TeleHealth

An article in Informationweek briefly described how Cincinnati Children's Hospital Medical Center is linking patients in ambulances with remote medical specialists. Their ambulances are equipped with video cameras and digital stethoscopes.
"This is telemedicine on the go," said Dr. Hamilton Schwartz, who came up with an idea for using high-resolution video and other telemedicine gear, such as digital stethoscopes, for pediatric patients--including sick premature infants--while these children are in transit to Cincinnati Children's Hospital Medical Center from other area hospitals.
Mass gen.hospital PICU is equipped with BOTS or PICU BOTS which link attendings at home to PICU patients and can virtually examine them and advise the in-house physicians. My dream is coming through! I talked about this kind of technology in 2001.

http://www.informationweek.com/news/healthcare/mobile-wireless/showArticle.jhtml?articleID=224600596

Methadone-Visual Problems

http://bjo.bmj.com/content/early/2010/04/12/bjo.2009.169284.short?q=w_bjo_ahead_tab
A descriptive case series of 20 patients and all are exposed to methadone in utero.

reduced acuity (95%), nystagmus (70%), strabismus (30%), refractive errors (30%), and cerebral visual impairment (25%). Visual electrophysiology was abnormal in 60%. A quarter of the children had associated neurodevelopmental abnormalities. The majority of children with nystagmus (79%) had been treated for neonatal abstinence syndrome (NAS). Exact cause is unknown. This is concerning and we need to follow up our babies experiencing neonatal abstinence syndrome more closely.
Br J Ophthalmol doi:10.1136/bjo.2009.169284

Lipoprotein (a), Birth Weight and Neonatal Stroke

An increased Lp(a) level was found in 26 mothers [38%; 95% confidence interval (CI) 28–50%] and in 15 children (22%; 95% CI 13–33%). Both rates were higher than the reference range reported in the general Caucasian population (10% in adults and 5% in children).

Conclusions: Elevated maternal Lp(a) is apparently a risk factor for neonatal arterial ischemic stroke. We speculate that the pathological mechanism of this relation may be mediated through a dysfunction of the placental vascularization.
Neonatology 2010;98:225-228

Bovine lactoferrin appears to decrease the incidence of sepsis in very low–birth weight infants

Conclusion Compared with placebo, BLF supplementation
alone or in combination with Lactobacillus rhamnosus GG (LGG),reduced the incidence
of a first episode of late-onset sepsis in VLBW neonates.
JAMA 2009;302:1421-8.

Human milk Fortifier- NEC

April issue of J Peds showed a significant difference in the incidence of surgical NEC between those who received bovine HMF and those who received PROLACTA a human milk based fortifier. The bovine group actually received higher amounts of mother's own milk but also had HMF based on bovine protein.
Prolacta is very expensive at this time, but may consider it if NEC incidence is high in their units or if babies are intolerant to cows milk protein.

Preeclampsia-BPD

J Peds Vol 156 No.4- interesting association between PET and BPD is brought up. Placenta is in a anti-angiogenic condition in PET and similar condition may exist in fetal lung as well disrupting angiogenesis in the lung --> BPD. This may be more common in growth restricted than in AGA preterms. However, this study lacks many important postnatal variables to conclude strongly. This study lays indirect role for nitric oxide post natally and vascular endothelial growth factor for antenatal use.
A working hypothesis is that disruption of angiogenesis during lung development impairs alveolarization contributing to BPD and that preservation of vascular growth and endothelial survival promotes growth and sustains the architecture of the distal airspace.[10] Withdrawal of angiogenic growth factors (such as vascular endothelial growth factor [VEGF} and nitric oxide) disrupts lung vascular growth and impairs alveolarization in infant rats

<26 weeks Preterm-Autism Spectrum Disorders Association.

J Peds April issue Vol 156, No.4 pg 525 has an interesting study which evaluated 219 surviving <26 week preterms who are now 11 years and noted that there was 8% incidence of autism in these preterms compared to none in term born classmates. Not having breast milk was also associated with autism spectrum disorders.
There is lot more to be done in our NICU population to improve their outcomes. One good news is breast milk may help in this aspect as well.

ROP and Weight Gain!!!

http://archopht.ama-assn.org/cgi/content/abstract/128/4/443
To validate longitudinal postnatal weight gain as a method for predicting severe retinopathy of prematurity (ROP) in a US cohort.
Harvard and Sweden researchers showed that postnatal weight gain can predict severe ROP and validates WINROP study.
The results showed A high-risk alarm occurred in 81 infants (25.5%) and detected all infants who developed severe ROP a median of 9 weeks before diagnosis. The remaining infants received no alarm or a low-risk alarm. None of these infants developed more than mild ROP.

Erythropoietin in Hypoxic Ischemic Injury

http://stroke.ahajournals.org/cgi/content/abstract/STROKEAHA.109.570325v1
Stroke journal published a study supporting the role of erythropoietin as a neuroprotective agent in reperfusion phase of hypoxic ishemic damage.
Study demonstrates that delayed administration of EPO promotes oligodendrogenesis and attenuates white matter injury concurrently with increased neurogenesis. These effects likely contribute to the observed improvement in neurological functional outcomes.

CPAP vs Bi-level CPAP in Preterm Infants

Arch Dis Child Feta Neonatal Ed March 2010. Gianluca et.al showed that in a RCT of 40 babies of 30 weeks mean GA, that Bi-level CPAP (8cm/4.5cms) needed shorter respiratory support 3.8 +/-1 days vs 6.2+/- 2 days in CPAP (6 cms) and shorter O2 dependency 6.5 +/- 4 days vs 13.8 +/- 8 days and discharged early at 35.6 weeks +/- 1.2 weeks vs 36.7 +/- 2.5 weeks. All were statistically significant.
I would like to see similar advantages in more premature babies such as <1 kg.