Evidence-Based Neo                  https://ebneo.org                     https://twitter.com/EBNEO

Mayo 2018


 

1.-  At what weight to wean moderately preterms from incubator  ?

 

Seetha Shankaran of :

 

Hypothesis:     LOS will be less if you wean at 1600 vs 1800g.

 

Findings: No difference in LOS but safe (besides some additional cold stress).

 

https://clinicaltrials.gov/ct2/history/NCT02160002?V_12=View#StudyPageTop

 


 

2.-  What about fentanyl use in preterms? - follow up of a randomised trial of fentanyl infusion in preterms: lower coordination scores at 2 years

 

Brain Injury and Development in Preterm Infants Exposed to Fentanyl

 

Christopher McPherson y Cols.

 

Annals of Pharmacotherapy 2015, Vol. 49(12) 12911297         DOI: 10.1177/1060028015606732

 

Abstract

 

Background: Fentanyl is commonly used in preterm infants. Relatively little is known regarding the neurodevelopmental outcomes of preterm infants exposed to fentanyl.

 

Objective: To investigate the association between cumulative fentanyl dose and brain injury and diameters in a cohort of preterm infants.

 

Methods: Data on demographics, perinatal course, and neonatal course, including total fentanyl exposure prior to term equivalent age, were retrospectively evaluated for 103 infants born at ≤30 weeks gestational age (mean gestational age 26.9 1.8 weeks) who underwent magnetic resonance imaging at term equivalent age. Magnetic resonance images were evaluated for brain injury and regional brain diameters. Developmental testing was conducted at term equivalent and 2 years of age.

 

Results: Seventy-eight infants (76%) received fentanyl (median cumulative dose 3 g/kg, interquartile range 1-441 g/kg). Cumulative fentanyl dose in the first week of life correlated with the incidence of cerebellar hemorrhage after correction for covariates (odds ratio 2.1, 95% confidence interval 1.1-4.1). Cumulative fentanyl dose before term equivalent age correlated with reductions in transverse cerebellar diameter after correction for covariates, including the presence of cerebellar hemorrhage (r = 0.461, P = 0.002). No correlation was detected between cumulative fentanyl dose and development at 2 years of age.

 

Conclusions: Higher cumulative fentanyl dose in preterm infants correlated with a higher incidence of cerebellar injury and lower cerebellar diameter at term equivalent age. Our findings must be taken with caution, but emphasize the need for future prospective trials examining the risks and benefits of commonly used analgesic agents in preterm infants.

 


 

3.-  Evidence for NIPPV for respiratory support in preterm neonates; highlights

 

Haresh Kirpalani of reviews

 

 

http://www.cochrane.org/CD003212/NEONATAL_nasal-intermittent-positive-pressure-ventilation-nippv-versus-nasal-continuous-positive-airway

 


 

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

 

Clyde J Wright y cols

 

Clinics in Perinatology               https://doi.org/10.1016/j.clp.2018.01.011             June 2018                    LINK