Management Of Preterm Infants Research Articles

Fentanyl dosage for preterm infants suggested by a pharmacokinetic, -dynamic, and -genetic model.

Fentanyl is commonly administered for procedural pain management in preterm infants, but target concentrations have not yet been defined. To investigate pharmacokinetics (PK), -dynamics (PD), and -genetics (PG), 25 infants (gestational age 23.3-34.1 weeks) received a fentanyl dose before a skin-breaking procedure (0.5 µg/kg) or tracheal intubation (2 µg/kg). Four pain scales were used as a PD endpoint to evaluate efficacy. The impact of polymorphism in genes encoding enzymes (UGT2B7, CYP3A7, CYP3A4, COMT, CYP2D6, KCNJ6), transporters (SLC22A1, ABCC1, ABCC3) and receptor (OPRM1) on PK parameters was explored. A two-compartment PK model adequately described the fentanyl concentration. The effects of weight and maturity on the clearance were included as covariates in the model. One genetic variant encoding the ABCC1 transporter (rs111517339 T/TA) and two encoding the ABCC3 transporter (rs11079921 T/C and rs8077268 C/T) had a significant effect on fentanyl elimination that explained 15% of the interindividual variability on the clearance. A proportional odds PK/PD model was used to describe the concentration-effect relationship of fentanyl using the Échelle de douleur et d'inconfort du nouveau-né (EDIN) pain score. The simulations suggest that an intravenous dose of 2 µg/kg would be appropriate in preterm infants for a clearly painful procedure, such as an intubation. Design of personalized analgesia with fentanyl for newborn infants should consider maturation and genetic variants of opioid transporters affecting drug elimination. The results indicate that an intravenous dose of 2 μg/kg fentanyl would be suitable before a clearly painful procedure in preterm infants. Genetic variants encoding ABCC1 and ABCC3 transporters increase the clearance of fentanyl, which is a novel finding.

Effects of implementing non-nutritive sucking on oral feeding progression and outcomes in preterm infants: A systematic review and meta-analysis.

Preterm infants have imperfect neurological development, uncoordinated sucking-swallowing-breathing, which makes it difficult to realize effective oral feeding after birth. How to help preterm infants achieve complete oral feeding as soon as possible has become an important issue in the management of preterm infants. Non-nutritive sucking (NNS), as a useful oral stimulation, can improve the effect of oral feeding in preterm infants. This review aimed to explore the effect of NNS on oral feeding progression through a meta-analysis. We systematically searched PubMed, CINHAL, Web of Science, Embase, Cochrane databases, China's National Knowledge Infrastructure (CNKI), Wanfang and VIP database from inception to January 20, 2024. Search terms included 'non-nutritive sucking' 'oral feeding' and 'premature.' Eligibility criteria involved randomized controlled studies in English or Chinese. Studies were excluded if they were reviews, case reports, or observational studies from which valid data could not be extracted or outcome indicators were poorly defined. The meta-analysis will utilize Review Manager 5.3 software, employing either random-effects or fixed-effects models based on observed heterogeneity. We calculated the mean difference (MD) and 95% confidence interval (CI) for continuous data, and estimated pooled odds ratios (ORs) for dichotomous data. Sensitivity and publication bias analyses were conducted to ensure robust and reliable findings. We evaluated the methodological quality of randomized controlled trials (RCTs) utilizing the assessment tool provided by the Cochrane Collaboration. A total of 23 randomized controlled trials with 1461 preterm infants were included. The results of the meta-analysis showed that NNS significantly shortened time taken to achieve exclusive oral feeding (MD = -5.37,95%CI = -7.48 to-3.26, p<0.001), length of hospital stay(MD = -4.92, 95% CI = -6.76 to -3.09, p<0.001), time to start oral feeding(MD = -1.41, 95% CI = -2.36 to -0.45, p = 0.004), time to return to birth weight(MD = -1.72, 95% CI = -2.54 to -0.91, p<0.001). Compared to the NNS group, the control group had significant weight gain in preterm infants, including weight of discharge (MD = -61.10, 95% CI = -94.97 to -27.23, p = 0.0004), weight at full oral feeding (MD = -86.21, 95% CI = -134.37 to -38.05, p = 0.0005). In addition, NNS reduced the incidence of feeding intolerance (OR = 0.22, 95% CI = 0.14 to 0.35, p<0.001) in preterm infants. NNS improves oral feeding outcomes in preterm infants and reduces the time to reach full oral feeding and hospitalization length. However, this study was limited by the relatively small sample size of included studies and did not account for potential confounding factors. There was some heterogeneity and bias between studies. More studies are needed in the future to validate the effects on weight gain and growth in preterm infants. Nevertheless, our meta-analysis provides valuable insights, updating existing evidence on NNS for improving oral feeding in preterm infants and promoting evidence-based feeding practices in this population.

Prevalence, Severity Patterns and Risk Factors of Bronchopulmonary Dysplasia in Preterm Infants Younger than 32 Weeks of Gestation in a Tertiary Centre in Oman.

This study aimed to determine the rate and severity patterns of bronchopulmonary dysplasia (BPD) and identify antenatal and postnatal factors associated with BPD in preterm infants <32 weeks of gestational age (GA). This retrospective observational study included preterm neonates <32 weeks of gestation admitted into the neonatal intensive care unit between January 2010 and December 2017 at Sultan Qaboos University Hospital, Muscat, Oman. A data set of antenatal and perinatal factors were collected. BPD was defined as the need for oxygen and/or respiratory support at 36 weeks post-menstrual age (PMA). Infants with and without BPD were compared in their antenatal and perinatal factors. A total of 589 preterm infants <32 weeks were admitted. Among them, 505 (85.7%) survived to 36 weeks' PMA and 90 (17.8%) had BPD. The combined BPD and mortality rate was 28.4%. Grades 1, 2 and 3 BPD constituted 77.8%, 7.8% and 14.4%, respectively. BPD was associated with lower GA, lower birth weight, need for intubation at resuscitation, lower Apgar scores, longer duration of ventilation, surfactant therapy and higher rates of neonatal morbidities. On binary logistic regression analysis, predictors of BPD were longer duration of ventilation, intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC). In an Omani centre, 17.8% of preterm infants (<32 weeks GA) developed BPD. Various perinatal and neonatal factors were associated with BPD. However, longer duration of ventilation, IVH grades 1 and 2 and NEC stages II and III were significant predictors. Future multicentre research is necessary to provide the overall prevalence of BPD in Oman to help optimise the resources for BPD prevention and management in preterm infants.

The effect of music on pain management in preterm infants during daily painful procedures: a systematic review and meta-analysis.

The present systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to investigate the effects of music on pain management in preterm neonates during painful procedures. The PubMed, Embase, Web of Science, EBSCO and Cochrane Library databases were searched to identify relevant articles published from their inception to September 2023. The study search strategy and all other processes were implemented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four RCTs that satisfied the inclusion criteria were included in this meta-analysis. The music group had significantly lower Premature Infant Pain Profile (PIPP) scores during (RR = -1.21; 95% CI = -2.02--0.40, p = 0.0032) and after painful procedures (RR = -0.65; 95% CI = -1.06--0.23, p = 0.002). The music group showed fewer changes in PIPP scores after invasive operations than did the control group (RR = -2.06; 95% CI -3.16--0.96; p = 0.0002). Moreover, our results showed that music improved oxygen saturation during (RR = 3.04, 95% CI = 1.64-4.44, p < 0.0001) and after painful procedures (RR = 3.50, 95% CI = 2.11-4.90, p < 0.00001). However, the change in peak heart rate during and after painful procedures was not statistically significant (RR = -12.14; 95% CI = -29.70-5.41 p = 0.18; RR = -10.41; 95% CI = -22.72-1.90 p = 0.10). In conclusion, this systematic review demonstrated that music interventions are effective for relieving procedural pain in preterm infants. Our results indicate that music can reduce stress levels and improve blood oxygen saturation. Due to the current limitations, large-scale, prospective RCTs should be performed to validate the present results.

Effect of non-pharmacological interventions on pain in preterm infants in the neonatal intensive care unit: a network meta-analysis of randomized controlled trials

ObjectiveTo evaluate the effectiveness of different non-pharmacological interventions for pain management in preterm infants and provide high-quality clinical evidence.MethodsRandomized controlled trials (RCTs) of various non-pharmacological interventions for pain management in preterm infants were searched from PubMed, Web of Science, Embase, and the Cochrane Library from 2000 to the present (updated March 2023). The primary outcome was pain score reported as standardized mean difference (SMD). The secondary outcomes were oxygen saturation and heart rate reported as the same form.ResultsThirty five RCTs of 2134 preterm infants were included in the meta-analysis, involving 6 interventions: olfactory stimulation, combined oral sucrose and non-nutritive sucking (OS + NNS), facilitated tucking, auditory intervention, tactile relief, and mixed intervention. Based on moderate-quality evidence, OS + NNS (OR: 3.92, 95% CI: 1.72, 6.15, SUCRA score: 0.73), facilitated tucking (OR: 2.51, 95% CI: 1.15, 3.90, SUCRA score: 0.29), auditory intervention (OR: 2.48, 95% CI: 0.91, 4.10, SUCRA score: 0.27), olfactory stimulation (OR: 1.80, 95% CI: 0.51, 3.14, SUCRA score: 0.25), and mixed intervention (OR: 2.26, 95% CI: 0.10, 4.38, SUCRA score: 0.14) were all superior to the control group for pain relief. For oxygen saturation, facilitated tucking (OR: 1.94, 95% CI: 0.66, 3.35, SUCRA score: 0.64) and auditory intervention (OR: 1.04, 95% CI: 0.22, 2.04, SUCRA score: 0.36) were superior to the control. For heart rate, none of the comparisons between the various interventions were statistically significant.ConclusionThis study showed that there are notable variations in the effectiveness of different non-pharmacological interventions in terms of pain scores and oxygen saturation. However, there was no evidence of any improvement in heart rate.

FRI163 Central Role Of Mirnas During Kidney Development And Establishment Of The Mineralocorticoid Signaling Pathway Establishment Of The Mineralocorticoid Signaling Pathway

Abstract Disclosure: I. Hani: None. T. Vu: None. R. Brillet: None. J. Perrot: None. J. Bouligand: None. J. Guegan: None. N. Cherradi: None. P. Kamenicky: None. M. Lombes: None. L. Martinerie: None. S. Viengchareun: None. In tight epithelia, aldosterone controls sodium and water homeostasis by binding to the Mineralocorticoid Receptor (MR), a steroid nuclear receptor. We have identified a specific temporal window during renal development in which the mineralocorticoid signaling pathway is ineffective due to downregulation of MR expression, explaining physiological sodium wasting observed in human newborns during first days of life. However, underlying molecular mechanisms controlling MR expression remain unknown. Recently, we demonstrated in adult renal KC3AC1 cell line that MR expression is controlled by microRNAs (miR-30c-2-3p and miR-324-5p) in response to variations of tonicity. These regulators bind to 3'-untranslated region (3'-UTR) of MR transcripts to modulate their stability and translation. Therefore, we hypothesized that these miRNAs may be responsible for low expression level of MR at birth, where variations in tonicity are observed due to the transition from intra-amniotic to extra-uterine life. Using primary cultures of renal epithelial cells from neonatal mouse kidneys, harvested at birth (D0) and at Day 8 postnatal (D8), we showed that only miR-30c-2-3p regulates MR expression at D8. For this reason, we performed a complete transcriptomic analysis (miRNA-Seq and RNA-Seq) of kidneys collected at D0 and D8 to identify other miRNAs specifically involved in regulation of MR expression in perinatal period. Bioinformatics analysis allowed us to identify deregulated miRNAs and transcripts between D0 and D8 and to specify their involvement in biological processes and/or signaling pathways. We mainly focused on deregulated miRNAs that may modulate MR expression and affect mineralocorticoid signaling. miR-Seq identified 221 differentially expressed miRNAs. First, we selected 3 over- (miR-431-5p, miR-409-3p, and miR-92a-1-5p) and 3 under-expressed (miR-30a-5p, miR-30e-5p, and miR-802-5p) candidate miRNAs (FDR&amp;lt;0.05 and log2FC&amp;gt;1) having putative binding sites in MR 3'-UTR. Paradoxically, we showed in primary kidney cultures that overexpression of miR-30a-5p, miR-30e-5p, or miR-802-5p increased MR expression (from 50 to 100%, P&amp;lt;0.05) at D0, suggesting that these miRNAs may either positively modulate MR expression or may involve an intermediate regulator. On the opposite, over-expression of miR-92a-1-5p, miR-431-5p, and miR-409-3p at D8 led to a decrease (from 30-40%, P&amp;lt;0.05) in MR expression, suggesting that these miRNAs may modulate MR expression in postnatal period. Currently, we are evaluating whether they could be used as prognostic or severity biomarkers of water loss in neonates by quantifying these candidate miRNAs in urine exosomes of preterm and term infants. A better understanding of mechanisms regulating MR expression in the perinatal period will undoubtedly have a major impact on the management of premature infants with sodium balance maladjustment at birth. Presentation Date: Friday, June 16, 2023

Nutrition of the preterm infant with persistent ductus arteriosus: existing evidence and practical implications.

The persistence of a patent ductus arteriosus (PDA) is a common condition in preterm infants with a prevalence inversely proportional to gestational age. PDA is associated with mild-to-severe gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which represent a major challenge for the nutritional management in preterm infants. In this context, the Section on Nutrition, Gastroenterology and Metabolism and the Circulation Section of the European Society for Pediatric Research have joined forces to review the current knowledge on nutritional issues related to PDA in preterm infants. The aim of the narrative review is to discuss the clinical implications for nutritional practice. Because there is little literature on postnatal nutrition and PDA in preterm infants, further research with well-designed studies on this topic is urgently needed. Guidelines should also be developed to clearly define the implementation and course of enteral nutrition and the target nutritional intake before, during, and after pharmacologic or surgical treatment of PDA, when indicated. IMPACT: Persistent ductus arteriosus (PDA) is associated with gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which pose a major challenge to the nutritional management of preterm infants. In PDA infants, fluid restriction may lead to inadequate nutrient intake, which may negatively affect postnatal growth and long-term health. The presence of PDA does not appear to significantly affect mesenteric blood flow and splanchnic oxygenation after enteral feedings. Initiation or maintenance of enteral nutrition can be recommended in infants with PDA.

Baseline azithromycin resistance in the gut microbiota of preterm born infants

BackgroundMacrolides, including azithromycin, are increasingly used in preterm-born infants to treat Ureaplasma infections. The baseline carriage of macrolide resistance genes in the preterm stool microbiota is unknown.ObjectivesIdentify carriage of azithromycin resistant bacteria and the incidence of macrolide resistant genes.MethodsAzithromycin resistant bacteria were isolated from serial stool samples obtained from preterm infants (≤32 weeks’ gestation) by culturing aerobically/anaerobically, in the presence/absence of azithromycin. Using quantitative PCR, we targeted 6 common macrolide resistance genes (erm(A), erm(B), erm(C), erm(F), mef(A/E), msr(A)) in DNA extracted from selected bacteria resistant to azithromycin.ResultsFrom 89 stool samples from 37 preterm-born infants, 93.3% showed bacterial growth in aerobic or anaerobic conditions. From the 280 azithromycin resistant isolates that were identified, Staphylococcus (75%) and Enterococcus (15%) species dominated. Macrolide resistance genes were identified in 91% of resistant isolates: commonest were erm(C) (46% of isolates) and msr(A) (40%). Multiple macrolide resistance genes were identified in 18% of isolates.ConclusionMacrolide resistance is common in the gut microbiota of preterm-born infants early in life, most likely acquired from exposure to the maternal microbiota. It will be important to assess modulation of macrolide resistance, if macrolide treatment becomes routine in the management of preterm infants.Impact StatementAzithromycin resistance is present in the stool microbiota in the first month of life in preterm infants91% of azithromycin resistant bacteria carried at least one of 6 common macrolide resistant genesIncreasing use of macrolides in the preterm population makes this an important area of study

Oral characteristics and dietary habits of preterm children: A retrospective study using National Health Screening Program for Infants and Children.

The rate of preterm birth is increasing worldwide and preterm infants are susceptible to oral health problems. Hence, this study aimed to investigate the effect of premature birth on dietary and oral characteristics as well as dental treatment experiences of preterm infants using a nationwide cohort study. Data was retrospectively analyzed from National Health Screening Program for Infants and Children (NHSIC) of the National Health Insurance Service of Korea. 5% sample of children born between 2008 and 2012 who completed first or second infant health screening were included and divided into full-term and preterm-birth groups. Clinical data variables such as dietary habits, oral characteristics, and dental treatment experiences were investigated and comparatively analyzed. Preterm infants showed significantly lower rates of breastfeeding at 4-6 months (p<0.001), delayed start of weaning food at 9-12 months (p<0.001), higher rates of bottle feeding at 18-24 months (p<0.001), poor appetite at 30-36 months (p<0.001) and higher rates of improper swallowing and chewing function at 42-53 months (p = 0.023) than full-term infants. Preterm infants also had eating habits leading to poor oral conditions and higher percentage of absence of dental visit compared to full-term infants (p = 0.036). However, dental treatments including 1-visit pulpectomy (p = 0.007) and 2-visit pulpectomy (p = 0.042) significantly decreased when oral health screening was completed at least once. The NHSIC can be an effective policy for oral health management in preterm infants.

On the 10th Anniversary of the Korean Neonatal Network

The Korean Neonatal Network (KNN), which is celebrating its 10th anniversary, currently has more than 100 staff and researchers from &gt;70 neonatal intensive care units nationwide in Korea. More than 85% to 90% of the population of very low birth weight infants in Korea are registered yearly, and more than half are followed up for up to 3 years at the KNN. A total of &gt;19,000 cases have been accumulated through a strict data quality management process of the KNN. Based on this, &gt;100 research projects have been proposed, &gt;70 peer-reviewed papers have been published in leading international journals, and the cornerstone of the quality improvement project has been launched. In addition, we recently expanded the number of subjects for registration to very premature infants &lt;32 weeks of age and continue to provide essential evidence data for establishing national health policies, such as linking with government policy projects of the Ministry of Health and Welfare for preterm infants. In such manner, the KNN is confident to be successfully and actively moving toward reaching the ultimate goal of standardizing neonatal intensive care and management of preterm infants in Korea by providing essential data for national health policy establishment along with quality improvement through evidence-based interactive data.

Fluid and electrolyte management in preterm infants with patent ductus arteriosus.

Optimal fluid management of preterm babies with suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is frequently challenging for neonatal care physician because of paucity of clinical trials. There is wide variation in practice across neonatal units, resulting in significant impact on outcomes in Extremely Low Birth Weight (ELBW) babies with hemodynamically significant PDA. A delicate balance is required in fluid management to reduce mortality and morbidity in this population. The purpose of this review is to lay out the current understanding about fluid and electrolyte management in ELBW babies with hemodynamically significant PDA and highlight areas for future research.

Development, evaluation and adaptation of a critical realism informed theory of procedural pain management in preterm infants: The PAIN-Neo theory.

To present the development, evaluation and adaptation of the PAIN-Neo theory. Theory development. A review of literature was conduct from 1980 to 2021. Using a critical realism paradigm, this paper presents the PAIN-Neo theory, which was developed from an analysis of existing theoretical perspectives on paediatric procedural pain, empirical studies conducted with preterm infants, and the research team's pain management expertise. The theory was then empirically tested and fine-tuned. The PAIN-Neo theory highlights that the neonatal nurse is part of a larger picture as she is influenced by factors related to her unit, hospital and country of practice. This theory emphasizes the importance of parental involvement in pain management, which is consistent with family-centred nursing practices. The PAIN-Neo theory reflects the complexity of pain management nursing. This theory is innovative and specific enough to guide practice, structure research projects and contribute to the body of knowledge in the discipline of nursing.

Precision caffeine therapy for apnea of prematurity and circadian rhythms: New possibilities open up.

Caffeine is the globally consumed psychoactive substance and the drug of choice for the treatment of apnea of prematurity (AOP), but its therapeutic effects are highly variable among preterm infants. Many of the molecular underpinnings of the marked individual response have remained elusive yet. Interestingly, the significant association between Clock gene polymorphisms and the response to caffeine therapy offers an opportunity to advance our understanding of potential mechanistic pathways. In this review, we delineate the functions and mechanisms of human circadian rhythms. An up-to-date advance of the formation and ontogeny of human circadian rhythms during the perinatal period are concisely discussed. Specially, we summarize and discuss the characteristics of circadian rhythms in preterm infants. Second, we discuss the role of caffeine consumption on the circadian rhythms in animal models and human, especially in neonates and preterm infants. Finally, we postulate how circadian-based therapeutic initiatives could open new possibilities to promote precision caffeine therapy for the AOP management in preterm infants.

25 Paracetamol versus Indomethacin for management of Patent Ductus Arteriosus in Premature Infants- A Systematic Review and Meta-Analysis

Abstract Background Premature infants with hemodynamically significant patent ductus arteriosus (HsPDA) have high rates of morbidity and mortality in neonatal units. Indomethacin has been the most common agent used for pharmacological closure of the PDA. Recently, paracetamol has gained interest in the neonatal community for its use for management of HsPDA. Objectives To conduct a systematic review of randomized controlled trials (RCTs) comparing the efficacy and safety of paracetamol with indomethacin for HsPDA management in preterm infants. Design/Methods We searched PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library (CDSR and Central), EBSCO CINAHL, and SCOPUS using controlled vocabulary and key words representing the concepts "preterm neonates" and "acetaminophen" and "indomethacin". Databases were searched from inception to June 15, 2021. Bibliographies of identified studies were searched for additional references. Studies were included if they enrolled preterm infants with HsPDA (diagnosed on echocardiogram), and randomised them for treatment with paracetamol or indomethacin for the primary outcome of HsPDA closure. Discrepancies among reviewers for study selection, RoB assessments, and data extraction were resolved by consensus. Data were analyzed with the help of Review Manager (RevMan) Version 5.3. Results Four RCTs were identified, enrolling a total of 380 subjects. There was no difference between the two interventions for the rates of PDA closure either after one course (4 studies; RR 1.04 [95% CIs: 0.84, 1.29], p-value 0.70) or after two courses of treatment (2 studies; RR 1.01 [95% CIs: 0.92, 1.12], p-value 0.77), and for PDA ligation (3 studies; RR 1.56 [95% CIs: 0.48, 5.12], p-value 0.46). However, the patients who received paracetamol had lower rates of necrotizing enterocolitis (NEC) (3 studies; RR 0.37 [95% CIs: 0.14, 0.95], p-value 0.04). There were no significant differences noted in the other important secondary outcomes, i.e., Intraventricular hemorrhage, bronchopulmonary dysplasia, retinopathy of prematurity requiring treatment, and death. Two studies reported baseline and post-treatment serum markers for renal and hepatic injury; there was significant post-treatment elevation of serum creatinine and blood urea noted with the indomethacin use in each of these studies, as compared to no change noted with paracetamol use. Conclusion The efficacy of paracetamol is comparable to indomethacin for the outcome of PDA closure, with lesser rate of NEC and post-treatment azotemia noted with the paracetamol use. Paracetamol should be preferred over indomethacin for HsPDA management in premature infants.

Comprehensive Clinical Approach to Nutritional Management in Preterm Infants: Review Article

Comprehensive Clinical Approach to Nutritional Management in Preterm Infants: Review Article

Initiating Ponseti management in preterm infants with clubfoot at term age.

Purpose:Currently, the optimal time to initiate treatment among preterm infants with clubfoot is unknown. The aim of this study was to describe treatment outcomes up to 1 year post-correction following Ponseti management in infants who were born preterm but treated at term age.Methods:A retrospective chart audit was conducted at a major pediatric hospital on preterm infants with clubfoot who commenced Ponseti management at term age (≥37 weeks of gestation). Data are expressed as mean values (±standard deviation) or 95% confidence intervals (95% CIs).Results:Twenty-six participants (40 feet) born at 32.6/40 (±3.1) weeks of gestation were identified. Thirteen (50%) were male, 14 (54%) presented bilaterally, and 7 (27%) presented with syndromic clubfoot. Ponseti management was initiated at 41.4/40 (±2.8) weeks gestation. Baseline Pirani scores were 5.2 (95%CI: 4.8–5.6) in the idiopathic group and 5.7 (95%CI: 5.0–6.4) in the syndromic group. The number of casts to correction was 5.9 (95% CI: 5.1–6.6) for those with idiopathic clubfoot and 6.1 (95%CI: 5.0–7.3) for those with syndromic clubfoot. Achilles tenotomies were required in 13 (21 feet) with idiopathic clubfoot and five (7 feet) with syndromic clubfoot. Recurrence occurred in four infants (5 feet): 4 feet required further casting and bracing, and 1 foot required additional surgery.Conclusion:Ponseti management at term age in preterm-born infants yields comparable 1-year outcomes to term-born infants. Further research is required to determine whether outcomes beyond 1 year of age align with growth and development demonstrated by term-born infants who are managed with the Ponseti method.Level of evidence:Level IV.

Intravenous Fluid Supplementation for Preterm Infants With Hyperbilirubinemia: A Retrospective Cohort Study.

Hyperbilirubinemia is one of the most frequently occurring problems in the neonatal period, and phototherapy has remained the primary treatment of choice. Fluid supplementation has been proposed to reduce serum bilirubin levels. To assess the risks and benefits of fluid supplementation compared with standard fluid management in preterm infants with unconjugated hyperbilirubinemia under conventional phototherapy. A retrospective cohort study of preterm infants (gestational ages ≥28 to ≤32 weeks) admitted to the neonatal intensive care unit at the Maternity and Children Hospital in Jeddah, Saudi Arabia, from January 1, 2017, to December 31, 2017, and required the initiation of phototherapy in the first week of life. One hundred and fifteen infants were included; 51 received fluid supplementation, and 64 received standard fluid management. There were no significant differences in demographic characteristics between groups. The infants who received fluid supplementation had a significantly larger decline in the total serum bilirubin level per day and a shorter phototherapy duration ( P < .01). There were no significant differences in weight ( P = .14), or sodium ( P = .79) change per day or the need for exchange transfusion between groups. The prematurity-related inhospital morbidities were similar between groups. Fluid supplementation in preterm infants receiving conventional phototherapy resulted in a faster decline in the bilirubin level and a shorter duration of phototherapy, without increasing prematurity-related morbidities. Future randomized controlled trials to assess the benefits and risks of fluid supplementation during conventional phototherapy in preterm infants are needed.

Expert consensus on the clinical practice of neonatal brain magnetic resonance imaging.

In recent years, magnetic resonance imaging (MRI) has been widely used in evaluating neonatal brain development, diagnosing neonatal brain injury, and predicting neurodevelopmental prognosis. Based on current research evidence and clinical experience in China and overseas, the Neonatologist Society of Chinese Medical Doctor Association has developed a consensus on the indications and standardized clinical process of neonatal brain MRI. The consensus has the following main points. (1) Brain MRI should be performed for neonates suspected of hypoxic-ischemic encephalopathy, intracranial infection, stroke and unexplained convulsions; brain MRI is not considered a routine in the management of preterm infants, but it should be performed for further evaluation when cranial ultrasound finds evidence of brain injury; as for extremely preterm or extremely low birth weight infants without abnormal ultrasound findings, it is recommended that they should undergo MRI examination at term equivalent age once. (2) Neonates should undergo MRI examination in a non-sedated state if possible. (3) During MRI examination, vital signs should be closely monitored to ensure safety; the necessity of MRI examination should be strictly evaluated for critically ill neonates, and magnetic resonance compatible incubator and ventilator can be used. (4) At present, 1.5 T or 3.0 T equipment can be used for neonatal brain MRI examination, and the special coil for the neonatal head should be used to improve signal-to-noise ratio; routine neonatal brain MRI sequences should at least include axial T1 weighted image (T1WI), axial T2 weighted imaging (T2WI), diffusion-weighted imaging, and sagittal T1WI or T2WI. (5) It is recommended to use a structured and graded reporting system, and reports by at least two reviewers and multi-center collaboration are recommended to increase the reliability of the report.

Corticosteroids in the prevention and treatment of infants with bronchopulmonary dysplasia: Part I. systemic corticosteroids.

Bronchopulmonary dysplasia (BPD) is the most significant respiratory complication of prematurity, and its consequences last from birth into adulthood. Unfortunately, the dramatic improvements in the management of premature infants have not led to a decreased incidence of BPD, or to breakthroughs in treatments offered for this long-lasting chronic respiratory disorder. Over recent decades the pathological picture of BPD has changed from inflammation, interstitial fibrosis and emphysema attributed to volu-, barotrauma and oxygen toxicity to larger, simplified alveoli and dysmorphic vessels related to arrested alveolarization and vasculogenesis with inflammation maintaining a central role. Corticosteroids (CSs) play a key role in the development of respiratory epithelial cells and lung maturation. These potent anti-inflammatory agents have long been used for the prevention and treatment of BPD; however, the risk/benefit ratio of their use remains unresolved. CSs administered antenatally have contributed to reduce mortality and respiratory distress syndrome, no such effect on BPD reduction has been observed. Postnatal systemic CSs reduced the rate and severity of BPD, yet their long-term neurodevelopmental and respiratory consequences markedly limit routine administration. This is the first in a two-part State-of-the-Art series that reviews the latest relevant clinical trials investigating the short-term and long-term effects of CSs in the prevention and treatment of BPD.

Oscillatory mechanics at birth for identifying infants requiring surfactant: a prospective, observational trial

BackgroundCurrent criteria for surfactant administration assume that hypoxia is a direct marker of lung-volume de-recruitment. We first introduced an early, non-invasive assessment of lung mechanics by the Forced Oscillation Technique (FOT) and evaluated its role in predicting the need for surfactant therapy.ObjectivesTo evaluate whether lung reactance (Xrs) assessment by FOT within 2 h of birth identifies infants who would need surfactant within 24 h; to eventually determine Xrs performance and a cut-off value for early detection of infants requiring surfactant.MethodsWe conducted a prospective, observational, non-randomized study in our tertiary NICU in Milan. Eligible infants were born between 27+0 and 34+6 weeks’ gestation, presenting respiratory distress after birth. Exclusion criteria: endotracheal intubation at birth, major malformations participation in other interventional trials, parental consent denied. We assessed Xrs during nasal CPAP at 5 cmH2O at 10 Hz within 2 h of life, recording flow and pressure tracing through a Fabian Ventilator for off-line analysis. Clinicians were blinded to FOT results.ResultsWe enrolled 61 infants, with a median [IQR] gestational age of 31.9 [30.3; 32.9] weeks and birth weight 1490 [1230; 1816] g; 2 infants were excluded from the analysis for set-up malfunctioning. 14/59 infants received surfactant within 24 h. Xrs predicted surfactant need with a cut-off − 33.4 cmH2O*s/L and AUC-ROC = 0.86 (0.76–0.96), with sensitivity 0.85 and specificity 0.83. An Xrs cut-off value of − 23.3 cmH2O*s/L identified infants needing surfactant or respiratory support > 28 days with AUC-ROC = 0.89 (0.81–0.97), sensitivity 0.86 and specificity 0.77. Interestingly, 12 infants with Xrs < − 23.3 cmH2O*s/L (i.e. de-recruited lungs) did not receive surfactant and subsequently required prolonged respiratory support.ConclusionXrs assessed within 2 h of life predicts surfactant need and respiratory support duration in preterm infants. The possible role of Xrs in improving the individualization of respiratory management in preterm infants deserves further investigation.