neonatalresearch

[neonatalresearch]

Breast is Best; is Fresher Better?

A recurrent problem in the NICU is “bandwagon-jumping”. An intervention with some preliminary positive data, and a possible physiologic rationale is widely adopted and made part of QI bundles with little or no reliable evidence that it is either effective or safe. One such is the hype surrounding fresh mother’s milk. There are a small number of studies showing the following impacts. (references…

[neonatalresearch]

Neurodevelopmental Impairment, who decides what it is?

I have written frequently about my concerns with “NDI” as an important measure of neonatal outcomes, indeed, it seems to be often thought of as if it were the only important measure. It has very often been included as part of a composite outcome measure “death or NDI”. So why am I disturbed about the use of NDI as a primary outcome measure? NDI is itself already a composite measurement,…

[neonatalresearch]

Not neonatology: trip to Panama

Just back from a week in Panama, organised by “Wings“, mostly in Darién province at the extreme east of the country. A really amazing experience, with over 300 bird species seen, including just over 200 “lifers” for me. On my other blog, I have posted several posts, a trip report with many photos. As a taster, this is a Collared Aracari, and below King Vultures. Collared Aracari King Vulture,…

[neonatalresearch]

Term and Near-Term babies at Risk of Early Onset Sepsis: Best Practice?

Sepsis caused by organisms transmitted during, or shortly before, labour is relatively uncommon in higher income countries with GBS screening programs; the incidence is now around 0.3 cases per 1000 live births, but varies, it may be as high as 10 times that, or as low as 0.1/1000. GBS remains the commonest organism, with E Coli close behind, followed by Strep viridans, and then a host of other…

[neonatalresearch]

Term and Near-Term babies at Risk of Early Onset Sepsis: Best Practice?

Sepsis caused by organisms transmitted during, or shortly before, labour is relatively uncommon in higher income countries with GBS screening programs; the incidence is now around 0.3 cases per 1000 live births, but varies, it may be as high as 10 times that, or as low as 0.1/1000. GBS remains the commonest organism, with E Coli close behind, followed by Strep viridans, and then a host of other…

[neonatalresearch]

Surfactant plus Budesonide? Not a PLUSS for outcomes

Many of us were already aware of the general direction of the results of this trial, a multi-centre RCT of surfactant with or without budesonide (Manley BJ, et al. Intratracheal Budesonide Mixed With Surfactant for Extremely Preterm Infants. JAMA. 2024), disappointingly negative results, with no impact on survival or on any index of lung injury. In order to put this in context, I have just been…

[neonatalresearch]

What Sick Babies Can Teach Us

As usual for a TED talk this is 18 minutes long, and, in that brief time, Annie recounts her trajectory: learning from families of kids with trisomy 13 and trisomy 18; our own experience with counselling for threatened extreme preterm birth, from both sides of the conversation; and the Parents Voices Project. The only thing I don’t like about this video is the still that was chosen by their…

[neonatalresearch]

Surgery for NEC; enterostomy or anastomosis?

There are only a few randomized trials in neonatal surgery, but those that exist have had a major impact. This new publication may do the same, even though the sample size is relatively modest, and there are some issues with the article. You can see some of the difficulties in doing such trials from the fact that it took 12 hospitals 9 years to recruit 80 patients, 58 of which came from only 3 of…

[neonatalresearch]

The nicuverse and 99NICU

As some of you may have noticed, I left Twitter (X), apart from sending a link to each new post on this blog. I never any longer visit the website and I have deleted the App on my phone. A great alternative is the nicuverse, nicuverse.org a Mastodon community with many similar functionalities that we could use to chat with each other, discuss research and clinical approaches. You will see also…

[neonatalresearch]

Making Clinical Research Oversight Fit-for-Purpose

The title is a slightly edited copy of the title a discussion article in JAMA, that discusses some important issues in IRB oversight of clinical research. (Kass NE, et al. Making the Ethical Oversight of All Clinical Trials Fit for Purpose. JAMA. 2024), and is part of a special issue including a renewed version of the Declaration of Helsinki World Medical Association Declaration of Helsinki:…

[neonatalresearch]

Badly performed, badly presented, unethical published research; what to do?

Since at least 2013 the World Medical Association Declaration of Helsinki has mandated registration of clinical trials prior to enrolment of the first subject. Since 2005 the International Committee of Medical Journal Editors has required trial registration as a condition of publication, before the onset of patient enrolment. This principle is reiterated in the new version of the declaration of…

[neonatalresearch]

Too much antibiotics, part 2

The multicentre project, that I started the last post with, has just published a new important article, which addresses the duration of antibiotic treatment (Dimopoulou V, et al. Antibiotic exposure for culture-negative early-onset sepsis in late-preterm and term newborns: an international study. Pediatr Res. 2024) and is particularly focused on those babies with negative blood and/or CSF…

[neonatalresearch]

Too much antibiotics, part 1.

An important multi-centre observational study examines how many newborn infants, term or late-preterm are receiving antibiotics, for how long, and the responses to negative cultures. Centres from Europe, Australia and North America are represented. Data collection differs between the participants which are all regional networks (or in the case of Norway, national), but all provided data on babies…

[neonatalresearch]

Does preterm formula cause NEC?

The question in the title was recently adjudicated in US courtrooms, with an enormous award of damages to the family of a premature infant who developed Necrotising Enterocolitis, and survived, but has, apparently, major neurodevelopmental issues. In July, the jury awarded the infant’s mother $95 million in compensatory damages and another $400 million in punitive damages against Abbott who…

[neonatalresearch]

Long-term outcomes after preterm birth; the next step

I usually try to avoid buzz-words and phrases like “paradigm shift” but it applies well, I think, to what is happening in the world of neonatal follow-up, and more broadly, I hope, to neonatal research as a whole. Neonatologists were pioneers in the development of outcome research (Barrington KJ, Saigal S. Long-term caring for neonates. Paediatr Child Health. 2006;11(5):265-6), when we started…

[neonatalresearch]

What should saturation targets be in established chronic lung disease with pulmonary hypertension?

This question has been puzzling me recently, as we are trying to evaluate our current approach, and whether it needs to be changed. My bias has been that oxygen is toxic, and we should only give the minimum needed to maintain adequate saturation. But that, of course, begs the question “what is adequate saturation”? I take my approach partly from the results of BOOST, this was the trial with…

[neonatalresearch]

Making decisions for extreme preterms, do parents regret their choices?

In 2022 we published an article addressing the question in the title. As part of the Parents’ Voices Project, we questioned families of very preterm infants at follow up about their experiences prior to, during, and after the NICU. 98% of families attending responded, the extremely high response rate being partly because they were given multiple different potential ways of participating (on-line,…