Archives of Disease in Childhood - Fetal and Neonatal Edition最新文献

Objective: During perinatal transition, compromised cerebral oxygenation may contribute to neonatal morbidity and mortality. Near-infrared spectroscopy measures cerebral regional tissue oxygen saturations (crSO₂) and may guide delivery room respiratory management. This review evaluated whether crSO₂ monitoring in addition to routine assessment (clinical assessment, pulse oximetry +/- ECG) compared with routine assessment alone improves neonatal outcomes.

Design: Systematic review and meta-analysis based on Ovid MEDLINE, Embase, and Cochrane CENTRAL searches (16 February and 5 November 2024).

Setting: Delivery room.

Patients: Newborn infants of all gestations, born via any mode, receiving continuous positive airway pressure and/or intermittent positive pressure ventilation during stabilisation/resuscitation.

Intervention: crSO₂ monitoring with a dedicated treatment guideline in addition to routine assessment compared with routine assessment alone.

Main outcome measures: Survival without neurodevelopmental impairment, survival, severe intraventricular haemorrhage and periventricular leukomalacia (infants <34 weeks); and crSO₂ <10th percentile.

Results: Among 566 articles, 3 articles reporting outcomes from 2 randomised controlled trials (RCTs) (667 preterm infants) were identified. No data were found for survival without neurodevelopmental impairment. We could not exclude benefit or harm from delivery room monitoring of crSO₂ for survival (relative risk (RR) 1.02, 95% CI 0.99 to 1.05), severe intraventricular haemorrhage (RR 0.76, 95% CI 0.38 to 1.54), periventricular leukomalacia (RR 1.93, 95% CI 0.66 to 5.70) (n=667; two RCTs) and crSO₂ <10th percentile (RR 1.00, 95% CI 0.78 to 1.29) (n=60; one RCT).

Conclusions: The limited evidence could not exclude benefit or harm from delivery room monitoring of crSO₂ with a dedicated treatment guideline in preterm infants.

Objective: Neonates requiring Non-InVasive respiratory Support (NIVS) are at high risk of device-related pressure injury (DRPI), with incidence rates of 20%-60% in extremely premature infants. Over a 4-year period, our team undertook a Quality Improvement Project to review aspects of the clinical management of NIVS: types of interfaces, introduction of hydrocolloid dressing and the development and implementation of nasal injury care plan (NICP) to reduce DRPI in high-risk neonates.

Design: A prospective descriptive study was completed in three stages: trial of nCPAP interfaces, preintroduction NICP (2016-2018), post-NICP (2018-2020) and (2021-2022) to measure sustainability of implementation. Data included: gestational age (GA), birth weight, NIVS days, incidence, grade and day of DRPI. Statistical analysis of incidence rate ratio was completed between pre and postgroups.

Setting: Australian neonatal intensive care unit.

Patients: All neonates ≤32 weeks requiring nCPAP.

Interventions: Evaluation of types of interfaces, introduction of hydrocolloid dressing and the development and implementation of NICPMain outcome measures: incidence and severity of DRPI.

Results: Total DRPI recorded in all CPAP babies pre/post NICP were (59/659 (9.0%), 26/574 (4.5%), p=0.0032, respectively). Analysis showed DRPI incidence rates per 1000 NIVS days ((10.6, 5.5), p=0.0001, respectively). 75 (88%) of DRPI occurred in the ≤32 week group of neonates requiring NIVS. Review of babies ≤32 weeks across the three intervals showed significant improvement with time (55 (19%); 27 (13%); 19 (9%), p=0.0001).

Conclusions: Preferred nCPAP interface, nasal dressing and NICP have reduced the incidence and severity of DRPI in the NICU.

Objective: To determine survival and neurodevelopmental outcomes in the Hypotension in Preterm (HIP) trial.

Design: Prospective follow-up of infants enrolled in randomised controlled trial.

Participants: 58 infants born before 28 weeks of gestation with low mean arterial blood pressure.

Intervention: Random allocation to treatment of low blood pressure values with infusion of dopamine or placebo.

Primary outcome: Survival without neurodevelopmental impairment to 24 months corrected age (CA).

Results: The HIP trial stopped early due to logistic and recruitment difficulties. Outcomes were determined for 55 infants (27 in the dopamine group and 28 in the placebo group) at 24 months CA. Survival without impairment was present in 13 (48%) infants in the dopamine group and 7 (25%) infants in the placebo group (OR 2.79 (95% CI 0.89, 8.72); p=0.078). The components of the primary outcome were similarly distributed between the two arms. Mean Bayley composite scores and the frequency of somatic impairments did not differ significantly between groups but infants were shorter and lighter at 2 years of age after dopamine administration.

Conclusion: In this placebo-controlled trial of the treatment of hypotension in extremely preterm infants, dopamine administration did not increase survival without impairment at 2 years CA. However, the study was not sufficiently powered and a clinically important effect cannot be excluded. The role of inotropic medication in facilitating good outcomes requires further study.

Objective: The James Lind Alliance (JLA) Most Premature Babies Priority Setting Partnership aimed to identify the most important areas for research for infants born <25 weeks' gestation.

Design: Employing standardised JLA methodology, questions for research were sought from stakeholders via an online survey. Summary questions were formed and checked against existing evidence, with unanswered questions compiled into a second shortlisting survey for prioritisation by stakeholders. A stakeholder consensus workshop was held to determine the top 10 research priorities.

Participants: People with lived experience of neonatal intensive care, including parents/carers of preterm infants and adults born preterm, and healthcare professionals caring for preterm infants across Australia, New Zealand and the UK.

Main outcome measure: The top 10 research priorities for infants born <25 weeks' gestation.

Results: From 844 questions received from the initial survey, 81 summary questions were formed, of which 80 were unanswered and included in the second shortlisting survey. The 19 top-ranked questions were taken to the final prioritisation workshop, where the top 10 research priorities were determined by people with lived experience and healthcare professionals. The most important research question identified was 'What can be done in the neonatal intensive care unit to improve long-term health and developmental outcomes?'. Other important areas for research included antenatal interventions and neonatal care at birth, preventing intraventricular haemorrhages, managing pain, postnatal corticosteroid treatment and supporting families.

Conclusions: This study identified the most important areas of research for infants born <25 weeks' gestation, as determined jointly by stakeholders. These findings should be used to guide future research and funding aimed at improving meaningful outcomes for these infants and their families.

Objective: To compare the efficacy of T-piece resuscitator (TPR) and self-inflating bag (SIB) for resuscitation of preterm neonates in the delivery room.

Settings: Level III neonatal intensive care unit in North India.

Design: Open-label, parallel-group, randomised controlled trial.

Patient: Preterm neonates of>26-34 weeks of gestation requiring positive pressure ventilation (PPV) at birth.

Intervention: Neonates needing PPV at birth were identified using Neonatal Resuscitation Programme guidelines, 2020, and resuscitated using either TPR or SIB as per permuted block random sequence.

Main outcome measures: Primary outcome was need for delivery room endotracheal intubation. Secondary outcomes were duration of PPV, oxygen saturation (SpO2) at 2 and 5 min, time to spontaneous respiration and heart rate>100 beats per minute.

Results: Mean gestation age (weeks; 30±2.1 vs 31±2) and birth weight (g; 1400±408 vs 1450±427) were comparable. Of the total 120, 8 (13.7%) in the TPR group versus 19 (30.6%) neonates in the SIB group were intubated in the delivery room (risk difference (95% CI), -0.16 (-0.31 to -0.02); p=0.03). SpO2 mean (SD) at 5 min in TPR group and SIB group were 82.9±8.7% and 78.9±12.1%, respectively; mean difference (95% CI), 3.99 (0.15 to 7.83); p=0.04). Median (IQR) of combined Apgar at 5 min in TPR group and SIB group were 13 (12-14) and 12 (10-13), p 0.02. Other outcomes were comparable.

Conclusion: TPR is more efficacious than SIB in terms of lesser delivery room intubation and better SpO2 at 5 min in preterm neonates.