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.
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.
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.
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.
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.
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 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.
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.
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 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.