EPILEPSY Determining the etiology of neonatal seizures can be complicated in the absence of an acute insult. This prospective cohort study followed neonates diagnosed with seizures, and compared those who had been diagnosed with epileptic encephalopathy to those who had acute symptomatic seizures, and found that genetic etiology was identifiable in 59% of neonates with epilepsy. Although this study requires additional follow-up, genetic testing may be useful in determining etiology and directing therapies in neonates with epilepsy.
Nasal CPAP Non-invasive ventilation is essential in the NICU, but is commonly associated with nasal injury. This prospective trial assessed the usefulness of nasal barrier dressings in preventing nasal injury in neonates <30 weeks' gestational age receiving NCPAP. Although there were significant limitations to the study, nasal barrier dressings significantly reduced the both the occurrence and degree of nasal injury.
HYPERGLYCEMIA Hyperglycemia commonly complicates the clinical course of premature infants, but data regarding the safety and efficacy of insulin therapy are mixed. This randomized controlled trial assessed the effectiveness of blood glucose maintenance with insulin therapy among VLBW infants with hyperglycemia. The study’s two year followup data indicate that “tight” glycemic control with immediate initiation of insulin therapy and targeting lower blood glucose concentrations did not improve neurodevelopmental outcome compared to standard insulin therapy, although height, lean body mass, and fasting blood glucose differed between the two groups. Additional followup is required to determine whether early insulin therapy is appropriate for management of neonatal hyperglycemia.
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.
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.
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.