Care Of Preterm Infants Research Articles

Consecutive daily administration of intratracheal surfactant and human umbilical cord-derived mesenchymal stem cells attenuates hyperoxia-induced lung injury in neonatal rats

BackgroundSurfactant therapy is a standard of care for preterm infants with respiratory distress and reduces the incidence of death and bronchopulmonary dysplasia in these patients. Our previous study found that mesenchymal stem cells (MSCs) attenuated hyperoxia-induced lung injury and the combination therapy of surfactant and human umbilical cord-derived MSCs (hUC-MSCs) did not have additive effects on hyperoxia-induced lung injury in neonatal rats. The aim is to evaluate the effects of 2 consecutive days of intratracheal administration of surfactant and hUC-MSCs on hyperoxia-induced lung injury.MethodsNeonatal Sprague Dawley rats were reared in either room air (RA) or hyperoxia (85% O2) from postnatal days 1 to 14. On postnatal day 4, the rats received intratracheal injections of either 20 μL of normal saline (NS) or 20 μL of surfactant. On postnatal day 5, the rats reared in RA received intratracheal NS, and the rats reared in O2 received intratracheal NS or hUC-MSCs (3 × 104 or 3 × 105 cells). Six study groups were examined: RA + NS + NS, RA + surfactant + NS, O2 + NS + NS, O2 + surfactant + NS, O2 + surfactant + hUC-MSCs (3 × 104 cells), and O2 + surfactant + hUC-MSCs (3 × 105 cells). The lungs were excised for histological, western blot, and cytokine analyses.ResultsThe rats reared in hyperoxia and treated with NS yielded significantly higher mean linear intercepts (MLIs) and interleukin (IL)-1β and IL-6 levels and significantly lower vascular endothelial growth factors (VEGFs), platelet-derived growth factor protein expression, and vascular density than did those reared in RA and treated with NS or surfactant. The lowered MLIs and cytokines and the increased VEGF expression and vascular density indicated that the surfactant and surfactant + hUC-MSCs (3 × 104 cells) treatment attenuated hyperoxia-induced lung injury. The surfactant + hUC-MSCs (3 × 105 cells) group exhibited a significantly lower MLI and significantly higher VEGF expression and vascular density than the surfactant + hUC-MSCs (3 × 104 cells) group did.ConclusionsConsecutive daily administration of intratracheal surfactant and hUC-MSCs can be an effective regimen for treating hyperoxia-induced lung injury in neonates.

Premature Babies Delivered by Assisted Reproductive Technology and Their Family Care Experience

Currently, the majority of couples who choose assisted reproductive technology (ART) have waited for and experienced the disappointment of natural conception. With the assistance of ART, they are finally able to “carry a baby to term.” This is wonderful for first-time parents. This case report involves a woman who delivered a premature baby weighing 1,520 g at 30+5 weeks using ART and her family care experience. During the period of care from October 23, 2016 to December 9, 2016, data were collected on this case through systemic assessment, clinical observation, and parental interview. Problems including gas exchange disorder, caregiver role tension, and the potential risk of parent-child attachment disorder were identified. In addition to providing appropriate medical care to maintain stable vital signs, we hoped to reduce the occurrence of comorbidities through a complete nursing assessment and comprehensive developmental care. We also attempted to build trust and to reduce parental anxiety and stress by providing relevant medical information and psychological support through active and proactive nursing care. The performance of “kangaroo care” with stable vital signs enhances parent-child attachment and a sense of involvement in the ongoing care of the infant. This strengthens the mother’s motivation and self-confidence in her caregiving role, enhances her sense of accomplishment as a mother, and promotes the growth and development of the infant after returning home. The weight of the infant reached 2,430 g before discharge. Before discharge, the mother was able to cite at least two caregiving skills and her eyes were no longer red from sobbing. We hoped that the parent-child attachment was well developed and that “kangaroo care” will assist the mother to face the future with a positive attitude after returning home. This article can be used as reference for nursing practitioners to improve the quality of care for premature babies.

Screening auf Frühgeborenenretinopathie – die wichtigsten Änderungen in der neuen deutschen Leitlinie 2020

HintergrundDurch Verbesserungen in der neonatologischen Versorgung von Frühgeborenen und die Entwicklung neuer Behandlungsmöglichkeiten der Frühgeborenenretinopathie („retinopathy of prematurity“ [ROP]) haben sich die Anforderungen an das ROP-Screening seit der Veröffentlichung der letzten Fassung der deutschen Leitlinie zum ROP-Screening im Jahr 2008 verändert. Auf Grundlage aktueller Studiendaten wurde die Leitlinie in 2020 grundlegend überarbeitet und in einer aktualisierten Fassung veröffentlicht.ZielDieser Artikel fasst die wichtigsten Änderungen in der neuen Leitlinie zusammen.ErgebnisseDie Altersgrenze für einen Screeningeinschluss wurde für Kinder ohne zusätzliche Risikofaktoren auf ein Gestationsalter von unter 31 Wochen gesenkt. Die Mindestdauer für eine Sauerstoffsupplementation, die einen Einschluss in das Screening bei Frühgeborenen erforderlich macht, wurde auf über 5 Tage angehoben. Eine Behandlung bei ROP in Zone II kann nun schon bei jedem Stadium 3 mit Plus-Symptomatik unabhängig von der Anzahl der betroffenen Uhrzeiten erfolgen. Für die Nachkontrollen nach Anti-VEGF („vascular endothelial growth factor“)-Therapie wurden Kriterien zur Frequenz und Dauer definiert. Das verbindliche Dokument für diese und weitere neue Empfehlungen ist die Leitlinie selber.SchlussfolgerungenDie Empfehlungen der Leitlinie ermöglichen eine zuverlässige Identifikation von Kindern mit ROP-Risiko für den Einschluss in das Screening und eine rechtzeitige Erkennung fortgeschrittener Krankheitsstadien für die Therapieeinleitung, um so Erblindung durch ROP zu verhindern.

Oxygen Blending is Urgently Needed in Resource-Limited Settings

Oxygen therapy was first used to treat hypoxemia from pneumonia 240 years ago.1 Since then, our understanding of oxygen’s physiological effects has evolved considerably. In the 1930s, Dr Julius Hess created an enclosed oxygen chamber to care for premature infants.2 Though the device was relatively crude, it laid the foundation for future advances in pediatric oxygen administration. In the following decades, technological improvements led to the development of commercially available oxygenated incubators, which became widely used to treat hypoxic infants.

Changed ophthalmic workload following introduction of digital retinal photography for retinopathy of prematurity screening.

ROP screening is vital in care of premature infants but is considered burdensome, difficult and time consuming for ophthalmologists. This study assessed the reduction in workload following the introduction of nurse-led WFDRI to a large neonatal nursery. We report a retrospective audit of 628 infants screened for ROP in the years 2010, 2013 and 2019 at the Royal Women's Hospital, Victoria. The last complete year of screening for ROP using binocular indirect ophthalmoscopy (BIO) alone (2010) was compared with two subsequent years after the introduction of nurse-led WFDRI. The main outcome measures were the time taken to report and document WFDRI and the time taken to undertake BIO examination of a premature infant and document the results. The ophthalmologist's time taken to conduct BIO, review images and document the results per 100 patient examinations was reduced from 16.7 hours before introduction of WFDRI to 3.7 hours. Similarly, the weekly time spent on this component of ROP screening fell from 2.3 hours per week to 0.8 and 1.0 hours per week after introduction of WFDRI. The introduction of nurse-led WFDRI has resulted in a dramatic and sustained reduction in ophthalmologist workload involved in ROP screening in a large Australian neonatal nursery. This may result in improved retention of the ophthalmic workforce required to undertake ROP screening.

UTI NEONATAL: o que dizem as mães

The present study has as objective to analize the percepcion of mothers of preterm babies with very low birth weight and extremely low birth weight under the process of hospitalization of their infants in a neonatal intensive therapy unit (NITU). Ten mothers of premature newborn infants hospitalized in a reference maternity in the execution of the Kangaroo Method, located in Florianópolis – SC participated of the research. The instruments used for the data gathering were the sociodemographic data record to trace the profile of the partcipants; and a semi structured interview script to explore some unfoldings about the experience of the hospitalization of their infants in the NITU, among them, the gestational and hospitalization process. The results suggests that these mothers experience an oscilation of feelings motivated by insecurity and fear, considering the clinical complications and the health situation of their infants. They also evidenced that the birth of a premature baby causes many modifications in the familiar life, specially of the mothers who takes on the role of accompany in the hospital unit, expressing the need of support, considering that sometimes, they leave their other infants under the care of another person and their further activities. Finally, it pointed out the importance of the care lined in the principles of humanization, meaning not only the care of preterm babies, but, of these mothers and families that find themselves fragilized due the lived experience, as well.

Knowledge of mothers and fathers\u2019 experiences of the early in-home care of premature infants supported by video consultations with a neonatal nurse

AimTo gain in-depth knowledge of mothers’ and fathers’ experiences of the whole trajectory of an early in-home care programme supported by video consultations with a neonatal nurse.DesignA qualitative interview study.MethodsData were collected through dyadic semi-structured interviews with mothers and fathers participating in virtual early in-home care programmes and were subjected to inductive content analysis.FindingsThe mothers and fathers were anxious about mastering the care of their premature infants at the start of the early in-home care phase but gradually developed confidence by the completion of the early in-home care programme. Being at home during the early in-home care programme gave the mothers and fathers an opportunity to test their decision making concerning the care of the infant while having the ability to obtain support from nurses when needed.ConclusionOur findings indicate that the trajectory of early in-home care programmes combined with video consultations contributes to parents’ increased confidence as mothers and fathers.Trial registrationClinical trial registration: REG-113-2014 and SJ-431.

Utility of telemedicine to extend neonatal intensive care support in the community

Moderately ill preterm infants residing in medically underserved areas are frequently transferred to tertiary care NICUs that are mostly located in urban areas, resulting in mother-infant separation, high transportation costs, and the emotional costs of limited infant visitation. In 2012, The American Academy of Pediatrics revised neonatal care guidelines, adding in-house neonatal services to the scope of Level II NICUs. Limited availability of neonatologists in medically underserved areas has prompted innovative solutions like telemedicine to meet this requirement. Telemedicine consultations for pediatric transports have demonstrated improved patient outcomes compared with phone consultation, but evidence regarding telemedicine use for neonatal transport is mostly limited to simulation settings. Also, there are limited data on telemedicine use as a primary means to provide intensive care to neonates in Level I/II NICUs. Recently, two groups demonstrated the feasibility and safety of synchronous telemedicine to guide care for premature infants at lower level NICUs. This approach prevented unnecessary transfer and appeared to provide the same quality of care that the baby would have received at the tertiary care facility. As current evidence regarding the use of telemedicine to extend intensive care is based on single-center experiences, additional research and evaluation of the effectiveness of telemedicine for this application is required. This chapter describes the use of telemedicine to support physicians at lower level nurseries and the transport team with management of critical neonates, utility as primary means to provide care at lower level NICUs, barriers for implementation, and future opportunities to enhance telemedicine's impact in NICU settings.

Neonatal outcome of small for gestational age infants born at 26-33 weeks' gestation in Chinese neonatal intensive care units.

BackgroundRate and outcomes of small for gestational age (SGA) infants admitted to Chinese neonatal intensive care units (NICU) has been poorly demonstrated. We aimed to describe the rate and outcomes of SGA preterm infants in Chinese NICU, and to evaluate the association of SGA status with neonatal outcomes in different gestational age (GA) and birth weight percentile groups.MethodsThis cohort study included all infants born at 26–33 weeks’ gestation and admitted to 25 tertiary Chinese NICUs from April 2015 to May 2018. SGA was defined as a birthweight <10th percentile for GA based on the Chinese neonatal birth weight curve.ResultsA total of 24,596 infants were included, and 1,867 (7.6%) infants were SGA. SGA infants had significantly higher rates of death or any major morbidity (29.8% vs. 20.5%), mortality (7.0% vs. 4.1%), bronchopulmonary dysplasia (BPD, 17.6% vs. 9.8%), necrotizing enterocolitis (NEC, 4.8% vs. 3.2%) and sepsis (7.3% vs. 4.8%) than non-SGA infants. SGA status was independently associated with increased risk of death or any major morbidity [adjusted odds ratio: 2.37 (2.08–2.71)] as well as increased risks of death, BPD, ROP, death or BPD, death or ROP, NEC and sepsis. The increased risks of adverse outcomes for SGA infants existed across GA groups. The risks of adverse outcomes were highest among infants with a birthweight <3rd percentile.ConclusionsSGA contributes significantly to adverse neonatal outcomes. Specific attentions are warranted when caring for SGA preterm infants.

Mothers’ voices and white noise on premature infants’ physiological reactions in a neonatal intensive care unit: A multi-arm randomized controlled trial

BackgroundA few positive effects of mothers’ voice on physiological outcomes have been studied and limited studies have focused on the level of cortisol. In addition, white noise has recently been found to be beneficial for human sleep, but studies in premature infants were limited and no study has compared the effects of mothers’ voice and white noise on premature infants. ObjectiveTo examine the effects of mothers’ voice and white noise on sleep-wake patterns, salivary cortisol levels, weight gain, heart rate, and oxygen saturation of premature infants in a neonatal intensive care unit (NICU). MethodsThis was a three-group randomized controlled trial. A total of 103 medically stable premature infants in incubators were recruited from the NICU of a women's and children's hospital in China between March and December 2017 and were randomized into three groups: the mothers’ voice group (n = 34), the white noise group (n = 34), and the routine care group (n = 35). Mothers’ voice, white noise, and no voice were provided to the three groups for 20 min at a time, three times a day for four consecutive days. The sound levels of the mothers’ voice and white noise were controlled between 50 and 55 dB. Sleep-wake patterns, salivary cortisol level, and weight were measured at pre-test and post-test whereas heart rate and oxygen saturation were measured every five-minute at 11am, 2pm, 5pm for four-consecutive days. ResultsA group difference was found only in weight gain (p = 0.003), with weight gain in the white noise group being significantly higher than the mothers’ voice group (Z=-3.447, p = 0.001). Significant declines in total sleep time and sleep efficiency and increases in wake time after sleep onset and average awakening time were only found in the routine-care group between the pre-test and post-test (p<0.05). No significant differences were found in the salivary cortisol levels, heart rates, and oxygen saturation levels among the three groups (p>0.05). A significant increase in oxygen saturation during the 20-min intervention was found in white noise group. Non-significant decreases in the heart rate during the 20-min intervention and salivary cortisol levels at post test were noted in all the three groups. ConclusionWhite noise is more useful for encouraging weight gain in preterm infants compared with mothers’ voices. White noise might be introduced for use in the care of premature infants in NICUs, and more high-quality randomized controlled trials are needed to confirm these findings.Trial Registration No: ChiCTR-INR-17012755.

Unequal care: Racial/ethnic disparities in neonatal intensive care delivery

Advances in neonatal intensive care have improved outcomes for preterm newborns, but significant racial/ethnic disparities persist. Neonatal disparities have their origin in a complex set of factors that include systemic racism and structural disadvantages endured by minority families, but differential quality of care in the neonatal intensive care unit (NICU) remains an important and modifiable source of disparity. NICU care has been shown to be segregated and unequal: Black and Hispanic infants are more likely to be cared for in lower quality NICUs and may receive worse care within a NICU. To eliminate disparities in care and outcomes, it is important to identify and address the mechanisms that lead to lower quality care for minority preterm infants. In this review, we identify improvements in both technical (clinical) and relational (engaging and supporting families) processes of care as critical to better outcomes for minority infants and families.

Outcome of management of preterm babies born below 34 weeks of gestation in a level - 3 Neonatal ICU of a teaching institution in a backward district of Kerala- A retrospective analysis

Background: Preterm birth is considered as the main cause of neonatal morbidity and mortality. This also results in major sequelae in surviving children. It is essential to establish the factors leading to pretermdelivery and the clinical profile of preterm infants. This is particularly important in a backward district where 20% of populations are tribal with poor access to health care. This study retrospectively analyses the outcome of care of preterm infants in a level 3 NICU. Objectives: I) To study the outcome of management of preterm babies below 34 weeks of gestational age at birth in a backward district of Kerala. 2) To evaluate the risk factors for mortality and permanent sequelae in these babies. Materials and Methods: This is a retrospective analysis of hospital records of preterm infants admitted in a neonatal ICU of a tertiary teaching hospital for one year from 1st of January 2017 till 31st of December 2017. Both inborn and out born infants born below 34 weeks of gestational age are included. Maternal and baby related factors are taken into account. All the infants are provided level 3 care and the details of the treatment and outcome are studied. The data are entered in Microsoft excel and analyzed. Results: Out of the 1036 babies admitted in this NICU over the year (01/01/2017 to 31/12/2017) 141 preterm babies who were born below 34 weeks of gestational age are included in this study. Lowest gestational age was 24 weeks. Lowest birth weight recorded is 364 grams. 6 infants died in the hospital and birth weight and gestational age are directly related to mortality. Conclusion: Out of 141 preterm infants, with a gestational age below 34 weeks’ gestational age at birth, admitted in the NICU, 6 (4.25%) died. Majority died in the first week of admission. Most of the children had multiple congenital anomalies and comorbid illnesses which is managed successfully in the NICU. Shortest hospital stay was 1 day and longest stay was 79 days, with

Barriers and facilitators of facility-based kangaroo mother care in sub-Saharan Africa: a systematic review

BackgroundHospital-based kangaroo mother care can help reduce preventable newborn deaths and has been recommended by the World Health Organization in the care of low birthweight babies weighing 2000 g or less. However, implementation has been limited. The objective of this review is to understand the barriers and facilitators of kangaroo mother care implementation in health facilities in sub-Saharan Africa, where there are the highest rates of neonatal mortality in the world.MethodsA systematic search was performed on MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, African Journals Online, African Index Medicus as well as the references of relevant articles. Inclusion criteria included primary research, facility-based kangaroo mother care in sub-Saharan Africa. Studies were assessed by the Critical Appraisal Skills Programme Qualitative Checklist and the National Institutes of Health quality assessment tools and underwent narrative synthesis.ResultsThirty studies were included in the review. This review examined barriers and facilitators to kangaroo mother care practice at health systems level, health worker experiences and perspectives of mothers and their families. Strong local leadership was essential to overcome barriers of inadequate space, limited budget for supplies, inadequate staffing, lack of guidelines and policies and insufficient supportive supervision. Workload burdens, knowledge gaps and staff attitudes were highlighted as challenges at health workers’ level, which could be supported by sharing of best practices and success stories. Support for mothers and their families was also identified as a gap.ConclusionBuilding momentum for kangaroo mother care in health facilities in sub-Saharan Africa continues to be a challenge. Strengthening health systems and communication, prioritizing preterm infant care in public health strategies and supporting health workers and mothers and their families as partners in care are important to scale up. This will support sustainable kangaroo mother care implementation as well as strengthen quality of newborn care overall. PROSPERO registration: CRD42020166742.

70740 Impact of fundus pigmentation on retinal layer visibility on investigational bedside optical coherence tomography in preterm infants

ABSTRACT IMPACT: This study helps translate investigational bedside optical coherence tomography into improved diagnosis and care of preterm infants at risk for retinopathy of prematurity. OBJECTIVES/GOALS: In retinopathy of prematurity screening, fundus photography may be of limited quality in eyes with dark fundus pigmentation (FP). The goal of this study was to evaluate the impact of FP on overall scan quality and retinal layer visibility on investigational bedside optical coherence tomography (OCT) in preterm infants. METHODS/STUDY POPULATION: We analyzed 846 OCT scans captured prospectively from 188 eyes of 94 preterm infants enrolled in the BabySTEPS study (NCT02887157). Trained ophthalmologists, masked to OCT findings, determined FP (blond, medium, or dark). Expert graders, masked to FP, evaluated OCT images for: 1) overall OCT quality (excellent, acceptable, poor, or unusable); and 2) all age-appropriate retinal layers visible (yes or no). To assess the association of FP with OCT quality (excellent/acceptable or poor/unusable) and retinal layer visibility, we performed multivariable logistic regression modeling, adjusting for biologic and demographic confounders and correlations from repeated OCT scans and paired eyes. RESULTS/ANTICIPATED RESULTS: Mean birthweight was 964 (SD=283) grams, mean gestational age was 27.8 (SD=2.6) weeks, 48 (51%) infants were male, and 51 (54%) were non-white. On exam, 72 (38%) eyes had blond FP, 92 (49%) had medium, and 24 (13%) had dark. OCT quality was excellent or acceptable in 725 scans (86%) and all age-appropriate retinal layers were visible in 781 scans (92%). Compared to eyes with blond FP, eyes with medium and dark FP did not have higher odds of poor/unusable OCT scan quality (adjusted OR 0.87 [95% CI 0.50-1.48] and 0.49 [95% CI 0.16-1.55], respectively) or not all age-appropriate retinal layers visible on OCT (adjusted OR 1.17 [95% CI 0.39-3.51] and 0.57 [95% CI 0.15-2.20], respectively). DISCUSSION/SIGNIFICANCE OF FINDINGS: Medium and dark FP did not impact overall scan quality or age-appropriate retinal layer visibility on investigational bedside OCT in preterm infants. This study supports the feasibility of using OCT to analyze retinal microanatomy in diverse populations of preterm infants with a range of FP.

Analysis on the Main Points of Nursing Premature Infants

&lt;p&gt;Compared with normal newborns, premature babies are more fragile and more sensitive to the external environment. Therefore, there are more precautions in the care of premature babies, because the incidence of preterm birth is relatively high. In the face of more premature infants, we should have a deep understanding of the relevant content of premature infant care. This article will conduct a detailed analysis of the key points of premature infant care and clarify the precautions of premature infants in the nursing process.&lt;/p&gt;

Kangaroo mother care for preterm infants and child development – evidence from São Paulo, Brazil

ABSTRACT Globally, an estimated 15 million children are born prematurely each year, resulting in a high burden of under-five mortality and neurodevelopmental disability. Kangaroo Mother Care (KMC) is a key intervention to support the development of preterm infants. However, evidence on the impact of KMC in routine care settings remains limited. This paper examines the associations between maternal KMC efforts and child development among preterm infants using data from a prospective cohort study conducted in São Paulo, Brazil. Study outcomes were height-for-age z-scores (HAZ) and cognitive development at age 3 years. Practicing KMC was positively associated with HAZ (+0.91 SD, 95% CI [0.126, 1.695]), and cognition (+0.37 SD, [0.034, 0.806]) of preterm children. The results suggest that KMC can improve children’s cognitive and physical development. New programmes to increase KMC uptake in the setting studied may be beneficial for both mothers and their preterm children.

Early Kangaroo Mother Care in Preterm Infants: Is it Safe?

Early Kangaroo Mother Care in Preterm Infants: Is it Safe?

Implementation Barriers for Practicing Continuous Kangaroo Mother Care from the Perspective of Neonatologists and Nurses.

Introduction: Kangaroo mother care (KMC), as a complement to incubator care, is one of the ten recommendations of the World Health Organization (WHO) for the care of preterm infants. The KMC stabilizes the heart rate, improves oxygen saturation, makes weight gain better, and reduces crying in the infant. In order to launch KMC unit, the barriers for implementing this type of care should be recognized. Methods: This qualitative research was conducted using a focus group discussion and individual semi-structured interview with nurses, doctors, executive and management staff of a neonatal unit of a third level teaching hospital in Tabriz, northwest Iran. The participants were selected using purposeful sampling. Content analysis was used for analyzing data. Data were analyzed by MAXQDA 10 software. Results: After analyzing data, four main themes were extracted including mother-related barriers, father-related barriers, physician- related barriers, and system-related barriers. Conclusion: Based on the findings of the research, it seems that in order to facilitate practicing continuous KMC, much emphasis should be placed on training the parents and health care providers. Furthermore, in some cases, reforming the payment system for physicians, providing an instruction for performing continuous KMC, and continuous assessment of hospitals annually are necessary.

Preventing Brain Injury in the Preterm Infant-Current Controversies and Potential Therapies.

Preterm birth is associated with a high risk of morbidity and mortality including brain damage and cerebral palsy. The development of brain injury in the preterm infant may be influenced by many factors including perinatal asphyxia, infection/inflammation, chronic hypoxia and exposure to treatments such as mechanical ventilation and corticosteroids. There are currently very limited treatment options available. In clinical trials, magnesium sulfate has been associated with a small, significant reduction in the risk of cerebral palsy and gross motor dysfunction in early childhood but no effect on the combined outcome of death or disability, and longer-term follow up to date has not shown improved neurological outcomes in school-age children. Recombinant erythropoietin has shown neuroprotective potential in preclinical studies but two large randomized trials, in extremely preterm infants, of treatment started within 24 or 48 h of birth showed no effect on the risk of severe neurodevelopmental impairment or death at 2 years of age. Preclinical studies have highlighted a number of promising neuroprotective treatments, such as therapeutic hypothermia, melatonin, human amnion epithelial cells, umbilical cord blood and vitamin D supplementation, which may be useful at reducing brain damage in preterm infants. Moreover, refinements of clinical care of preterm infants have the potential to influence later neurological outcomes, including the administration of antenatal and postnatal corticosteroids and more accurate identification and targeted treatment of seizures.

Gastroesophageal Reflux Disease in Neonates: Facts and Figures.

* Abbreviations: AAP: : American Academy of Pediatrics BPD: : bronchopulmonary dysplasia CMPA: : cow milk protein allergy GEJ: : gastroesophageal junction GER: : gastroesophageal reflux GERD: : gastroesophageal reflux disease H2RA: : histamine 2 receptor antagonist LES: : lower esophageal sphincter NASPGHAN: : North American Society of Pediatric Gastroenterology, Hepatology and Nutrition pH-MII: : multichannel intraluminal pH impedance PPI: : proton pump inhibitor SLESR: : swallow-associated lower esophageal sphincter relaxation SSI: : symptom sensitivity index TLESR: : transient lower esophageal sphincter relaxation VLBW: : very low-birthweight Clinicians caring for premature infants need to recognize the natural history and pathophysiology of gastroesophageal reflux (GER) and GER disease. Clinicians also need to make the most out of the diagnostic tools available in their clinical settings and offer the most appropriate therapy for these conditions, which constitute a significant burden to patients and to our health care system. After completing this article, readers should be able to: 1. Explain the terminology, mechanisms, and controversies surrounding gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in neonates. 2. Describe the epidemiology, pathophysiology, and risk factors of GER and GERD in neonates. 3. Explain the approach to evaluate, diagnose, and manage GERD in neonates. Gastroesophageal reflux (GER) is a normal physiologic process that occurs in all age groups. In healthy preterm infants, an average of 2 to 3 reflux events occur per hour, as has been reported using 24-hour pH impedance monitoring. (1) GER has historically been associated with a wide variety of behaviors commonly attributed to “GERD-like” symptoms in infants. (2) However, the association between a specific symptom and GER needs supporting data. (3) In the NICU infant, many of these symptoms may have multisystemic etiologies related to prematurity, chronic lung disease, and neuropathology, among others, rather than solely GER. Over the years, GER has remained a controversial topic for clinicians because of the challenges that entail its accurate diagnosis, as well as the uncertainty of treatment efficacy in symptomatic neonates. Furthermore, various studies have shown that histamine 2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), and prokinetics therapy may be associated with serious adverse outcomes in preterm infants. (4)(5)(6)(7) In addition, the American Academy of Pediatrics (AAP) through the “Choosing Wisely in Newborn Medicine” initiative highlighted routine use of antireflux medications in symptomatic GER in preterm infants …