BPD Bronchopulmonary Dysplasia is a significant morbidity of prematurity for which few preventative therapies exist. This randomized controlled trial assessed the prophylactic effectiveness of inhaled budesonide vs. placebo in the prevention of BPD in high risk infants. The trial found no significant difference in the outcomes of death or BPD in infants who received inhaled budesonide. Although not statistically significant, mortality rate was higher in the budesonide group. Thus, inhaled budesonide cannot be recommended as a prophylactic for BPD.
CONFERENCE VIDEO SERIES: GORDON GUYATT Gordon Guyatt discusses the GRADE system, with a particular focus on evaluating findings from randomized controlled trials, at the 2015 EBNEO meeting in Philadelphia.
UMBILICAL CORD MILKING While delayed cord clamping is recommended for all preterm neonates, whether umbilical cord milking confers the same benefits is unkown. This randomized controlled trial compared delayed cord clamping and cord milking among preterm infants delivered by cesarean section. While underpowered to detect statistically significant differences in IVH, the trial’s findings suggest that umbilical cord milking results in greater placental transfusion and possible improved organ perfusion. Importantly, long-term follow up is necessary to further assess outcomes following use of these methodologies.
Vitamin A Deficiency Maternal Vitamin A deficiency is common in low- and medium-resource settings and is associated with increased infant mortality. This randomized controlled trial assessed whether oral Vitamin A supplementation delivered to neonates within 72 hours of birth could reduce mortality in the first 6 months of age. Although supplementation resulted in short-term improvements in Vitamin A deficiency, no significant difference in mortality was found. While further analysis is necessary, neonatal Vitamin A supplementation is not effective in preventing infant mortality.
Patent Ductus Arteriosus PDA is a common and severe morbidity among preterm neonates, and current treatment options are limited. This randomized controlled trial assessed the effectiveness of paracetamol in inducing closure of a hemodynamically significant PDA as compared to ibuprofen. The investigators concluded that paracetamol was equally as effective as ibuprofen for PDA closure; however, given the power of the study is limited by the size of trial, significant further study is necessary to determine the true efficacy and safety of paracetamol as a treatment for PDA.
Bronchopulmonary Dysplasia Permissive hypercapnia has been proposed as a way to limit ventilator-induced lung injury and prevent the development of BPD in preterm neonates. This randomized controlled trial assessed whether targeting higher PaCO2 in the first 14 days of life would prevent BPD in ELBW infants. Interim analysis revealed no benefit to permissive hypercapnia, and this study was stopped early (~20% of planned recruitment). Further study is needed to define the role of permissive hypercapnia in the NICU.
INFECTION The WHO recommends that neonates exhibiting symptoms of possible serious bacterial infection be referred to the hospital for daily injected penicillin and gentamicin. However, in many low- and middle-income countries, referral is impossible. This randomized controlled trial performed in DR Congo sought to determine the efficacy of daily oral amoxicillin administered by parents or community health workers in treating possible bacterial infections in neonates presenting with tachypnea. The trial revealed no significant difference in treatment failure between injected and oral antibiotics. Thus, when referral is impossible, oral amoxicillin is an option for treatment of symptomatic infants.
AIRWAY SUPPORT Effective airway support is essential to aiding the neonatal transition. This prospective randomized controlled trial assessed the effectiveness of supreme laryngeal mask airway versus standard facemask ventilation for delivery of PPV in neonates >34 weeks gestational age and >1500 g requiring delivery room ventilation. The trial revealed that SLMA is more effective than facemask ventilation at preventing endotracheal intubation at delivery.
CAFFEINE Caffeine is a common therapy for apnea of prematurity; however, its long-term outcomes as a prophylactic treatment are unknown. This observational study assessed outcomes of early or late caffeine administration in premature neonates and found that early caffeine administration (<3 days of life) is associated with improved outcomes. These findings should be further studied in a randomized controlled trial before caffeine can be recommended as a prophylactic therapy.
SEPSIS Late-onset sepsis is a common and severe neonatal morbidity. This randomized controlled trial studied the effectiveness of lactoferrin in preventing late-onset sepsis among infants <2500 grams. This study showed no significant difference in the incidence of late-onset sepsis in lactoferrin or placebo-supplemented groups. Thus, lactoferrin cannot currently be considered an effective therapy to prevent late-onset sepsis