RBC Transfusions and Extension of IVH!!

http://onlinelibrary.wiley.com/doi/10.1111/j.1537-2995.2011.03081.x/abstract;jsessionid=77A09B82CD7BD12A05826302C638022C.d01t03

Red blood cell transfusion of preterm neonates with a Grade 1 intraventricular hemorrhage is associated with extension to a Grade 3 or 4 hemorrhage
Vickie L. Baer
RESULTS: Grade 1 IVH was identified in 417 neonates; 24 subsequently became a Grade 3, and 22 a Grade 4. These 46 were born earlier, 25 ± 2 weeks versus 30 ± 3 weeks (p = 0.000), with lower birth weight, 811 ± 284 g versus 1432 ± 603 g (p = 0.000); lower 5-minute Apgar scores, 5 ± 2 versus 8 ± 2 (p = 0.000); and slightly lower cord pH, 7.24 ± 0.16 versus 7.28 ± 0.10 (p = 0.009). Older gestational age was the most significant contributor lowering the odds of IVH extension (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.98). Administering a red blood cell (RBC) transfusion up to and on the day the Grade 1 was detected was the most significant contributor increasing the odds (OR, 2.92; 95% CI, 2.19-3.90) of extension. In both groups (resolving vs. extending) criteria for ordering transfusions were similar as was the proportion of transfusions given out of compliance with guidelines.

Conclusions:An association exists between RBC transfusion and extension of a Grade 1 IVH into a Grade 3 or 4. However, the explanation is unclear and could involve either the reasons transfusion are ordered or the transfusions themselves. Additional studies are needed to discover why neonates are more likely to have IVH extension if transfused.

NeOProM

NeOProM: Neonatal Oxygenation Prospective Meta-analysis Collaboration study protocol

http://www.biomedcentral.com/1471-2431/11/6
I am just presenting the summary of evidence as of now. Very interesting though!
In the Benefits of Oxygen Saturation Targeting (BOOST) trial , 358 infants born at less than 30 weeks' gestation were randomly assigned, from 3 weeks or more after birth until they breathed air, to target a SpO₂ range of either 91-94% or 95-98%. This trial found no evidence that higher SpO₂ targeting improved growth or development, but it did increase days of oxygen therapy and use of health care resources.
In a more recent cohort study, Tin et al that lower SpO₂ correlated with improved short term respiratory and growth outcomes in infants born at less than 28 weeks' gestation.
Babies in the neonatal intensive care units (NICU) targeting SpO₂ 70-90% had ROP surgery less often than those in the NICUs targeting SpO₂ 88-98% (6.2% v 27.2%, 80% relative risk reduction (RRR), p < style="color: rgb(153, 102, 51); font-style: italic;">ventilated less often (13.9 v 31.4 days), fewer needed oxygen at 36 weeks' postmenstrual age (18% v 46%, 61% RRR), and fewer were below the 3rd centile for weight at discharge (17% v 45%, 62% RRR) (all p <>v 53%) and cerebral palsy (15% v 17%) at one year were similar.

Long-term effects of routine morphine infusion in mechanically ventilated neonates on children’s functioning: Five-year follow-up of a randomized controlled trial.

http://www.painjournalonline.com/article/PIIS0304395911001266/abstract?rss=yes
conducted a follow-up study among 5-year-olds who, as mechanically ventilated neonates, had participated in a placebo-controlled trial on effects of morphine administration on pain and neurologic outcome. They were now tested on intelligence, visual motor integration, behavior, chronic pain, and health-related quality of life.
scores on one IQ subtest, “visual analysis,” were significantly negatively related to having received morphine and to open-label morphine consumption the first 28days. The finding of a significant effect of morphine on the “visual analysis” IQ subtest calls for follow-up at a later age focusing on the higher-order neurocognitive functions.

2) Lactobacillus reuteri accelerates gastric emptying and improves regurgitation in infants

http://www.ingentaconnect.com/content/bsc/ejci/2011/00000041/00000004/art00010
European Journal of Clinical Investigation, Volume 41, Number 4
Thirty-four infants completed the study (19 infants receiving probiotics and 15 placebo).At baseline, the whole group of infants was similar to the control group as regards anthropometric and physiological data. The median fasting antral area was significantly reduced, (P = 0·01) the delta in gastric emptying rate was significantly increased (P = 0·01) and the median episodes per day of regurgitation was reduced (, P  < 0·001) in the probiotic group compared to the placebo group. In the whole group, the frequency of regurgitation and the basal antral area showed a positive correlation (r = 0·53, P = 0·004). Conclusions  In infants with functional GER, L. reuteri DSM 17938 reduce gastric distension and accelerate gastric emptying. In addition, this probiotic strain seems to diminish the frequency of regurgitation.

Prevalence of Congenital Heart Disease Assessed by Echocardiography in 2067 Consecutive Newborns

http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2011.02248.x/abstract

Acta Paediatrica

Methods:  A cohort screening study was conducted in an unselected series of all live-birth newborns. Two-dimensional and color Doppler echocardiography was performed at 0 to 4 days of life in 2067 consecutive neonates who were born at the Hamamatsu University Hospital, Japan, between May 2005 and April 2010.

Results:  There were 104 cases of CHD in the 2067 live births. Ventricular septal defect and patent ductus arteriosus were the most frequent cardiac abnormalities. The prevalence of newborns with CHD who had signs or symptoms of CHD and/or required invasive intervention was 21.3 per 1000 live births. However, 60 patients (29.0 per 1000 live births) with CHD were asymptomatic and did not need invasive intervention. The overall prevalence of CHD in this series was 50.3 per 1000 live births.

Conclusion:  This prospective study using echocardiography for all newborns shows a higher prevalence of CHD than almost all of the previous studies.