Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network.

OBJECTIVE: This report presents data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network on care of and morbidity and mortality rates for very low birth weight infants, according to gestational age (GA). METHODS: Perinatal/neonatal data were collected for 9575 infants of extremely low GA (22-28 weeks) and very low birth weight (401-1500 g) who were born at network centers between January 1, 2003, and December 31, 2007. RESULTS: Rates of survival to discharge increased with increasing GA (6% at 22 weeks and 92% at 28 weeks); 1060 infants died at CONCLUSION: Although the majority of infants with GAs of \u3eor=24 weeks survive, high rates of morbidity among survivors continue to be observed

Aggressive vs. conservative phototherapy for infants with extremely low birth weight.

BACKGROUND: It is unclear whether aggressive phototherapy to prevent neurotoxic effects of bilirubin benefits or harms infants with extremely low birth weight (1000 g or less). METHODS: We randomly assigned 1974 infants with extremely low birth weight at 12 to 36 hours of age to undergo either aggressive or conservative phototherapy. The primary outcome was a composite of death or neurodevelopmental impairment determined for 91% of the infants by investigators who were unaware of the treatment assignments. RESULTS: Aggressive phototherapy, as compared with conservative phototherapy, significantly reduced the mean peak serum bilirubin level (7.0 vs. 9.8 mg per deciliter [120 vs. 168 micromol per liter], P\u3c0.01) but not the rate of the primary outcome (52% vs. 55%; relative risk, 0.94; 95% confidence interval [CI], 0.87 to 1.02; P=0.15). Aggressive phototherapy did reduce rates of neurodevelopmental impairment (26%, vs. 30% for conservative phototherapy; relative risk, 0.86; 95% CI, 0.74 to 0.99). Rates of death in the aggressive-phototherapy and conservative-phototherapy groups were 24% and 23%, respectively (relative risk, 1.05; 95% CI, 0.90 to 1.22). In preplanned subgroup analyses, the rates of death were 13% with aggressive phototherapy and 14% with conservative phototherapy for infants with a birth weight of 751 to 1000 g and 39% and 34%, respectively (relative risk, 1.13; 95% CI, 0.96 to 1.34), for infants with a birth weight of 501 to 750 g. CONCLUSIONS: Aggressive phototherapy did not significantly reduce the rate of death or neurodevelopmental impairment. The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. This reduction may be offset by an increase in mortality among infants weighing 501 to 750 g at birth. (ClinicalTrials.gov number, NCT00114543.

Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants

To estimate risk of NEC for ELBW infants as a function of preterm formula and maternal milk (MM) intake and calculate the impact of suboptimal feeding on NEC incidence and costs

Oral Feeding Containers and Their Influence on Intake and Ventilation in Preterm Infants

In order to determine whether changes in feeding container properties could expedite oral feeding without compromising ventilation, the rate of feeding and respiration were studied in 10 healthy preterm infants while using a collapsible feeding container, and the findings were compared to those obtained with the standard rigid bottle. Equal volumes of formula were offered from both containers. With the collapsible container, the total duration of feeding was significantly shorter, and the rate of ingestion of formula was significantly faster (p < 0.01), while minute ventilation remained equally reduced from control levels during both feeds (p < 0.05). The fall in ventilation was secondary to a reduction in tidal volume (p < 0.001). Breathing frequency and transcutaneous oxygen tension did not change significantly with either trial. During feeding activity in both trials, airflow interruption occurred in both phases of the breathing cycle, but the total duration of interrupted airflow was greater with the collapsible container feed (p < 0.001). Similar amounts of intra-oral negative pressure changes developed with sucking during both feeds. Results show that decreasing the rigidity of the feeding container shortened feeding time significantly without significantly affecting ventilation. Despite the greater duration of airflow interruption with the collapsible container, minute ventilation was sufficiently maintained to prevent compromised oxygenation

Persistent pulmonary hypertension in the neonate: Diagnosis and management

PPHN should be recognized as a clinical conditionassociated with a number of pulmonary and systemic diseases. Present therapy has resulted in increased survival, but the aggressive methods required to produce improvement necessitate a clear understanding of the underlying pathophysiology in order to minimize sequelae

Fatal Adenovirus Pneumonia in two Newborn Infants, One Case Caused by Adenovirus Type 30

Adenovirus rarely causes pneumonia in the newborn infant. We added 2 cases of fatal adenovirus neonatal pneumonia to the 3 cases previously reported. One of our cases was caused by adenovirus type 30, which is not previously known to be a pathogen. While the pneumonia could have been acquired in the nursery, the presence of chonoamnionilis and mixed infection with group B beta-hemolytic streptococcus suggests that an ascending infection from the birth canal might be another mode of transmission for neonatal adenovirus pneumonia

Comparison of dynamic and static measurements of respiratory mechanics in infants

The objective of this study was to compare the conventional method of measuring respiratory mechanics, which requires the passage of an esophageal tube, with the occlusion technique, which is less invasive. Thirty-nine preterm infants who received mechanical ventilation on the first day were studied before discharge (mean±SD: postnatal age 67±23 days; weight 1790±300 gm), and 27 of them again at 1 year (weight 8.1±1.4 kg). Flow were measured through a nosepiece by pneumotachometry, tidal volume by integration of flow, esophageal pressure through a water-filled tube, and airway pressure directly at the nasal plece. Airway occlusion was performed at the end of inspiration, and the following relaxed exhalation was analyzed to give compllance (Crs) and resistance (Rrs) of the respiratory system. These values were compared with dynamic lung compliance (Cdyn) and expiratory resistance (Re) of the previous unoccluded breath. In the younger infants, dynamic and static measurements did not differ significantly and were well correlated (Cdyn/Crs, r=0.91; Re/Rrs, r=0.95). In the older infants, Crs was 80% of Cdyn ( p<0.001), and Rrs was 24% higher than Re ( p<0.001). The measurements were well correlated (Cdyn/Crs, r=0.94; Re/Rrs, r=0.91). The regression line Cdyn versus Crs had a slope (0.77) significantly less than 1; the regression Re versus Rrs had an intercept (13.8) significantly greater than zero. The lower Crs and higher Rrs values can be expected because the static determinations include the chest wall. In the more immature infants, the very compliant chest wall, in combination with an underestimation of Cdyn because of the higher breathing frequency of these infants, may obscure this difference. We conclude that the occlusion technique gives accurate and reproducible results, is easily applied, does not need the passage of an esophageal tube, and is well tolerated by the infants

Use of Mechanical Ventilation for Clinical Management of Persistent Pulmonary Hypertension of the Newborn

Following a discussion of arterial blood gas examinations for specific diagnosis of PPHN, the authors present guidelines for the management of these infants using mechanical ventilation