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…

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Non-Invasive Respiratory Support. The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN)  Rec­om­men­da­tions 1. CPAP should be start­ed from birth in all babies at risk of RDS, such as those <30 weeks’ ges­ta­tion who do not need intu­ba­tion for sta­bi­liza­tion (A1). 2. Any one of the sev­er­al sys­tems of deliv­er­ing CPAP can be used. How­ev­er, we rec­om­mend…

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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…

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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…

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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…

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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…

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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…

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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…

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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,…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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Impact of Minimally Invasive Surfactant Therapy in Preterm Infants at 29–32 Weeks Gestation

Dar­gav­ille et al, Neona­tol­ogy 2018 Abstract Back­ground: Most preterm infants born at 29–32 weeks ges­ta­tion now avoid intu­ba­tion in ear­ly life, and thus lack the usu­al con­duit through which exoge­nous sur­fac­tant is giv­en if need­ed. Objec­tive: The aim of this work was to exam­ine whether a tech­nique of min­i­mal­ly inva­sive…

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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…

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Parenteral Nutrition in Critically Ill Children

Nilesh and Mehta, N Engl J Med 2016 Ade­quate nutri­ent deliv­ery may help to off­set the cata­bol­ic bur­den imposed by crit­i­cal ill­ness, pre­vent­ing nutri­tion­al dete­ri­o­ra­tion and improv­ing out­comes. How­ev­er, ques­tions regard­ing the most appro­pri­ate dose of macronu­tri­ents, the route of deliv­ery, and par­tic­u­lar­ly the tim­ing of sup­ple­men­tal par­enter­al nutri­tion in crit­i­cal­ly…

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Newborn Bilirubin Screening for Biliary Atresia

Bil­iary atre­sia accounts for approx­i­mate­ly 60% of the liv­er trans­plan­ta­tions in infants younger than 1 year of age. These com­pli­cat­ed ear­ly trans­plan­ta­tions can be pre­vent­ed only with the use of the Kasai hepato­por­toen­teros­to­my. The suc­cess of the Kasai pro­ce­dure is var­ied, but a good out­come is more like­ly if the…

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Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review

Bat­ters­by et al, Arch Dis Child Fetal Neona­tal Ed. 2018 Jan Abstract The ear­ly sur­vival of preterm babies has increased in high-resource set­tings, and as a con­se­quence, the num­ber at risk of seri­ous com­pli­ca­tions that com­mon­ly occur in the neona­tal peri­od, such as necro­tis­ing ente­ro­col­i­tis (NEC), is increas­ing. NEC is now one of the…

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Nasal High-Flow Therapy for Primary Respiratory Support in Preterm Infants

Roberts  et al, N Engl J Med. 2016 Sep  Abstract BACKGROUND: Treat­ment with nasal high-flow ther­a­py has effi­ca­cy sim­i­lar to that of nasal con­tin­u­ous pos­i­tive air­way pres­sure (CPAP) when used as pos­tex­tu­ba­tion sup­port in neonates. The effi­ca­cy of high-flow ther­a­py as the pri­ma­rymeans of res­pi­ra­to­ry sup­port for preterm infants with res­pi­ra­to­ry dis­tress has not been proved.   CONCLUSIONS: When used as pri­ma­ry sup­port for preterm infants with res­pi­ra­to­ry dis­tress, high-flow ther­a­py result­ed in a sig­nif­i­cant­ly high­er rate of treat­ment fail­ure than did…

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