Study protocol: baby-OSCAR trial: Outcome after Selective early treatment for Closure of patent ductus arteriosus (PDA) in preterm babies, a multi-center, masked, randomized placebo-controlled parallel group trial. The comparison of early treatment of PDA vs. to wait until symptoms appear, is clinically important. In preterm babies <29 weeks' gestation, the PDA will fail to close spontaneously in about 40%, and in some even by 4 months of age. The authors compared early-targeted treatment of a large PDA with parenteral ibuprofen in extremely preterm infants (23-28 weeks' gestation) improves short and long-term health and economic outcomes. Babies with a large PDA on echocardiography, defined by diameter >1.5 mm and unrestricted pulsatile PDA flow pattern, were randomly allocated to either ibuprofen or placebo within 72 h of birth. The primary endpoint was the composite outcome of death or moderate/severe bronchopulmonary dysplasia by 36 weeks' post-menstrual age. Their results show that prophylactic pharmacological treatment of all preterm babies unnecessarily exposed them to potentially serious side effects, when their PDA may have closed spontaneously. However, delaying treatment until babies become symptomatic could result in loss of treatment benefit as irreversible damage may have already been done. Further study is needed for targeted, early pharmacological treatment of PDA in asymptomatic babies.
Does the food processing contaminant acrylamide cause developmental neurotoxicity? There is a worldwide concern on adverse health effects of dietary exposure to acrylamide (AA) due to its presence in commonly consumed foods. AA is formed when carbohydrate rich foods containing asparagine and reducing sugars are prepared at high temperatures and low moisture conditions. Upon oral intake, AA is rapidly absorbed and distributed to all organs. AA is a known human neurotoxicant that can reach the developing foetus via placental transfer and breast milk. Its effects in human infants need study. Epidemiological studies suggest that AA could impair foetal growth and limit the head circumference of the neonate. We need further research to elucidate the effects of whether pre- and perinatal AA exposure.
Zika virus infection in pregnant travellers and impact on childhood neurodevelopment in the first two years of life: a prospective observational study. Zika virus (ZIKV) can affect maternal and children's health. The authors investigated the clinical and epidemiological characteristics of pregnant women returning from ZIKV affected areas, and the effects of maternal ZIKV infection on birth outcomes and children's health. This was a hospital-based prospective observational study conducted in Spain, on 195 pregnant women who had travelled to ZIKV affected areas during pregnancy. Four women (2.1%) had a confirmed ZIKV infection, 40 (20.5%) had a probable infection, and 151 (77.4%) were negative for ZIKV. Among the ZIKV confirmed cases, one suffered a miscarriage, plausibly associated with ZIKV infection. Brain cysts and microcalcifications were detected in 7% of fetuses or infants from women with confirmed or probable ZIKV infection. Neurodevelopmental delay in the language function was found in 33.3% out of the 21 children evaluated. There is a need for long-term surveillance in pregnant travellers to ZIKV-infested areas and their children.
Does enteral zinc improve preterm outcomes? This systematic review and meta-analysis included 3 RCTs with 765 infants (4 month follow up) and 672 infants (with 12 month follow up). The primary aim (ASQ total score) pooled analysis was possible only for 12 month follow-up. No differences were found between the delayed (DCC) vs. early cord clamping (ECC) groups. DCC improved infants’ communication and personal-social domains at 12 months, although the personal-social scores were lower at 4 months. The authors concluded that infants neurological outcomes could be improved with the simple, non-observational and cost-effective approach of DCC.
Delayed cord clamping (DCC) and long term neurodevelopmental outcomes. This systematic review and meta-analysis included 3 RCTs with 765 infants (4 month follow up) and 672 infants (with 12 month follow up). Primary aim (ASQ total score) pooled analysis was possible only for 12 month follow up and no differences were found between the delayed (DCC) vs early cord clamping (ECC) groups. DCC approach significantly improved infants’ communication and personal-social domains at 12 months although the DCC group showed lower scores in personal-social domains at 4 months. The authors concluded that infants neurological outcomes could be improved with the simple, non-observational and cost-effective approach of DCC.
Impact of feed volume on growth of preterm infants. This updated Cochrane review compared high (>180-200 ml/kg/day) vs. standard (≤180-200 ml/kg/day) volume enteral feeds in preterm LBW infants. A total of 3 RCTs with 347 infants were analyzed, and two with 283 infants were included. The authors concluded that high volume (180 mL/kg/day) of fortified human milk or preterm formula, or 200 mL/kg/day of unfortified human milk or term formula probably improved weight gain during hospital stay. However, these data were inadequate to draw firm conclusions for growth and other clinical outcomes (NEC).
Last updated by Dr. Gayatri Jape, Perth, May 2021
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