Pain and Sedation. The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN)  Recommendations 1. The routine use of morphine infusions in ventilated preterm infants is not recommended (C2). 2. Opioids should be used selectively, when indicated by clinical judgement and evaluation of pain indicators (D1). 3. Sucrose analgesia and other non-pharmacological methods may be employed to reduce…

Continue reading

Managing Blood Pressure and Perfusion.The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN)  Recommendations 1. Treatment of hypotension is recommended when it is confirmed by evidence of poor tissue perfusion such as oliguria, acidosis and poor capillary return rather than purely on numerical values (C2). 2. Hb concentration should be maintained within normal limits. A suggested Hb threshold…

Continue reading

Monitoring and Supportive Care. The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN)  Recommendations 1.Body temperature should be maintained at 36.5–37.5°C at all times (C1). 2.Most babies should be started on intravenous fluids of 70–80 ml/kg/day while being kept in a humidified incubator although some very immature babies may need more (B2). Fluids must be tailored individually according…

Continue reading

Prophylactic treatment for sepsis. The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN)  Recommendations 1. Infection control measures should be strictly applied  2. Antibiotics are often started in babies with RDS until sepsis has been ruled out, but policies should be in place to narrow the spectrum and minimize unnecessary exposure. A common regimen includes penicillin or ampicillin in…

Continue reading

Mechanical Ventilation Strategies.The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN)  Recommendations 1.After stabilization, MV should be used in babies with RDS when other methods of respiratory support have failed (A1). Duration of MV should be minimized (B2). 2.Targeted tidal volume ventilation should be employed as this shortens the duration of ventilation and reduces BPD and…

Continue reading

Oxygen Supplementation beyond Stabilization. The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN)  Recommendations 1. In preterm babies receiving oxygen, the saturation target should be between 90 and 94% (B2). 2. To achieve this, suggested alarm limits should be 89 and 95% (D2). 3. Following the administration of a surfactant, a hyperoxic peak should be avoided by rapid…

Continue reading

SURFACTANT THERAPY. The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN)  Recommendations 1. Babies with RDS should be given a natural surfactant preparation (A1). 2.A policy of early rescue  surfactant (within 2 hours of birth) should be standard (A1) but there are occasions when surfactant should be administered in the delivery suite, such as those who…

Continue reading

DELIVERY ROOM STABILIZATION. The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN)  Recommendations 1.If possible delay clamping the umbilical cord for at least 60 seconds to promote placentofetal transfusion (B1). 2.Oxygen for resuscitation should be controlled using a blender. An initial concentration of 30%-60% oxygen is appropriate for babies <28 weeks’ gestation and 21–30% for those of…

Continue reading

PRENATAL CARE. The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN)  Recommendations 1. Mothers at high risk of preterm birth <34 weeks’ gestation should be transferred to perinatal centers with experience in the management of RDS (C1) 2.Clinicians should offer a single course of prenatal corticosteroids to all women at risk of preterm delivery, from when…

Continue reading

Effect of Prophylactic Indomethacin in Extremely Low Birth Weight Infants Based on the Predicted Risk of Severe Intraventricular Hemorrhage

Foglia et al, Neonatology 2018 Abstract Background: Prophylactic indomethacin reduces the risk of severe intraventricular hemorrhage (IVH) but does not reduce death or neurodevelopmental impairment (NDI) among extremely low birth weight (ELBW) infants. Some investigators have suggested that prophylactic indomethacin may have a greater treatment effect on severe IVH among infants at high…

Continue reading

Diagnosis and Management of Necrotizing Enterocolitis: An International Survey of Neonatologists and Pediatric Surgeons

Valpacos et al, Neonatology 2018 Abstract Background: Necrotizing enterocolitis (NEC) is a serious complication of prematurity. Currently, there is limited evidence to guide investigation and treatment strategies.  Objectives: To evaluate the parameters used to diagnose or exclude NEC, and to identify differences between neonatologists and pediatric surgeons.  Conclusion: Results indicate a wide variation in…

Continue reading

The Laryngeal Mask Airway and Its Use in Neonatal Resuscitation: A Critical Review of Where We Are in 2017/2018

Bansal et al, Neonatology 2018 Abstract Studies using videotape recordings and respiratory function monitoring have shown that both face mask (FM) application and endotracheal tube (ETT) placement represent a challenge for resuscitators. Hence, there is a strong need for devices that can largely be used independently of individual operator training levels,…

Continue reading

Topical Coconut Oil in Very Preterm Infants: An Open-Label Randomised Controlled Trial

Strunk et al, Neonatology 2018 Abstract Background: The immature fragile skin of preterm infants represents an inadequate protective barrier. The emollient and anti-infective properties of coconut oil make it a potentially beneficial topical agent for this population.  Objectives: Our aim was to evaluate feasibility, safety, and the effects of topical coconut oil on…

Continue reading

Early Use of Mother’s Own Raw Milk, Maternal Satisfaction, and Breastfeeding Continuation in Hospitalised Neonates: A Prospective Cohort Study

Fischer Fumeaux et al, Neonatology 2018 Abstract Background: Despite the critical importance of breast milk for preterm and sick neonates, there is no consensus regarding the use of raw mother’s own milk (MOM) in neonatal units.  Objectives:This study aimed to describe the use of raw MOM in hospitalised neonates before day 7…

Continue reading

BMI Is a Better Body Proportionality Measure than the Ponderal Index and Weight-for-Length for Preterm Infants

Ferguson et al, Neonatology 2018 Abstract Background: Clinicians have observed preterm infants in the neonatal intensive care unit growing disproportionally; however, the only growth charts that have been available were from preterm infants born in the 1950s which utilized the ponderal index. Prior to creating the recently published BMI curves, we found only 1…

Continue reading

Early Nutrition and Growth until the Corrected Age of 2 Years in Extremely Preterm Infants

Hiltunen et al, Neonatology 2018   Abstract Background: Extremely preterm birth is associated with a high risk of extrauterine growth retardation, which has been linked with adverse developmental outcomes.    Objective: We investigated whether nutritional management during the first 7 days of life affects growth patterns until the corrected age of 2 years…

Continue reading

The Cerebellar-Cerebral Microstructure Is Disrupted at Multiple Sites in Very Preterm Infants with Cerebellar Haemorrhage

Neubauer et al, Neonatology 2018   Abstract Background:  Recent advances in magnetic resonance imaging (MRI) techniques have prompted reconsideration of the anatomical correlates of adverse outcomes in preterm infants. The importance of the contribution made by the cerebellum is now increasingly appreciated. The effect of cerebellar haemorrhage (CBH)on the microstructure of the…

Continue reading

Hypoxemia Episodes during Day and Night and Their Impact on Oxygen Saturation Targeting in Mechanically Ventilated Preterm Infants

Neonatology 2018 Abstract Background: Hypoxemia episodes (HE) occur frequently in ventilated preterm infants and hinder the achievement of arterial oxygen saturation (SpO2) targets. These episodes may increase the risk for retinopathy of prematurity and neurodevelopmental disability. There are no data on the variation in HE and SpO2 targeting between day…

Continue reading

Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth

Basset et al, Neonatology 2018 Abstract Background: There are concerns about the efficacy of antenatal corticosteroid treatment (ACT) in the growth-restricted fetus. Objective: To evaluate the effect of ACT on neurodevelopmental outcome at 2 years of corrected age according to the z score of birth head circumference (ZS HC) in…

Continue reading

Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial

Bensouda et al, Neonatology 2018 Abstract Background: Hypothermia on admission to intensive care is associated with poor outcomes in preterm infants. The neonatal resuscitation program recommends the use of servo-control thermoregulation during resuscitation. Very little evidence exists to guide optimal temperature probe placement in the delivery room. Objective: The aim…

Continue reading

The Impact of Maternal Gestational Hypertension and the Use of Anti-Hypertensives on Neonatal Myocardial Performance

Breatnach et al, Neonatology 2018 Abstract Background: Assessment of myocardial performance in neonates using advanced techniques such as deformation imaging and rotational mechanics has gained considerable interest. The applicability of these techniques for elucidating abnormal myocardial performance in various clinical scenarios is becoming established. We hypothesise that term infants born…

Continue reading

First Trimester Vaginal Ureaplasma Biovar Colonization and Preterm Birth: Results of a Prospective Multicenter Study

Waldhoer et al, Neonatology 2018 Background: While there is a proven association of upper genital tract Ureaplasma infection during pregnancy with adverse pregnancy outcome, the effect of vaginal Ureaplasma colonization on preterm delivery has been controversially debated. Objectives: We hypothesized that women with isolation of vaginal U. parvum but not…

Continue reading