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Indian Pediatr 2017;54: 606 |
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Clippings
Theme:
Neonatology
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Sriparna Basu
Email:
[email protected]
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Lower versus higher arterial oxygen saturations for
preterm infants. (Cochrane Database Syst Rev. 2017;4:CD011190)
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Though oxygen is the most frequently used drug in preterm infants, there
is hardly any consensus regarding the target oxygen saturation (SpO2)
range, which would optimally balance potential benefits with harms. This
systematic review of 5 trials (4965 infants) analyzed the effects of
lower ( £90%)
versus higher (>90%) SpO2 range targeting, on death or major morbidities
in extremely preterm (<28 weeks) infants. There was no significant
difference in the composite primary outcome between lower (85-89%)
versus higher (91-95%) SpO2 groups (RR 1.04, 95% CI 0.98, 1.10)
(high-quality evidence). Compared to higher, lower SpO2 significantly
increased the incidence of death at 18 to 24 months corrected age (RR
1.16, 95% CI 1.03, 1.31) (high-quality evidence) and necrotizing
enterocolitis (RR 1.24, 95% 1.05, 1.47) (high-quality evidence).
However, lower SpO2 significantly decreased the incidence of retinopathy
of prematurity requiring treatment (RR 0.72, 95% CI 0.61, 0.85)
(moderate-quality evidence). There were no significant differences for
blindness, severe hearing loss, cerebral palsy, or other morbidities
between the groups.
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Simplified antibiotic regimens for treatment
of clinical severe infection in the outpatient setting. (Lancet
Glob Health. 2017;5:e177-85
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This three-arm, randomized, open-label, equivalence trial was carried
out to compare the availability and feasibility of different antibiotic
treatment regimen in young infants (age 0-59 d) in community settings,
who are not critically sick. Infants were randomly assigned to receive
either intramuscular procaine benzylpenicillin and gentamicin once daily
for 7 days (reference group); or oral amoxicillin twice daily plus
intramuscular gentamicin once daily for 7 days; or intramuscular
procaine benzylpenicillin plus gentamicin once daily for 2 days followed
by oral amoxicillin twice daily for 5 days. Primary outcome variable was
treatment failure within 7 days of enrolment. Authors finally included
2251 infants for per-protocol analysis. Treatment failure within 7 days
was reported in 90 (12%) infants in reference group, 76 (10%) in
amoxicillin plus gentamicin group (risk difference -1·9, 95% CI -5·1,
1·3), and 99 (13%) in procaine benzylpenicillin, gentamicin, and
amoxicillin group (risk difference 1·1, 95% CI -2·3, 4·5), indicating
that simplified antibiotic regimens requiring fewer injections are
equivalent to the reference treatment, and have the potential to treat
sick young infants where referral is not possible.
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Comparative study of medications for closure
of patent ductus arteriosus. (Eur J Pediatr. 2017;176:233-40)
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The efficacy and side effects of indomethacin, ibuprofen, and paracetamol was
assessed in 300 preterm neonates with hemodynamically significant PDA
(hs-PDA). One hundred neonates were randomly allocated in each group.
Paracetamol group received 15 mg/kg/6 h intravenous (IV) paracetamol
infusion for 3 days. Ibuprofen group received 10 mg/kg IV ibuprofen
infusion followed by 5 mg/kg/day for 2 days. Indomethacin group received
0.2 mg/kg/12 h of IV infusion of indomethacin for three doses. Regarding
PDA closure, there was no significant difference among the groups (P = 0.868).
However, a significant increase in serum creatinine and blood urea
nitrogen and a significant reduction in platelet count and urine output
were noted in both ibuprofen and indomethacin groups (P <0.001).
A significant increase in bilirubin levels was observed in the ibuprofen
group only. The study results indicated that paracetamol was as
effective as indomethacin and ibuprofen for closure of hs-PDA in preterm
neonates with lesser side effects.
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Probiotics for the prevention of necrotizing
enterocolitis in very-low-birth-weight infants: A meta-analysis
and systematic review. (Acta Paediatr. 2017 May 4. doi:
10.1111/apa.13902. [Epub ahead of print])
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This meta-analysis of 23 randomized controlled trials (7325 neonates)
measured the efficacy of probiotic supplementation for prevention of
necrotizing enterocolitis (NEC) stage e"2 and death in very low birth
weight infants. 145 (3.9%) infants in the probiotic group developed NEC
compared to 240 (6.6%) in control group (RR 0.57, 95% CI 0.43, 0.74;
P<0.001). Fewer deaths occurred in the probiotic group compared to
controls (RR 0.72, 95% CI 0.57, 0.92; P=0.009). Trials using a
combination of Bifidobacterium and Lactobacillus species
reported a statistically significant reduction in the incidence of NEC.
Trials that utilized a Lactobacillus species or
Bifidobacterium species alone or a combination of Bifidobacterium
and Streptococcus thermophilus species showed a
non-significant reduction in relative risk of developing NEC.
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Skin-to-skin care patterns in the NICU and
their effect on early cognitive and communication performance.
(BMJ Open. 2017;7:e012985)
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This study investigated the impact of skin-to-skin care (SSC) on early
cognitive and communication performance of 97 extremely preterm infants
(22-26 weeks). Median (IQR) total SCC duration was 17.2 (5.1, 36.6)
hours. In majority of cases, SSC was provided by mothers. A steep
decline in SSC participation of parents was noted at 30 weeks corrected
age. Infants with high (above median) SSC participation were more likely
to score ³80
on the cognitive and communication scales of Bayley-III than low SSC
participation (below median) at 6 and 12 months. However, the results
were not statistically significant.
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