Reviews

Preterm Neuroimaging and School-Age Cognitive Outcomes

PRETERM NEUROIMAGING The prediction of neurodevelopmental outcomes among infants born at <28 weeks' gestational age is challenging and inexact. This prospective study assessed the usefulness of near-term neuroimaging in predicting the development of poor neurodevelopmental outcomes among these infants and found that at school age, there was a consistent association between near-term adverse cranial ultrasound findings (35-42 weeks' gestational age) and cognitive impairment compared to early CUS (4-14 days of age) or MRI. Thus, near-term cranial ultrasound may be a useful predictor of neurodevelopmental outcome in infants born at <28 weeks' gestational age.

Growing identification of genetic etiologies for neonatal-onset epilepsies: lessons from the Neonatal Seizure Registry

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.

Does Using a Nasal Barrier Dressing Prevent Nasal Injury in Premature Infants Receiving Nasal Continuous Positive Airway Pressure?

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.

Does tight glycemic control with insulin therapy in the early neonatal period improve long-term outcomes?

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.

Is paracetamol as effective as indomethacin or ibuprofen in closing a hemodynamically significant patent ductus arteriosus in preterm infants?

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.

Quality-Improvement Effort to Reduce Hypothermia Among High- Risk Infants on a Mother-Infant Unit

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.

A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis

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.