Reviews

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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.

Does a comprehensive family-centred early intervention service affect stress reactivity and emotion regulation in very low birth weight preterm infants at toddler age?

BEHAVIORAL DEVELOPMENT Preterm infants are at risk for a broad spectrum of poor neurodevelopmental outcomes, including poor emotional regulation and stress response throughout childhood. This randomized controlled trial assessed whether a child-parent dyad-focused early intervention could improve primitive behaviors, reactivity, and stress response in ex-preterm toddlers. The trial found that home- or clinic-based intervention programs moderately improved primitive behavior and response to stress after interventions in the clinic or the home; however, further study is necessary to confirm these data.

Antenatal Betamethasone for Women at Risk for Late Preterm Delivery Reduces the Rate of Neonatal Respiratory Complications

ANTENATAL CORTICOSTEROIDS Adminstration of antenatal betamethasone is the standard of care for women at risk of preterm delivery; however, whether antenatal bethamethasone reduces the risk of neonatal complications in the late preterm period is unknown. This randomized controlled trial assessed the effectiveness of two doses of antenatal betamethasone in women at risk of late preterm delivery in preventing neonatal respiratory complications. The trial revealed that despite an increase in neonatal hypoglycemia among neonates whose mothers received betamethasone, the treatment effectively prevents neonatal respiratory complications.

Is High-Flow Nasal Cannula Noninferior to Nasal CPAP for the Initial Management of Preterm Infants?

NASAL CPAP
Effective ventilatory support is essential to the survival of extremely preterm infants in the NICU; however, much is still unknown regarding avoidance of treatment failure and progression to invasive mechanical ventilation. This randomized trial assessed the effectiveness of high flow nasal cannula versus nasal CPAP among infants >28 weeks’ gestational age with early RDS, and found an increase in treatment failure among infants receiving high flow nasal cannula.

Does dextrose gel prevent treatment failure in infants with neonatal hypoglycemia?

HYPOGLYCEMIA Neonatal hypoglycemia remains a challenging condition requiring admission to the NICU; significant improvements to intravenous dextrose treatment can be made. This randomized controlled trial assessed the efficacy of oral dextrose gel to treat neonatal hypoglycemia, obviating the need for NICU admisson and IV dextrose treatment. The study revealed that among breastfeeding infants at 35-42 weeks’ gestational age, oral dextrose gel safely reduced neonatal hypoglycemia and prevented NICU admissions. Thus, oral dextrose gel represents a potentially useful therapeutic option for neonatal hypoglycemia.

Admission hypo- and hyperthermia are associated with increased mortality and morbidity in very preterm infants

ADMISSION TEMPERATURE Both hypo- and hyperthermia have been associated with poor neonatal outcomes. This retrospective study assessed the relationship between admission temperature and outcome in extremely preterm infants (<33 weeks' gestation). The study revealed that hypo- and hyperthermia were very common among neonates being admitted, and that both were significantly associated with poor outcomes, indicating that continuous, accurate temperature monitoring during admission may be a useful predictive tool at the bedside.

Probiotics for prevention of suspected sepsis in low birthweight infants

SEPSIS Early- and late-onset sepsis are common among low birthweight infants. This randomized controlled trial assessed the effectiveness of probiotics to prevent sepsis, and identified a reduction in sepsis risk among infants 1500-1999 g; however, additional study is required before probiotics can be considered an effective preventative measure against sepsis.

Oxygen-Saturation Targets in Extremely Preterm Infants

OXYGEN SATURATION Significant difficulties exist in answering the essential question of ideal oxygen saturation targets in extremely preterm infants. This report describes the two-year findings of the BOOST-II Australia and BOOST-II UK randomized controlled trials targeting low- and high-range oxygen saturations, and confirms previous findings that although targeting lower oxygen saturation ranges does not increase risk of disability, rates of death are increased. Thus, although oxygen saturation targeting remains a complex and important issue, targeting high oxygen saturation ranges is recommended in extremely preterm infants.

Predictors for Referral-Warranted ROP

RETINOPATHY OF PREMATURITY Serial opthalmologic examination is considered necessary to prevent ROP in preterm neonates. This observational study assessed demographic, medical, and ocular factors predicting referral-warranted ROP among ELBW neonates. While several significant factors predicting RW-ROP were identified, additional studies are necessary to confirm these findings before modifying opthalmological surveillance practices in ELBW neonates.

EBNEO 2015 Conference Video Series: Barbara Schmidt Presents "Making Sense of the Recent Oxygen Saturation Targeting Trials in Extremely Preterm Infants"

CONFERENCE VIDEO SERIES: BARBARA SCHMIDT Watch as Barbara Schmidt discusses the strengths, weaknesses, and results of recent oxygen saturation trials in extremely preterm infants.