Predictors of successful patent ductus arteriosus closure with acetaminophen in preterm infants

The authors objective was to evaluate predictors of successful patent ductus arteriosus (PDA) closure following acetaminophen treatment.

Retrospective cohort study of ≤30 weeks GA infants born from 1 January 2013–30 September 2019, and treated with single course acetaminophen by symptomatic PDA treatment strategy. Multiple maternal and neonatal variables were identified as potential predictors. Univariate analysis and multivariable regression models were applied to evaluate the strongest predictors.

Sixty-six patients were included, 28 (42.4%) had successful PDA closure following acetaminophen. Success was associated with GA > 26 weeks (65% vs. 33%, AUC = 0.64), birthweight >750 g (53% vs. 32%, AUC = 0.61), PDA size ≤0.2 cm (63% vs. 32%, AUC = 0.64), and no prior indomethacin use (56% vs. 33%, AUC = 0.61). Multivariable model identified GA > 26 weeks (RR = 1.92, CI 1.20–3.09) and PDA size ≤0.2 cm (RR: 1.82, CI 1.11–2.98) as the strongest predictors.

The authors concluded that acetaminophen may be more successful in targeted PDA closure in >26 weeks GA infants with PDA size ≤0.2 cm.

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COVID-19: neonatal–perinatal perspectives

The coronavirus disease 2019 (COVID-19) pandemic, resulting from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused severe and widespread illness in adults, including pregnant women, while rarely infecting neonates. An incomplete understanding of disease pathogenesis and viral spread has resulted in evolving guidelines to reduce transmission from infected mothers to neonates. Fortunately, the risk of neonatal infection via perinatal/postnatal transmission is low when recommended precautions are followed. However, the psychosocial implications of these practices and racial/ethnic disparities highlighted by this pandemic must also be addressed when caring for mothers and their newborns. This review provides a comprehensive overview of neonatal–perinatal perspectives of COVID-19, ranging from the basic science of infection and recommendations for care of pregnant women and neonates to important psychosocial, ethical, and racial/ethnic topics emerging as a result of both the pandemic and the response of the healthcare community to the care of infected individuals.

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Antibiotic regimens for late‐onset neonatal sepsis

A new Cochrane Systematic review has concluded the “current evidence is insufficient to support any antibiotic regimen being superior to another. RCTs assessing different antibiotic regimens in late‐onset neonatal sepsis with low risks of bias are warranted.”

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Antibiotic regimens for early‐onset neonatal sepsis

A new Cochrane Systematic Review has found that the “current evidence is insufficient to support any antibiotic regimen being superior to another. Large RCTs assessing different antibiotic regimens in early‐onset neonatal sepsis with low risk of bias are warranted.

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Neurodevelopment outcome of extremely preterm infants at 2 and 10 years of age

Although extremely preterm (EPT; gestational age <28 weeks) survivors are at-risk for significant neurodevelopmental impairment (NDI), some children may show improvement over time as illustrated in a large cohort study (Extremely Low Gestational Age Newborn Study [ELGANS]) of 1506 EPT infants. In a follow-up assessment of 802 survivors, neurodevelopmental status improved in 27 percent, worsened in 5 percent, and remained unchanged in 67 percent of children when comparing evaluations completed at 2 and 10 years of age. Of note, two-thirds of individuals who were initially classified with moderate to profound NDI (n = 335) had either no or only mild NDI primarily due to improved cognitive function. These results help inform anticipatory guidance for caregivers of children with significant NDI in infancy. Nevertheless, we continue to perform early clinical assessment to identify EPT survivors with severe NDI impairment that typically does not resolve by school age and who can benefit from early intervention. (See “Long-term neurodevelopmental outcome of preterm infants: Management”, section on ‘Clinical assessment’.)

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