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.
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.
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.
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.
NEUROIMAGING Much effort has been devoted to developing accurate neurodevelopmental prognostic assessments for extremely preterm neonates. This prospective cohort study compared different types and timing of neuroimaging with accurate predictions of poor neurodevelopmental outcome or death in neonates born at 24-27 weeks’ gestational age, and found that cranial ultrasound performed at 35-42 weeks postmenstrual age was more accurate than CUS performed at 4-14 days of life and comparable to MRI at 35-42 weeks PMA for predicting neurodevelopmental impairment. Although significant additional follow-up study is needed, CUS performed at near-term corrected gestational age may be a useful prognostic tool for neurodevelopmental outcome in extremely preterm neonates
MUSIC Much thought has been given to providing developmentally supportive care for infants in the NICU; however, little is known about how music therapy might play a role in neurodevelopmental outcomes for preterm infants. This literature review analyzed the data of ten methodologically rigorous publications studying the effectiveness of music in the NICU. The reviewers found that although both delivery of music and measures of outcome are disparate, music therapy may help to support neurodevelopment in preterm infants; however, additional study is necessary to fully validate and understand these findings
ACTIVITY LEVELS Children who were born preterm are at increased risk of developing numerous morbidities. This prognostic cohort study assessed physical activity levels in 7 year old children who were born at <37 weeks' gestation, and demonstrated that males born at term were significantly more active than males born at <32 weeks' gestation. Further study is necessary to determine the reasons for this difference.
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.