<p>Background: Oxygen has been a key component of neonatal resuscitation for nearly two centuries. Based on clinical trials that demonstrated worse outcomes when neonatal resuscitation was initiated with 100% oxygen, the...<p>Background: Oxygen has been a key component of neonatal resuscitation for nearly two centuries. Based on clinical trials that demonstrated worse outcomes when neonatal resuscitation was initiated with 100% oxygen, there was a change in approach to using 21% oxygen at the initiation of ventilation for newborns at birth. However, for extremely preterm newborns, lower oxygen levels lead to early hypoxia and bradycardia, leading to higher rates of severe intraventricular hemorrhage and death. The balance between hyperoxia and hypoxia-related injury needs further refinement and may not be generalizable to all gestations and birth conditions. Summary: This article reviews the current evidence on oxygen use during delayed cord clamping, during resuscitation of term and preterm neonates, during chest compressions, after return of spontaneous circulation and in the post-resuscitation phase, and the impact of hyperoxia. Key Messages: Supplemental oxygen during neonatal resuscitation is actively being investigated by researchers worldwide to fill the knowledge gap to avoid hypoxia and hyperoxia while improving neonatal outcomes. Until further evidence emerges, we recommend starting resuscitation in the delivery room of very-low-birth-weight infants with an FiO of 0.3-1, probably in the lower part of this scale, and titrating up by 10-20% every 30 s to achieve the target SpO for age. An SpO of 80-85% should be targeted by 5 min after birth. </p>.
INTRODUCTION: Premature infants are predisposed to respiratory failure. Body position impacts lung volumes and pulmonary function. Respiratory inductance plethysmography (RIP) measures thoracoabdominal motion and can pro...INTRODUCTION: Premature infants are predisposed to respiratory failure. Body position impacts lung volumes and pulmonary function. Respiratory inductance plethysmography (RIP) measures thoracoabdominal motion and can provide objective, noninvasive diagnostic measurements of work of breathing (WOB) indices. The objective of this study was to compare WOB indices and oxygen saturation in the semi-reclined position to the supine position for preterm infants with and without BPD at discharge. METHODS: A prospective, observational study of premature infants (<32 weeks of gestation) admitted to the neonatal intensive care unit. RIP is a noninvasive way to objectively measure WOB indices. Measurements (phase angle [Փ]) were made with infants in the semi-reclined and supine positions. RESULTS: This study included 28 premature infants with both supine and semi-reclined data. Infants demonstrated decreased phase angle (supine vs. semi-reclined Φ deg (standard error of mean [SEM], 65.2 [10.2] vs. 28.5 [5.9], p = 0.027) and LBI (supine vs. semi-reclined, 1.82 [0.27] vs. 1.13 [0.04], p < 0.01) in the semi-reclined position. Saturations were statistically but not clinically lower in the semi-reclined position (supine vs. semi-reclined %, 96.7 [0.4] vs. 95.3 [0.4]). Infants with BPD demonstrated a greater improvement in WOB in the semi-reclined position compared to premature controls. CONCLUSION: This is the first study to evaluate and compare discharge oxygen saturation and WOB indices in premature infants with and without BPD in the semi-reclined and supine position. Our findings demonstrate improved breathing parameters and a small clinically insignificant decrease in saturations in the semi-reclined position.
INTRODUCTION: This study aimed to assess the feasibility of using specific defined daily doses for neonates (DDDn) as a standardized metric for monitoring antimicrobial consumption in neonatal populations, thereby enhanc...INTRODUCTION: This study aimed to assess the feasibility of using specific defined daily doses for neonates (DDDn) as a standardized metric for monitoring antimicrobial consumption in neonatal populations, thereby enhancing antimicrobial stewardship programs (ASPs). To this end, DDDn values have been established for those antimicrobials that had not previously been defined. METHODS: This observational study was conducted in the Neonatology Unit of a tertiary-care teaching hospital. Data on antimicrobial use were prospectively collected from January 2016 to December 2023. Both the DDDn values validated in a previous study and the new DDDn values obtained in the present work were used. Antimicrobial consumption was measured quarterly and expressed as DDDn per 1,000 occupied bed days (OBDs). Additionally, a conversion factor was defined to transform DDD into DDDn. RESULTS: Out of 1,326 prescriptions, 310 met the inclusion criteria. The study successfully validated DDDn for 10 antimicrobials, including piperacillin-tazobactam, cefepime, and amoxicillin-clavulanic acid. However, DDDn for certain antimicrobials could not be established due to insufficient prescribing data. The mean global antimicrobial consumption was 5.271 ± 1.435 DDDn per 1,000 OBDs per year. The most commonly used antimicrobials were cefotaxime, amoxicillin-clavulanic acid, and ampicillin. The conversion factor was established for five oral antimicrobials and 17 intravenous ones. CONCLUSION: DDDn proved to be a feasible tool for monitoring antimicrobial consumption in neonatal populations, offering a standardized metric that could improve ASPs and optimize antibiotic usage. More research is needed to validate DDDn across different antimicrobials and clinical settings.
UNLABELLED: <p>Introduction: Peripheral intravenous catheterization is commonly required in sick neonates but remains challenging due to small vessels, leading to multiple attempts and complications. This review evaluate...UNLABELLED: <p>Introduction: Peripheral intravenous catheterization is commonly required in sick neonates but remains challenging due to small vessels, leading to multiple attempts and complications. This review evaluated the benefits and harms of device-assisted techniques versus standard technique. METHODS: We searched MEDLINE, Embase, CENTRAL, Cochrane Reviews, WHO ICTRP, and ClinicalTrials.gov (October 2024) for randomized controlled trials (RCTs). Data collection and analysis followed Cochrane methodology. RESULTS: We included 12 RCTs (1,251 neonates). Devices were used for placement in 5 studies (417 neonates) and tip confirmation in 6 studies (740 neonates). One study used ultrasound for both PICC placement and tip confirmation (94 neonates). Devices may increase first-attempt success compared to standard technique: risk ratio (RR): 1.18, 95% confidence interval (CI): 1.04-1.33 for placement and RR: 1.20, 95% CI: 1.10-1.30 for tip confirmation. Six studies (528 neonates) reported a shorter time to successful catheterization. Devices likely reduce hematoma (RR: 0.32, 95% CI: 0.13-0.75), bleeding (MD: -0.68, 95% CI: -0.83 to -0.53), and phlebitis (RR: 0.19, 95% CI: 0.06-0.58). Evidence was of very low certainty for thrombosis for placement (RR: 0.33, 95% CI: 0.01-7.99) and tip confirmation (RR: 0.25, 95% CI: 0.05-1.16), catheter-related bloodstream infection (RR: 1.25, 95% CI: 0.34-4.58), and arrhythmia (RR: 0.09, 95% CI: 0.01-0.70). CONCLUSION: Device-assisted catheterization may improve first-attempt success and reduce procedure time in neonates. Evidence on safety is limited. Due to variability in study methodologies and outcome reporting, high-quality RCTs with standardized outcome measures are needed. </p>.
INTRODUCTION: The impact of intrauterine growth status as measured by BW percentiles on retinopathy of prematurity (ROP) pathogenesis remains inadequately characterized. The objectives of the study were to establish BW p...INTRODUCTION: The impact of intrauterine growth status as measured by BW percentiles on retinopathy of prematurity (ROP) pathogenesis remains inadequately characterized. The objectives of the study were to establish BW percentile-specific risk gradients for ROP development. METHODS: A multicenter cohort study was conducted with data were collected from Chinese Neonatal Network between January, 2019 and December, 2021. The exposure was GA- and sex-specific BW percentile. The primary outcome was incidence of ROP. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated, adjusted for potential confounders, and stratified by GA, infant sex, maternal hypertension, singleton/multiple birth. RESULTS: Totally 17,882 preterm infants were enrolled, BW was 1,300.0 (1,100.0-1,500.0) g and GA was 29.9 (28.6-31.0) weeks. The incidence was 27% for any stage ROP and 3.7% for severe ROP (stage 3 or above). Each decrease of BW percentile by 10% was associated with 15% increase of odds for either any stage ROP (aOR 0.85 [95% CI: 0.83-0.86]) or severe ROP (aOR 0.85 [95% CI: 0.82-0.89]). The optimal discriminative BW percentile on receiver operating characteristic curve was 26% for predicting any stage ROP and 19% for predicting severe ROP. Lower BW percentile under these cut-offs were associated with elevated odds of any stage ROP (aOR 2.20 [95% CI: 1.97-2.47] and severe ROP (aOR 2.91 [95% CI: 2.22-3.80]). CONCLUSIONS: ROP incidence was negatively associated with BW percentile. Each 10% decreased BW percentile was associated with 15% increased odds of any stage ROP and severe ROP.
INTRODUCTION: Electroencephalography (EEG), including both conventional EEG (cEEG) and amplitude-integrated EEG, is early prognostic tools utilized in neonates with hypoxic ischemic encephalopathy (HIE). However, the rep...INTRODUCTION: Electroencephalography (EEG), including both conventional EEG (cEEG) and amplitude-integrated EEG, is early prognostic tools utilized in neonates with hypoxic ischemic encephalopathy (HIE). However, the reported predictive accuracy of EEG varies widely. METHODS: We evaluate the diagnostic accuracy of EEG in predicting neurodevelopment impairment (NDI) among neonates ≥35 weeks with any stage HIE. MEDLINE, Embase, Cochrane Library, and Scopus were searched from inception until 24th December 2024. Observational studies evaluating EEG performed in the first 72 h of life in neonates with HIE, and reporting NDI outcomes assessed after 12 months were included. Two authors independently extracted data. A Bayesian random-effects bivariate model was used for diagnostic test accuracy meta-analysis. Risk of bias was assessed using QUADAS-2, and certainty of evidence (CoE) with GRADE. NDI defined as cognitive/motor scores <1 SD below the mean or presence of motor disability. RESULTS: Sixty-two studies (n = 3,929) were included. In neonates who underwent therapeutic hypothermia (TH) (34 studies, n = 2,538), EEG showed a sensitivity of 88.3% (95% credible interval [CrI]: 83.7%, 92.8%) and specificity of 63.9% (53.6%, 72.8%). In no TH group (33 studies, n = 1,391), the sensitivity was 87.2% (77.5%, 93.5%) and specificity was 76.3% (61.5%, 86.8%). Further, in neonates who received TH (12 studies, n = 868), cEEG had an acceptable sensitivity of 84.1% (77.3%, 89.9%) and specificity of 76.7% (66.9%, 84.3%). CoE being predominantly moderate. CONCLUSION: EEG has good sensitivity in predicting NDI regardless of TH status and may aid in identifying high-risk neonates for further evaluation.
INTRODUCTION: Hypoxic-ischaemic encephalopathy (HIE) due to perinatal asphyxia remains a significant cause of neonatal morbidity and mortality. Despite therapeutic hypothermia (TH), a considerable proportion of survivors...INTRODUCTION: Hypoxic-ischaemic encephalopathy (HIE) due to perinatal asphyxia remains a significant cause of neonatal morbidity and mortality. Despite therapeutic hypothermia (TH), a considerable proportion of survivors experience a wide range of deficits, including auditory impairment (AI), which needs deeper knowledge. This review aimed to describe AI outcomes in infants with HIE. METHODS: A systematic literature review was performed using standard methods outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. A qualitative synthesis of all the included studies and a meta-analysis with seven eligible studies were conducted. RESULTS: In the sixteen studies comprised, a mean incidence of 4.54% of AI occurred among participants meeting the inclusion criteria. In the meta-analysis, in subgroup A (healthy newborns vs. newborns with HIE), an OR = 10.74 with a 95% CI 2.02-57.16 and a p value of 0.010 was observed, indicating tenfold higher odds of AI in HIE newborns; subgroup B (newborns with HIE who received standard care vs. those who underwent TH) exhibited an OR = 0.77 with a 95% CI 0.35-1.68 and a p value of 0.510, demonstrating that newborns who received TH had a 0.77-fold lower odds of developing AI. CONCLUSION: This review highlights HIE as a risk factor for AI and the possibility of TH being a protective factor. However, the variations in participant characteristics, HIE criteria, and methods of hearing assessment contribute to significant variability between studies, identifying the need for a standard evaluation of auditory outcomes in this setting, extended over the long term.
INTRODUCTION: Evidence regarding the association between patent ductus arteriosus (PDA) and brain development in very preterm infants is inconclusive. The aim of the current study was to systematically evaluate brain inj...INTRODUCTION: Evidence regarding the association between patent ductus arteriosus (PDA) and brain development in very preterm infants is inconclusive. The aim of the current study was to systematically evaluate brain injury and microstructural brain maturation as assessed by magnetic resonance imaging (MRI) at term-equivalent age in a contemporary cohort of very preterm infants with and without PDA. METHODS: This was a retrospective, single-center study. Preterm infants born at <32 weeks' gestation with PDA and cerebral MRI were eligible for this study. They were matched 1:1 according to gestational age (GA) to infants without PDA. MRI was assessed for brain injury. We measured fractional anisotropy and apparent diffusion coefficient in 12 brain regions as indicators for microstructural brain maturation. RESULTS: We included 148 infants with PDA and 148 matched controls. We found no significant differences in brain injury rates between the groups. The evaluation of microstructural brain maturation revealed differences in some regions. After adjusting for differences in neonatal characteristics, a significant difference was seen only in the right middle cerebellar peduncle. Among infants with PDA, those who underwent surgical ligation exhibited elevated rates of both cerebellar hemorrhage and severe IVH and further showed a more immature brain maturation pattern. Statistical difference was lost for all variables after adjusting for GA. CONCLUSION: Our results indicate that the presence of PDA is not intrinsically associated with brain injury or impaired brain development.
INTRODUCTION: Bifidobacteria typify the gut microbiota of healthy, breastfed infants. Altered gut microbiota composition in early infancy characterized by decreased Bifidobacterium abundance has been linked with a height...INTRODUCTION: Bifidobacteria typify the gut microbiota of healthy, breastfed infants. Altered gut microbiota composition in early infancy characterized by decreased Bifidobacterium abundance has been linked with a heightened risk of non-communicable diseases. Our goal was to assess factors impacting on the gut microbiota composition in infants throughout the allergy and obesity epidemics of the past decades. METHODS: We studied deliveries from a series of clinical studies, grouped by the year of birth into three time periods (1997-2001, 2005-2009, 2015-2022). Altogether, 48 full-term breastfed infants' having fecal samples available at the age of 1-3 months were studied for microbiota profiling by 16S rRNA gene amplicon sequencing. Perinatal factors including mode of birth and antibiotic exposure during pregnancy and at birth were taken into account. RESULTS: The richness and diversity of the infant gut microbiota decreased significantly over the three time periods. Reduced abundance of the phylum Actinobacteriota and its genus Bifidobacterium was detected in children born in 2015-2022 as compared to those born during the time periods 1997-2001 and 2005-2009. The time period of birth was the strongest determinant of the gut microbiota composition, followed by maternal pre-pregnancy body mass index, antibiotic exposure during pregnancy, and mode of birth. The relative abundance of members of the genus Bifidobacterium was significantly associated with elapsed time (1997-2022) and intrapartum antibiotic exposure. CONCLUSIONS: The depletion of gut microbiota richness and diversity and the selective reduction of relative abundance of the genus Bifidobacterium have occurred parallel to the increase in the prevalence of non-communicable diseases.
Lavizzari A, Hutten GJ, Heiring C
… +29 more, van de Loo M, Onland W, Alonso-Ojembarrena A, Ehrhardt H, Cetinkaya M, Szczapa T, Sartorius V, Rocha G, Wald M, Soukka H, Danhaive O, Dassios T, Cucerea MC, Calkovska A, Dimitriou G, Barzilay B, Filipovic-Grcic B, Hentschel R, Thome UH, Bohlin K, Lista G, Schulzke S, Plavka R, Tameliene R, O'Donnell CPF, van Kaam AH, Sindelar R, Klingenberg C, ESPR Pulmonary Research Consortium
INTRODUCTION: Episodes of apnoea are common in extremely preterm infants (EPIs) and usually treated with caffeine and respiratory support. Understanding differences in apnoea definitions, monitoring practices, and use of...INTRODUCTION: Episodes of apnoea are common in extremely preterm infants (EPIs) and usually treated with caffeine and respiratory support. Understanding differences in apnoea definitions, monitoring practices, and use of respiratory stimulants is essential to improve future treatment. METHODS: Between March and July 2024, one lead consultant at European tertiary neonatal intensive care units (NICUs) was invited to complete a web-based survey on respiratory practices in EPIs. We sought information how they defined apnoea and monitored for it, and how they treated it with caffeine, doxapram, and non-invasive respiratory support. RESULTS: We received replies from 447/721 (62%) NICUs across 24 European countries. Most NICUs (74%) use both electrocardiogram electrodes and pulse oximetry for apnoea monitoring. All NICUs reported using caffeine citrate, with 102 centres (23%) starting it in the delivery room. The median loading, maintenance and maximum maintenance doses used are 20 mg/kg, 5 and 10 mg/kg/day, respectively. Caffeine is occasionally given twice daily in some NICUs (30%) and stopped at 34-35 weeks of postmenstrual age at most of them (74%). Doxapram is used at 111 (25%) NICUs, with geographical differences. Strategies for the use and escalation of non-invasive respiratory support in case of persistent apnoea are not clearly defined. Automatic closed-loop oxygen delivery is used at 25% of NICUs. CONCLUSION: Despite consistency in the dosing and weaning of caffeine, there is much variation in the management of apnoea in preterm infants across Europe. Future research should focus on timing and dosage of caffeine, the use of doxapram, and strategies for optimising non-invasive respiratory support.
INTRODUCTION: Advances in neonatology, neonatal surgery, and extracorporeal membrane oxygenation have improved the prognosis of congenital diaphragmatic hernia (CDH). However, CDH survivors are at considerable risk of lo...INTRODUCTION: Advances in neonatology, neonatal surgery, and extracorporeal membrane oxygenation have improved the prognosis of congenital diaphragmatic hernia (CDH). However, CDH survivors are at considerable risk of long-term neurological morbidity. Magnetic resonance imaging (MRI) abnormalities are reported in up to 84% of CDH survivors but have only been rarely compared with neurodevelopmental outcomes. This study aims to investigate whether assessment of postnatal MRI in CDH survivors allowed association with and prediction of long-term outcome. METHODS: Brain MRI was performed in 36 neonates with CDH using the Weeke score, assessing the mammillary bodies, the corpus callosum, cortical folding, and cerebrospinal fluid space (CSF). Outcomes were measured using Bayley-III-examinations at 12 months. RESULTS: In total, 91.6% of the neonates exhibited MRI abnormalities. Among them, 83.3% showed white matter (WM), 16.6% gray matter abnormalities, 8.3% cerebellar abnormalities, and 20% had an intracranial hemorrhage. A total of 30.5% showed abnormal mammillary bodies, 44.4% enlarged CSF, 5.5% reduced cortical folding, and 8.3% reduced corpus callosum thickness. While the use of the Weeke score was not helpful for outcome prediction, specific MRI abnormalities were associated with adverse long-term outcomes. Based on these findings, a novel MRI-scoring system was developed. This easy-to-perform score effectively predicted adverse outcomes at 12 months. CONCLUSION: Interpretation of MRI in neonates with CDH should focus on WM pathologies, CSF enlargement, internal capsule involvement, mammillary body abnormalities, and intraventricular hemorrhage. Our novel simple scoring system helps identify neonates at risk for adverse neurological outcomes at discharge and aids to implement therapeutic strategies at an early point.
INTRODUCTION: Extremely preterm-born infants are at risk for neurodevelopmental impairments. Corticosteroids are used to reduce systemic inflammation. Early dexamethasone therapy is associated with poorer neurodevelopmen...INTRODUCTION: Extremely preterm-born infants are at risk for neurodevelopmental impairments. Corticosteroids are used to reduce systemic inflammation. Early dexamethasone therapy is associated with poorer neurodevelopmental outcomes; thus, hydrocortisone is currently widely used. However, the long-term effects of hydrocortisone treatment on neurodevelopmental outcomes remain unclear, and thus, we conducted a pilot study of extremely preterm infants. METHODS: The study cohort included 66 extremely preterm-born infants, who were followed up for 6.5 years. Data on corticosteroid treatment were collected from medical records, and the cumulative doses of hydrocortisone and dexamethasone were calculated. Cognitive outcomes at 6.5 years were assessed using a standardized test of intelligence, and the associations with corticosteroid therapy were evaluated. RESULTS: Twenty-nine (44%) children were treated with corticosteroids, 18 with hydrocortisone, 3 with dexamethasone, and 8 with hydrocortisone and dexamethasone. The mean full-scale (FSIQ), performance (PIQ) and verbal (VIQ) intelligence quotients did not differ significantly between children treated with corticosteroids and those not treated at 6.5 years. The incidence of cognitive impairment (FSIQ, PIQ, and VIQ <85) was higher in children treated with corticosteroids than in those not treated. However, the difference was not statistically significant. CONCLUSION: This pilot study indicates that high-dose postnatal corticosteroid treatment may have long-term adverse effects on cognitive development. Longitudinal studies of the long-term effects of corticosteroid treatment are required to clarify their safety.
INTRODUCTION: Investigation the association between cerebral oxygenation and short-term adverse outcome in asphyxiated infants with hypoxic-ischemic encephalopathy (HIE) during therapeutic hypothermia (TH). METHODS: Near...INTRODUCTION: Investigation the association between cerebral oxygenation and short-term adverse outcome in asphyxiated infants with hypoxic-ischemic encephalopathy (HIE) during therapeutic hypothermia (TH). METHODS: Near infrared spectroscopic-derived cerebral oxygen saturation (rScO) pattern during first 4 days was compared to early brain MRI (4-10 days) using the Weeke score to define MRI-derived brain injury of infants with GA >35 weeks treated with TH within 6 h between 2010 and 2023. Weeke scores of >9 were considered adverse short-term outcome. Infants with congenital abnormalities, chromosomal disorders, or on ECMO were excluded. RESULTS: 292 infants (mean ± 1 SD: GA 39.4 ± 1.9 weeks; BW 3,442 ± 621 g; median [IQR] 5-min Apgar score 4 [3]) were eligible. According to the Sarnat staging, HIE was mild, moderate, or severe in 77, 148, and 67 infants. Adverse short-term outcome/death occurred in 0, 39 (26.4%), and 67 (100%) infants in mild, moderate, and severe HIE groups. Severe HIE infants had higher rScO values compared to moderate or mild HIE infants. Mixed model analysis showed an association between rScO (dependent variable), time after birth, adverse short-term outcome, and inhaled nitric oxide. Logistic regression showed that adverse outcome had a positive association with rScO and first lactate levels. DISCUSSION: High cerebral oxygen saturation during TH is associated with adverse short-term outcome. This knowledge may contribute to early counseling and decision-making. Combination with early blood lactate levels strengthened this association. Simultaneous NO-ventilation may confound this association.
BACKGROUND: Whether very preterm infants benefit from provision of respiratory support prior to cord clamping has been an important knowledge gap. Four randomised controlled trials have recently been published on this to...BACKGROUND: Whether very preterm infants benefit from provision of respiratory support prior to cord clamping has been an important knowledge gap. Four randomised controlled trials have recently been published on this topic and have provided new insights. These 4 studies and 2 previous ones included preterm infants less than 32 weeks of gestational age receiving deferred cord clamping (DCC). The intervention consisted of providing respiratory support in the form of continuous positive airways pressure or positive pressure ventilation via T piece. The intervention group had cord clamping performed when preset stability criteria were met in one study or after an elapsed time of up to 120 s was achieved in the other 5 studies (50-120 s range). The control group had time-based cord clamping after 30-60 s without respiratory support (5 studies) or cord milking (1 study). SUMMARY: Outcome measures based on important neonatal outcomes such as death, severe intraventricular haemorrhage (sIVH), and bronchopulmonary dysplasia (BPD) were reported as were other outcomes such as admission temperature and transfusions. Overall outcomes (death, sIVH, and BPD) were similar in intervention and control groups in these studies with moderate certainty of evidence to conclude there was no benefit for these outcomes. Maintaining normothermia was difficult, and the mean difference in admission temperature was significantly lower in the intervention group, although hypothermia was generally mild. KEY MESSAGE: Overall, the provision of respiratory support during DCC did not improve important neonatal outcomes (moderate certainty of evidence). Although we do not currently recommend the procedure as routine practice, we acknowledge there is room for further studies.
Salas AA, Binder C, Wiechers C
… +4 more, Gsöellpointner M, Haiden N, Fusch C, Rochow N
Neonatology
· 2025 Aug · PMID 40820518
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INTRODUCTION: There is a need to establish realistic, rather than idealistic, postnatal growth targets. We aimed to characterize body composition outcomes of preterm infants growing along recently defined individualized...INTRODUCTION: There is a need to establish realistic, rather than idealistic, postnatal growth targets. We aimed to characterize body composition outcomes of preterm infants growing along recently defined individualized growth trajectories. METHODS: In this cohort study, infants born <33 weeks of gestation in the United States, Canada, Germany, and Austria between 2012-2022 were included if they had body composition measurements at term-equivalent age. Growth trajectories for each infant were generated retrospectively based on weight data collected at birth and at term-equivalent age. This allowed for the calculation of the difference between actual and target weight at term-equivalent age or discharge and stratification of infants into three growth trajectories: 1) 100g or further below target, 2) within target (±99g), and 3) 100g or more above target. RESULTS: A total of 1052 infants were included. The median gestational age and birthweight were 28 weeks and 1060g, respectively. A linear correlation between the actual versus target weight difference and fat-free mass (FFM) z-scores was found (r = 0.34, p < 0.0001). Among infants whose weights remained within the target range (30%), the mean FFM z-score was -1.6 [SD: 1.2] and the mean body fat percentage was 15 [SD: 5.9]. In addition to lower mean FFM z-scores, infants whose weight fell below the target range had greater declines in weight, length, and head circumference z-scores. CONCLUSIONS: Weight trajectories below a recently defined target is linked to lower FFM. Further research is needed to determine whether prospectively targeting these individualized growth trajectories improves FFM outcomes.
INTRODUCTION: As many as 40-100% of the neonates admitted to a neonatal intensive care unit (NICU) require peripheral intravenous (PIV) cannulation, for varying reasons. Though unproven, splinting is conventionally thoug...INTRODUCTION: As many as 40-100% of the neonates admitted to a neonatal intensive care unit (NICU) require peripheral intravenous (PIV) cannulation, for varying reasons. Though unproven, splinting is conventionally thought to increase the lifespan of the cannula. The objective of this study was to determine whether standard fixation without splinting, after cannula insertion near a joint, influences its lifespan. METHODS: This unmasked, parallel group, randomized controlled trial was approved by the Hospital Ethics Committee. Eligible PIV cannula insertions were divided into: "No Splint" and "Splint" group. In the "Splint group" after standard fixation of the PIV, a readymade splint was used. Written informed consent was obtained from parents. The primary outcome was measured as difference in the lifespan of the PIV cannula in both the groups. RESULTS: We enrolled 341 cannulations in "No Splint" and 344 in "Splint" group. The demographic details of both the groups were comparable. Mean gestational age, age at time of enrollment, and birthweight was 33+3 weeks, 3.4 days and 2,160 g, respectively. The mean (95% confidence interval) life of PIV cannula in the "No splint" and the "Splint" groups were 48.5 (45.1, 52.2) and 47.5 (43.6, 51.3) hours (p value 0.7), respectively. Subgroup analysis showed longer PIV cannula life in "No Splint" group neonates who were term and weighed ≥2,500 g. CONCLUSION: In neonates with a PIV cannula placed over a joint, standard fixation without splinting did not shorten the cannula life. Not splinting may be associated with increased lifespan of the PIV cannula in term, normal birthweight neonates.