prior epochs, 1991 and 1997. This study’s findings highlight important questions about non-invasive ventilation and drug administration in the NICU, and demonstrate the need for further prospective studies of today’s ELBW neonates.

Does late therapeutic hypothermia reduce risk of death or disability?

THERAPEUTIC HYPOTHERMIA Therapeutic hypothermia is commonly initiated within 6 hours of birth to treat neonates displaying symptoms of HIE; however, whether therapeutic hypothermia is an effective treatment modality for neonates > 6 hours of age is unknown. This randomized controlled trial assessed the effectiveness of therapeutic hypothermia lasting 96 hours in infants between 6 and 24 hours of age, and demonstrated a minor benefit to initiating late therapeutic hypothermia. Thus, therapeutic hypothermia can be considered in infants > 6 hours of age.

Activity levels of preterm children at seven years of age

ACTIVITY LEVELS Children who were born preterm are at increased risk of developing numerous morbidities. This prognostic cohort study assessed physical activity levels in 7 year old children who were born at <37 weeks' gestation, and demonstrated that males born at term were significantly more active than males born at <32 weeks' gestation. Further study is necessary to determine the reasons for this difference.

Cost-effectiveness of Universal and Targeted Newborn Screening for Congenital Cytomegalovirus Infection

CMV Congenital CMV is common disease causing long-term morbidities, but is often unidentified at birth. This study assessed the cost effectiveness of universal screening compared to identification by newborn hearing test failure for congenital CMV in neonates >21 days of age. The study demonstrated that in highly resourced settings, universal screening for congenital CMV improves outcomes in neonates with congenital CMV.

Does Erythropoietin monotherapy reduce mortality or moderate/severe disability in neonates with hypoxic ischemic encephalopathy?

HYPOXIC ISCHEMIC ENCEPHALOPATHY HIE is commonly treated with therapeutic hypothermia, but erythropoeitin (EPO) exists both as a monotherapy and an adjunct therapeutic option. This randomized controlled trial studied the use of EPO monotherapy initiated within 6 hours of birth in preventing death or severe disability at 19 months of age in term neonates with moderate or severe HIE. Although further analysis is needed, the trial revealed that EPO monotherapy reduces the risk of death or disability compared to placebo.

Do fidgety general movements predict cerebral palsy and cognitive outcome in clinical follow-up of very preterm infants?

CEREBRAL PALSY Strategies to accurately predict development of neurodevelopmental impairment in preterm neonates are limited. This cohort study assessed the relationship between neonatal movement and development of cerebral palsy at 2 years’ age, and found an association between absent fidgeting movements and CP development. While further study is necessary, General Movement Assessment is useful in identifying infants who may go on to develop CP.

Shaken or Stirred? Evaluating the combination of budesonide-surfactant for survival free of bronchopulmonary dysplasia

BPD Very few proven strategies exist to prevent BPD development in VLBW neonates . This randomized controlled trial assessed the usefulness of combined intratracheal budesonide and surfactant administration in VLBWs with severe RDS in preventing BPD or death. The study revealed that treatment significantly reduced incidence of BPD or death; further study is necessary to assess cognitive outcomes in infants receiving combined budesonide and surfactant therapy.

Does a procalcitonin-guided approach to term and late-preterm neonates with suspected early-onset sepsis safely decrease unnecessary antibiotic exposure?

SEPSIS Suspected early-onset sepsis requires antibiotic administration and lengthened NICU stay. This randomized controlled trial studied the non-inferiority of using procalcitonin levels to determine appropriate antibiotic discontinuation in neonates with suspected or proven early-onset sepsis. While the trial was not powered to prove non-inferiority to standard antibiotic administration, the data demonstrated that procalcitonin-guided antibiotic decisions resulted in shorter antibiotic treatment. Thus, procalcitonin measurement may be useful in treatment decisions for neonates with suspected early-onset sepsis.

Antenatal Magnesium for Preterm Delivery Reduces Risk of Cerebral Palsy Among Surviving Very Preterm Infants

CEREBRAL PALSY
Magnesium sulfate is commonly used antenatally in mothers at high risk of preterm delivery. This randomized controlled trial tested the effectiveness of antenatal magnesium sulfate administration to prevent cerebral palsy in neonates born at 24-31 weeks gestational age. The trial found that compared to placebo, magnesium sulfate treatment reduced the incidence of CP in preterm neonates at 2 years of age. While further study is necessary to streamline treatment recommendations and address effectiveness in preterm infants <24 weeks gestational age, magnesium sulfate is effective in reducing the incidence of cerebral palsy in preterm infants.

Early hydrocortisone improves survival without bronchopulmonary dysplasia in extremely preterm born infants.

HYDROCORTISONE Postnatal steroids represent an attractive therapeutic option for BPD prevention in extremely preterm neonates, but questions remain about their safety. This randomized controlled trial assessed the safety and efficacy of intravenous low-dose hydrocortisone administration to prevent BPD in ELBW neonates at 24-27 weeks’ gestational age. The trial revealed that survival without BPD was significantly improved in neonates receiving hydrocortisone. While further study is required to determine its long-term neurodevelopmental effects, the trial suggests that hydrocortisone may be effective in preventing BPD in ELBW infants.