Reviews

Does single mega-dose vitamin A in the early neonatal period reduce mortality during infancy in low- and middle-income countries?

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.

Oral paracetamol or oral ibuprofen to close the ductus arteriosus: both “work,” but do we know when to use them?

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.

Permissive hypercapnia in extremely-low-birthweight infants: how far should we go?

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.

Is oral amoxicillin as safe and effective as intramuscular procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants (

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 during neonatal resuscitation: How effective is a laryngeal mask?

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.

Association of Early Versus Late Caffeine Administration on Neonatal Outcomes in Very Preterm Neonates

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.

Randomized Controlled Trial of Lactoferrin for Prevention of Sepsis in Peruvian Neonates Less than 2500g

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

Do probiotics or prebiotics alone or in combination reduce the incidence of NEC in very low birth weight (

PROBIOTICS Necrotizing enterocolitis causes significant morbidity among preterm infants; recent research suggests that probiotic treatment may help prevent NEC. This randomized controlled trial studied the effectiveness of probiotic, prebiotic, or synbiotic (probiotic + prebiotic) treatment in preventing NEC, and found that only probiotic and synbiotic treatment reduced the incidence of NEC among VLBWs, arguing against a beneficial effect of prebiotics alone. However, given the relatively low incidence of NEC, long-term follow up studies are essential to confirm the safety of this prophylactic treatment.

Cord stripping in preterm neonates

CORD STRIPPING Delayed cord clamping has been associated with improved neonatal outcomes. This randomized controlled trial studied whether cord stripping in additon to delayed cord clamping improves outcomes in preterm neonates when compared to delayed cord clamping alone. Though trends suggested a possible benefit when combining cord stripping with delayed cord clamping, there were no significant differences found between either strategy.

Longer treatment for symptomatic congenital cytomegalovirus infection may have only modest long-term benefits.

VALGANCICLOVIR The long-term audiologic benefits of ganciclovir treatment for CMV infection are unclear. This randomized controlled trial evaluated the effectiveness of 6 week or 6 month valganciclovir therapy in improving audiologic outcomes. Although short-term outcomes were not different between groups, 6 month-treatment was associated with a slight improvement in hearing and neurodevelopmental outcome at 12 and 24 months. Thus, extended valganciclovir treatment may be appropriate for CMV infection.