ERA

Neonatology

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  1. D-Penicillamine for preventing retinopathy of prematurity in preterm infants [Download]

    Title: D-Penicillamine for preventing retinopathy of prematurity in preterm infants
    Creator: Qureshi Mosarrat J.
    Description: Background The rate of retinopathy of prematurity (ROP) in moderately premature infants has decreased dramatically with improved care in the neonatal intensive care unit. A low rate of this disorder was unexpectedly observed among infants treated with intravenous D-penicillamine to prevent hyperbilirubinaemia. This observation led to the investigation of its use, both enterally as well as intravenously, to prevent ROP. Objectives To determine the effect of prophylactic administration of D-penicillamine on the incidence of acute ROP or severe ROP and other morbidities in preterm infants. Search methods We used the Cochrane Neonatal Review Group search strategy. Two review authors independently searched multiple electronic databases, previous reviews including cross references, abstracts, conference/symposia proceedings, and expert informants. We updated the search on November 27, 2012. Selection criteria We included randomised or quasi-randomised controlled trials if they administered D-penicillamine and compared it with no treatment or placebo to premature infants and reported on the outcome of ROP. Data collection and analysis We used the criteria and standard methods of the Cochrane Neonatal Review Group to assess the methodological quality of the included trials. One review author examined trials for validity. A second review author checked validity and they reached consensus on the final data before entry into this review. We used the standards of the Neonatal Cochrane Review Group to analyse data. Main results Three randomised trials met the inclusion criteria. The meta-analysis showed no significant differences in the risk of any stage ROP (typical risk ratio (RR) 0.32, 95% confidence interval (CI) 0.03 to 3.70), severe ROP (typical RR 0.38, 95% CI 0.03 to 4.26) or death (typical RR 0.95, 95% CI 0.68 to 1.32) in all treated infants. When the subgroup of infants under 1500 g birth weight was examined, the results were similar. No side effects were reported, and follow-up at one year revealed no significant differences in spasticity or developmental delay. Authors' conclusions Administration of prophylactic D-penicillamine in preterm infants does not prevent acute or severe ROP, death or neurodevelopmental delay. D-penicillamine cannot be recommended for the prevention of ROP based on the available evidence.
    Subjects: Randomized Controlled Trials as Topic, Infant, Retinopathy of Prematurity, Penicillamine, Newborn, Premature, Humans, Chelating Agents
    Date Created: 2013
  2. Low-dose heparin for prolonging the patency of peripheral intravenous catheters in adults: A Systematic review and Meta-analysis [Download]

    Title: Low-dose heparin for prolonging the patency of peripheral intravenous catheters in adults: A Systematic review and Meta-analysis
    Creator: Kumar Manoj
    Description: Objective: To assess evidence from randomized controlled trials (RCTs) about the efficacy of low-dose heparin for prolonging patency of peripheral intravenous catheters in adults. Design: Systematic review and meta-analysis. Data Sources: We searched MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials (CCTR) to identify studies up to July 6, 2012. Additional citations were retrieved from the bibliography of the selected articles. No language restrictions were placed. Eligibility criteria for selecting studies: The eligible studies were RCTs of low-dose heparin, used as continuous infusion or as intermittent flush, through peripheral intravenous catheter as compared to a control; and measured any one of the following outcomes: duration of catheter patency, occlusion rates or local site reactions such as thrombophlebitis. Results: Eight RCTs were identified (5 testing heparin as continuous infusion and 3 as intermittent flush). Catheters using heparin infusions had longer patency [Mean difference = 13.37 hours, 95%CI (3.37, 23.37), p=0.009], however, no difference in the duration of patency was noted from its use as intermittent flushing solution. Similarly, continuous infusion of heparin resulted in approximately 50% lower rates of infusion failures [rate ratio = 0.50, 95%CI (0.33, 0.76), p=0.001] and phlebitis [rate ratio = 0.47, 95%CI (0.31, 0.73), p<0.001] compared to no difference noted with its use as intermittent flushing solution. Few studies reported treatment related adverse events. Conclusion: Low-dose heparin used as continuous infusion in PIV catheters resulted in longer catheter patency with lesser episodes of infusion failures and phlebitis. Heparins use as intermittent flush solutions had no benefit.
    Subjects: Heparin, Phlebitis, Systematic Review, Infusion Failure, Patency
    Date Created: 2014
  3. Utilization of national clinical practice guidelines: A survey of Canadian pediatric physicians [Download]

    Title: Utilization of national clinical practice guidelines: A survey of Canadian pediatric physicians
    Creator: Nasir Fareeha
    Description: Background: It is not clear how physicians currently use clinical practice guidelines (CPGs). Objectives: The objective was to describe how Canadian pediatric residents and pediatricians use CPGs and to identify barriers to CPG use. Methods: Pediatric emergency physicians and general pediatricians in Edmonton and Ottawa and all Canadian pediatric residents were surveyed regarding patterns of use for CPGs and barriers to use. Results: Response rate was 178/847 (21%). The majority of responding residents (62%), emergency physicians (54%) and general pediatricians teaching more than 6 weeks annually on a clinical teaching unit (CTU) use CPGs at least monthly (55%) with less frequent use by pediatricians who teach 1 to 6 weeks on CTU (14%) or rarely/never teach on CTU (21%) (p<0.001). Canadian physicians are more likely to read Canadian Paediatric Society guidelines when they are published versus referring to them later when dealing with clinical problems while the opposite appears to be true for American Academy of Pediatrics guidelines. The most common barrier to use of guidelines is forgetting that a guideline exists for a specific problem. The majority of physicians access CPGs electronically and support development of web based tools to improve accessibility. Conclusions: Almost all pediatric residents, pediatric emergency physicians and general pediatricians sometimes refer to CPGs. General pediatricians teaching less than 6 weeks per year on CTUs are an important target population, as most use CPGs infrequently. Prompts that CPGs exist and accessible online summaries of CPGs appear to have potential for overcoming the barriers to use.
    Subjects: Pediatrics, Cross-Sectional Studies, Continuing Medical Education, Survey, Clinical Practice Guidelines
    Date Created: 2015
  4. Suggested health services research action to achieve reduction of neonatal mortality in India [Download]

    Title: Suggested health services research action to achieve reduction of neonatal mortality in India
    Creator: Kumar Manoj
    Description: Despite several national programs to reduce infant mortality, India had repeatedly failed to achieve its set targets for infant mortality. There are approximately one million neonatal deaths in India each year which accounts for nearly two-thirds of the infant deaths in India. India’s current trajectories of neonatal and infant mortality rates make it unlikely that it will achieve its targets for infant mortality rate for 2015 set under the Millennium Development Goals. Since two-thirds of infant deaths in India are neonatal deaths, implementation of effective neonatal care strategies would be essential to reduce infant mortality considerably. The history of child health services in India suggests an inattention to qualitative parameters, hindering a reversal of its failures. We discuss a format of mixed-methods participatory research, integrated with routine district level household surveys (DLHS), as a model of health services research which would better delineate the problems encountered in delivering effective newborn care at the primary care level.
    Subjects: Health Services Research, Neonatal Mortality, Mixed-Methods Research, Infant Mortality, Qualitative
    Date Created: 2011
  5. Laser photocoagulation versus transscleral cryotherapy for threshold retinopathy of prematurity [Download]

    Title: Laser photocoagulation versus transscleral cryotherapy for threshold retinopathy of prematurity
    Creator: Hendson L
    Subjects: Cryotherapy, Laser coagulation, Retinopathy of prematurity (ROP), Light coagulation
    Date Created: 2002
  6. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis [Download]

    Title: Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis
    Creator: Schmölzer Georg M.
    Description: Objective To assess the role of nasal continuous positive airway pressure (CPAP) initiated at birth for prevention of death and bronchopulmonary dysplasia in very preterm infants. Design Systematic review. Data sources PubMed, Embase, the Cochrane Central Register of Controlled Trials, and online Pediatric Academic Society abstracts from the year of inception to June 2013. Eligibility criteria for selecting studies Randomised controlled trials evaluating the effect of nasal CPAP compared with intubation in preterm infants born at less than 32 weeks’ gestation and presenting the outcomes of either death or bronchopulmonary dysplasia, or both (defined as the need for oxygen support or mechanical ventilation at 36 weeks corrected gestation), during hospital stay. Results Four randomised controlled trials (2782 participants) met the inclusion criteria, with 1296 infants in the nasal CPAP group and 1486 in the intubation group. All the trials reported bronchopulmonary dysplasia independently at 36 weeks corrected gestation, with borderline significance in favour of the nasal CPAP group (relative risk 0.91, 95% confidence interval 0.82 to 1.01, risk difference −0.03, 95% confidence interval −0.07 to 0.01). No difference in death was observed (relative risk 0.88, 0.68 to 1.14, risk difference −0.02, −0.04 to 0.01, respectively). Pooled analysis showed a significant benefit for the combined outcome of death or bronchopulmonary dysplasia, or both, at 36 weeks corrected gestation for babies treated with nasal CPAP (relative risk 0.91, 0.84 to 0.99, risk difference −0.04, -0.07 to 0.00), number needed to treat of 25). Conclusion One additional infant could survive to 36 weeks without bronchopulmonary dysplasia for every 25 babies treated with nasal CPAP in the delivery room rather than being intubated.
    Subjects: Neonatal Health, Child Health, Internet, Infant Health, Mechanical Ventilation, Clinical Trials (Epidemiology)
    Date Created: 2013
  7. Antibiotic Administration for Meconium Aspiration Syndrome in Neonates: A Systematic Review [Download]

    Title: Antibiotic Administration for Meconium Aspiration Syndrome in Neonates: A Systematic Review
    Creator: Pongmee Pharuhad
    Description: Objectives: To conduct a systematic review of the clinical trials evaluating the role of antibiotics for prevention or treatment of meconium aspiration syndrome (MAS). Methods: We searched several electronic databases including MEDLINE, EMBASE, CINAHL, SCOPUS (until September 2013), and CENTRAL (until August 2013). Additional citations were retrieved from the bibliographies of the selected articles. Studies were included if they were: Randomized or quasi-randomized trials, compared use of antibiotics with no antibiotics for treatment or prevention of MAS, and reported on clinical outcomes in the neonatal period. Results: Four randomized controlled trials (RCTs) were identified; three studies enrolled subjects for treatment of MAS and one study evaluated the prophylactic use of antibiotics in infants exposed to meconium stained amniotic fluid (MSAF). These trials enrolled 695 infants, with the duration of antibiotics between 3 and 7 days. All studies excluded subjects considered to be at higher risk for neonatal sepsis at onset. There were no differences noted for the outcomes of infection rates (relative risk [RR] [95% confidence interval: 0.85 [0.42, 1.73] for clinical sepsis, and 0.93 [0.36, 2.40] for culture-proven sepsis), need for mechanical ventilation (RR: 1.39 [0.68, 2.82]), air leaks syndrome (RR: 1.65 [0.68, 3.99]), hospital stay (mean difference − 0.34 days [−1.13, 0.45]), or mortality (RR: 1.25 [0.36, 4.39]) between the intervention and control groups. Conclusions: In neonates at low-risk for sepsis, insufficient evidence exists to support the routine use of antibiotics following exposure to MSAF or for the treatment of for suspected MAS. We discuss the implications and limitations of review findings for clinical practice.
    Subjects: Antibiotics, Meconium-Stained Amniotic Fluid, Meta-Analysis, Systematic Review, Meconium Aspiration Syndrome
    Date Created: 2015