Showing posts with label preterm. Show all posts
Showing posts with label preterm. Show all posts

Wednesday, May 27, 2015

The Glycerin Suppository: Friend or Foe of the Preterm Infant

By: Lewis First, MD, MS; Editor-in-Chief      

          We certainly see preterm infants being helped in evacuating meconium or in relieving abdominal distension due to retention of stool with the use of a glycerin suppository or enema.  So how effective are they—and are there any adverse effects we should know about?  
       Livingston et al. (doi: 10.1542/peds.2015-0143) have performed a meta-analysis of all glycerin suppository and/or enema studies.  Outcome measures reported include earlier passage of stool, easier transition to enteral feeds, as well as complications like bleeding and necrotizing enterocolitis (NEC) and mortality. So what does the systematic review of these studies show?  While some indicators might suggest the benefits of this medication, others do not—and there is even the suggestion that use of a glycerin suppository may increase risk of NEC in preterm infants.   
     Take a hard look at this study, and hopefully you’ll find that with or without the use of glycerin, when it comes to stooling patterns in preterm infants, everything will come out fine in the end.

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Friday, April 24, 2015

Does Extremely Preterm Outcome Hinge on the Intensity of Perinatal Care Provided?

      We often read that investing resources into the tiniest of preterm babies may not be cost-effective given the mortality risk as well as the neurodevelopmental disability that can occur in the extremely preterm infant. Yet maybe the more intensive care resources we provide, the better the outcomes?  That opinion is substantiated by Serenius et al. (doi:10.1542/peds.2014-2988) as they describe some interesting findings using a national prospective study of more than 800 fetuses alive at the time a mother was admitted for delivery.  To our surprise, being proactive and increasing the intensity of perinatal care does result in some pretty impressive risk-reduction in these ELBW infants. So what should we conclude about the use of proactive care in this high risk population of infants.   
      Doctor Cody Arnold and Doctor Eric Eichenwald weigh in with an accompanying commentary that sheds further light on the findings in this study (doi: 10.1542/peds.2015-0536) Maybe the cost is outweighed by the benefit—but we’d love to know your thoughts about how much is too much when it comes to trying to provide whatever it takes to help an extremely preterm baby? 
     Share your opinion on the findings in this study by responding to our blog, writing an e-letter or post your comments on our Facebook or Twitter sites.

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Monday, March 30, 2015

Follow-up Studies of Preterm and Late Preterm Infant Neurocognitive Performance Continue To Develop

By: Lewis First, MD, MS; Editor-in-Chief  
     Our readers tell us they learn a lot reading the studies we publish on long-term follow-up of infants born early particularly in terms of their neurodevelopment. Well this week we don’t want to disappoint our readers and therefore bring you three studies of interest in the area of cognitive development of preterm, and late preterm infants. 
      The first study by Burnett et al. (doi: 10.1542/peds.2014-3188) focuses on extremely preterm (less than 28 weeks) and extremely low birth weight (less than1000 g) infants in terms of their executive function, not just in infancy and toddlerhood but into adolescence. 
     Sadly, poor performance in executive function tasks seen early in life carries on into the teen years, and while some aspects of executive function improve over time, a number of aspects do not, suggesting the need to intervene sooner than later to try to further develop executive function skills over time.
      A second study by Heinonen et al. (doi: 10.1542/peds.2014-3556) looks at late preterm infants and follows their neurocognitive performance not just into adolescence, but into late adulthood. The authors traced a cohort of more than 900 men and women born in Finland in 1934-44 who were assessed  as adults with a battery of tests to identify signs of Alzheimer disease and believe it or not, those who were identified as late-preterm had a higher risk of showing neurocognitive impairment.  Interestingly enough however, those who were able to pursue higher education did not show such findings. 
     Finally there is a third study by Schonhaut et al. (doi:10.1542/peds.2014-1957)  that looks at developmental impairment relative to gestational age in moderate, late preterm and early term infants and once again, there is an inverse association between gestational age and developmental delay.
     There are a lot of interesting comments one can make about the findings in all three studies, and at the same time, one has to be amazed that cohorts of infants are now being followed not just into early childhood but through adolescence and into adulthood without major losses to follow-up.  As a result, we are learning more and more about the developmental outcomes associated with being born early.   
     To help make even more sense of these types of studies and what we can do to perhaps improve developmental outcomes in these patients, Dr. Betty Vohr (doi: 10.1542/peds.2015-0227) offers her perspective in a very interesting commentary.  Read all three studies and the commentary and then see what develops in regard to interventional strategies to improve developmental outcomes in these infants born preterm.

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