Clippings

clippings

Indian Pediatr 2017;54: 606

	Clippings *Theme:* Neonatology
Sriparna Basu Email: [email protected]
	Lower versus higher arterial oxygen saturations for preterm infants. (Cochrane Database Syst Rev. 2017;4:CD011190)
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.
	Simplified antibiotic regimens for treatment of clinical severe infection in the outpatient setting. (Lancet Glob Health.　2017;5:e177-85
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.
	Comparative study of medications for closure of patent ductus arteriosus. (Eur J Pediatr.　2017;176:233-40)
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.
	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])
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.
	Skin-to-skin care patterns in the NICU and their effect on early cognitive and communication performance. (BMJ Open.　2017;7:e012985)
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.