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Indian Pediatr 2018;55: 623 |
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Clippings
Theme: Neonatology
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Sriparna Basu
Email:
[email protected]
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Paracetamol (acetaminophen) for patent ductus
arteriosus in preterm or low birthweight infants (Cochrane
Database Syst Rev. 2018;4:CD010061)
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Use of intravenous or oral paracetamol is gradually becoming the
preferred choice over ibuprofen or indomethacin for the management of
hemodynamically-significant patent ductus arteriosus (hs-PDA). Safety,
efficacy and previous reporting of prenatal or postnatal exposure to
paracetamol and later development of autism or autism spectrum disorder
remains the major concern. This updated Cochrane review included 916
infants (eight studies) to compare the use of paracetamol with other
practices. GRADE analysis suggested that paracetamol is as effective as
ibuprofen (moderate-quality evidence); more effective than placebo or no
intervention (low-quality evidence); and as effective as indomethacin
(low-quality evidence) in closing hs-PDA. No difference in
neurodevelopmental outcome in children exposed to paracetamol, compared
to ibuprofen was observed (low-quality evidence). Overall, serum
creatinine levels, daily urine output and platelet counts were
significantly better in the paracetamol group compared with indomethacin
or ibuprofen group.
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Efficacy of subthreshold newborn phototherapy
during the birth hospitalization in preventing readmission for
phototherapy (JAMA Pediatr. 2018;172:378-85)
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Subthreshold phototherapy, defined as its initiation at total bilirubin
below threshold levels, is often used in newborn infants to avoid
subsequent re-hospitalization. This large retrospective study of a
cohort of 25895 neonates born at 35 or more weeks’ gestation documented
that though subthreshold phototherapy reduced readmission rates, but the
number needed to treat to avoid a single readmission ranged from 6 to
60, varying with the predicted risk of hyperbilirubinemia. The authors
concluded that subthreshold phototherapy lengthened the newborn hospital
stay, exposed the infant to the potential hazards of phototherapy
including separation from its mother. In presence of good post-discharge
follow-up services, it would be better to avoid subthreshold
phototherapy during birth hospitalization.
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Prolonged use of antibiotics after birth is
associated with increased morbidity in preterm infants with
negative cultures (J Matern Fetal Neonatal
Med. 2018;23:1-201)
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Preterm infants are often exposed to prolonged antibiotic therapy in
spite of negative blood culture. Very few studies have been carried out
to determine the beneficial and harmful effects of this practice. In
this study, a cohort of 620 hospitalized infants of birthweight <1250 g
with negative blood and CSF cultures in the first 2 days of life were
followed up. Out of 620, 238 infants (38%) received initial empirical
antibiotics greater than 5 days, whereas 382 (62%) received the same for
up to 5 days. On multivariable regression analysis, the odds ratio (OR)
for the prolonged antibiotics group, adjusted for gestational age, SNAP
II score, intra-uterine growth restriction, gender, maternal
hypertension, prenatal steroid treatment, clinical chorioamnionitis,
intrapartum antibiotic treatment, and multiple births, was 1.83
(1.15-2.92) for the composite outcome [necrotizing enterocolitis (NEC),
late onset sepsis (LOS) and death], for LOS, 2.02 (1.20-3.39); and for
bronchopulmonary dysplasia, 1.58 (1.04-2.29). Isolated mortality and NEC
were not significantly different. The authors concluded that more than
5 days of antibiotic treatment in very preterm infants with negative
cultures was associated with increased morbidity.
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Neurobehavioral outcomes 11 years after neonatal caffeine
therapy for apnea of prematurity (Pediatrics.
2018;141.pii:e20174047)
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Caffeine is frequently administered to very low birth weight infants
(VLBW) neonates to reduce the duration of respiratory support as for the
management of apnea of prematurity. The study investigated the
long-term neurobehavioral outcomes of the 11-year-old VLBW cohorts of
the Caffeine for Apnea of Prematurity (CAP) trial. General intelligence,
attention, executive function, visuomotor integration and perception,
and behavior were assessed by regression models. The caffeine group
performed better than the placebo group in fine motor coordination (P=0.01),
visuomotor integration (P<0.05), visual perception (P=0.02),
and visuospatial organization (P=0.003). General intelligence,
attention, and behavior were similar, highlighting the long-term safety
of caffeine therapy in VLBW neonates.
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Rapid systematic review shows that using a
high-flow nasal cannula is inferior to nasal continuous positive
airway pressure as first-line support in preterm neonates (Acta
Paediatr. 2018;doi: 10.1111/apa.14396)
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Use of high-flow nasal cannula (HFNC), a respiratory support technique
to provide heated and humidified mixture of oxygen and air through small
nasal prongs at flow rates to match, or exceed, the patient’s
inspiratory flow rate, is growing popularity in NICUs due to its ease of
application, reduced nasal trauma and perceived better comfort. There is
a debate whether it is better than the age-old practice of nasal
continuous positive airway pressure (nCPAP) as a first-line non-invasive
respiratory support in preterm neonates. This systematic review analysed
pooled results from 1227 neonates (six trials) and showed that HFNC was
associated with a higher rate of failure than nCPAP in preterm neonates
³ 28 weeks of
gestation, with a risk ratio of 1.57 (moderate-quality evidence). No
significant difference was observed between HFNC and nCPAP in the need
for intubation and bronchopulmonary dysplasia rate (Low-quality
evidence). However, rate of nasal injury was lower with HFNC (risk ratio
0.50).
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