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Preventing Continuous Positive Airway Pressure Failure: Evidence-Based and Physiologically Sound Practices from Delivery Room to the Neonatal Intensive Care Unit


DOI: 10.1016/j.clp.2018.01.011
The incidence of bronchopulmonary dysplasia, and the competing outcomes death or bronchopulmonary dysplasia, is decreased with early initiation of nCPAP.  The best available evidence supports the premise that efforts to minimize CPAP failure start in the delivery room.  Various modes and interfaces to deliver CPAP exist; although there may be considerable differences in the ability of these various CPAP devices to prevent failure, little data from RCT exist to support this.


Optimizing Caffeine Use and Risk of Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review, Meta-analysis, and Application of Grading of Recommendations Assessment, Development, and Evaluation Methodology


DOI: 10.1016/j.clp.2018.01.012
Earlier initiation of caffeine, compared to later initiation, is associated with a decreased risk of bronchopulmonary dysplasia.  High-dose caffeine, compared to standard-dose caffeine, may reduce the risk of bronchopulmonary dysplasia.  The overall quality of evidence of studies on the dose and timing of caffeine and risk of bronchopulmonary dysplasia is low.  Higher-quality evidence is needed to understand the risks and benefits of early initiation and high-dose caffeine to decrease the risk of bronchopulmonary dysplasia.


Attention deficit hyperactivity disorder and autism spectrum disorder symptoms in school-age children born very preterm


DOI: 10.1016/j.ridd.2018.01.001
Background Very preterm (VP) children face a broad range of neurodevelopmental sequelae, including behavioral problems.
Aim To investigate prevalence, pervasiveness and co-occurrence of symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in school-age children born very preterm.
Methods Using questionnaire and diagnostic interview data, parent and teacher reported symptoms of ADHD and ASD of 57 VP-children (mean age = 9.2 years) were compared with 57 gender and age matched full-term children using t-tests. Intra-class correlation coefficients quantified parent-teacher agreement. Correlation analysis investigated co-occurrence of ADHD/ASD symptoms. ADHD/ASD measures were aggregated using principal component analysis. Regression analyses investigated the contribution of perinatal risk factors, sex and SES to ADHD/ASD symptoms.
Results VP-children showed higher levels of parent and teacher reported attention problems, social impairment and compromised communication skills. Fair to strong agreement was found between parent and teacher reported ADHD and ASD symptoms, indicating pervasiveness of observed difficulties. Co-occurrence of ADHD and ASD symptoms in VP-children was found. Lower gestational age was associated with higher ADHD and ASD symptom levels, male sex with higher ADHD symptom levels and lower SES with higher ASD symptom levels.
Conclusion School-age VP-children show higher levels of ADHD and ASD symptoms, and attention, socialization and communication difficulties in particular. Routinely screening for these problems is recommended in follow-up care.


Preterm formula use in the preterm very low birth weight infant


DOI: 10.1016/j.siny.2016.08.005
Whereas human milk is the recommended diet for all infants, preterm formulas are indicated for enteral feeding of preterm very low birth weight infants when sufficient maternal breast milk and donor human milk are not available. Feeding with preterm formulas helps to ensure consistent delivery of nutrients. The balance of risks and benefits of feeding preterm formulas versus supplemented maternal and donor breast milk for preterm infants, however, is uncertain. Numerous studies and extensive practice have shown improved growth with preterm formulas, but there is concern for increased risks of necrotizing enterocolitis, possibly from cow milk antigen in the formulas or from different gut microbiomes, increased duration of total parenteral nutrition, and increased rates of sepsis in infants receiving preterm formulas. Furthermore, whereas preterm formulas improve neurodevelopmental outcomes compared to term formulas and unfortified donor milk, they do not produce neurodevelopmental outcomes better than fortified human milk, again indicating that maternal milk has unique properties that formulas need to mimic as closely as possible.


Use of donor milk in the neonatal intensive care unit


DOI: 10.1016/j.siny.2016.08.003
Own mother's milk is the first choice in feeding preterm infants and provides multiple short- and long-term benefits. When it is unavailable, donor human milk is recommended as the first alternative. Donor milk undergoes processing (i.e. pasteurization) to reduce bacteriological and viral contaminants but influences its bioactive properties with potentially fewer benefits than raw milk. However, there is no clinical evidence of health benefit of raw compared to pasteurized human milk, and donor milk maintains documented advantages compared to formula. Nutrient content of donor and own mother's milk fails to meet the requirements of preterm infants. Adequate fortification is necessary to provide optimal growth. There are significant challenges in providing donor milk for premature infants; therefore, specific clinical guidelines for human milk banks and donor milk use in the neonatal intensive care unit should be applied and research should focus on innovative solutions to process human milk while preserving its immunological and nutritional components. In addition, milk banks are not the only instrument to collect, process and store donor milk but represent an excellent tool for breastfeeding promotion.