PERMISSIVE HYPERCAPNIA EBNEO Review on Permissive Hypercapnia and Increased Risk for Neurodevelopmental Sequelae
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.
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.
CRANIAL ULTRASOUND Neurodevelopmental impairment is a common morbidity of preterm birth. This prospective cohort study sought to determine the accuracy of cranial ultrasound (CUS) and/or MRI in predicting NDI at 18-22 months of age. Near-term CUS was the most effective predictor of NDI, however likelihood ratios show that no imaging study provides overwhelming predictive power. Thus, the limitations of these studies must be understood before they are widely used as a useful prognostic tool.