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.
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.
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
MUSIC Much thought has been given to providing developmentally supportive care for infants in the NICU; however, little is known about how music therapy might play a role in neurodevelopmental outcomes for preterm infants. This literature review analyzed the data of ten methodologically rigorous publications studying the effectiveness of music in the NICU. The reviewers found that although both delivery of music and measures of outcome are disparate, music therapy may help to support neurodevelopment in preterm infants; however, additional study is necessary to fully validate and understand these findings
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.
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 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.
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.
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.