Use and timing of surfactant administration: impact on neonatal outcomes in extremely low gestational age infants born in Canadian Neonatal Intensive Care Units.

Background: Use, timing and doses of surfactant in preterm infants are variable in practice in modern NICUs.

Objective: The objective of this study is to explore the association between use and timing of surfactant administration and common neonatal adverse outcomes in preterm infants with gestational age (GA) < 28 weeks.

Material And Methods: Neonates admitted to a participating Canadian Neonatal Network NICU between 2013 and 2015 were studied.

Prophylactic Interventions in Neonatology: How Do They Fare in Real Life?

Objective: This study aims to evaluate the association of prophylactic antenatal steroids, indomethacin, and phototherapy with extremely preterm infant outcomes in a pragmatic setting.

Study Design: Retrospective study of infants born at <28 weeks gestation and admitted to 26 Canadian Neonatal Network neonatal intensive care units between 2010 and 2012. Mortality, severe neurological injury, retinopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, nosocomial infection, and patent ductus arteriosus ligation rates were compared between infants who received antenatal steroids, prophylactic indomethacin, and/or prophylactic phototherapy and those who did not.

Temporal changes in blood product usage in preterm neonates born at less than 30 weeks' gestation in Canada.

Background: Knowledge of neonatal transfusion practices remains limited to local cohorts or survey-based studies. This study evaluated the pattern and temporal changes in the types and frequency of blood product use among preterm neonates born at less than 30 weeks' gestation in Canada.

Study Design And Methods: A retrospective cohort study of preterm neonates born at less than 30 weeks' gestation and admitted to participating neonatal intensive care units in the Canadian Neonatal Network from 2004 to 2012 was conducted to evaluate blood product usage.

Quality improvement for neonatal nurses, part II: using a PDSA quality improvement cycle approach to implement an oral feeding progression guideline for premature infants.

The development of clinical practice guidelines involving multiple health care providers presents a challenge in the neonatal intensive care unit (NICU). Implementation and evaluation of the guideline is as important as the development of the guideline itself. We explored the use of a quality improvement approach in the implementation of a feeding framework.

Quality improvement for neonatal nurses, part I: a framework for advancing the quality and safety of care.

Quality improvement (QI) and patient safety are becoming increasingly powerful drivers for health care planning and delivery. In this two-part series, the concept of QI will be introduced and implications for neonatal nursing care will be discussed. Part I reviews trends in the fields of QI and patient safety and introduces how neonatal practitioners are currently taking up QI and patient safety in their practice.

The changing epidemiology of preterm twins and triplets admitted to neonatal intensive care units in Canada, 2003 to 2008.

We describe trends in the rates of admission of preterm twin and triplet infants to neonatal intensive care units (NICUs) across Canada and compare their neonatal outcomes over a 6-year period. Temporal trends of admission rates for 5193 twins and triplets < 33 weeks' gestational age to participating NICUs in the Canadian Neonatal Network between 2003 and 2008 were assessed. Trends in infant outcomes were evaluated using logistic regression.

Early life events, sex, and arterial blood pressure in critically ill infants.

Objective: To determine whether photo-protecting total parenteral nutrition in preterm infants influences arterial blood pressure differently according to gender. Blood pressure is influenced by complex mechanisms of vasomodulation. Oxidants are mediators and effectors in such reactions.

Impact of shielding parenteral nutrition from light on routine monitoring of blood glucose and triglyceride levels in preterm neonates.

Background: Premature infants are vulnerable to complications related to oxidative stress. Exposure to light increases oxidation products in solutions of total parenteral nutrition (TPN) such as lipid peroxides and hydrogen peroxide. Oxidative stress impairs glucose uptake and affects lipid metabolism.

Variations in metabolic response to TPN are influenced more by sex than by light exposure.

Background: Failure to protect total parenteral nutrition (TPN) solutions from ambient light induces the generation of peroxides, which contributes to the oxidation of several amino acids. We hypothesized that photo-protection improves the metabolic response to TPN.

Aim: To study the effects of photo-protecting TPN on urinary nitrogen and vitamin C excretion and to evaluate in premature infants the influence of sex.

In preterm neonates, is the risk of developing bronchopulmonary dysplasia influenced by the failure to protect total parenteral nutrition from exposure to ambient light?

Light-exposed total parenteral nutrition (TPN) generates peroxides that contribute to an oxidant load. Shielding TPN from light protects against lung remodelling. In preterm infants, photoprotection of TPN is associated with a 30% reduction in bronchopulmonary dysplasia in a post-hoc analysis.

Photoprotection of parenteral nutrition enhances advancement of minimal enteral nutrition in preterm infants.

Background: Light exposure of TPN generates peroxides which induce vasoconstriction. Mesenteric vasoconstriction may affect feeding tolerance. Since photo-protection of TPN decreases peroxide generation, we hypothesized that shielding TPN from light may improve the establishment of minimal enteral nutrition in preterm infants.

Superfetation as a cause of growth discordance in a multiple pregnancy.

A triplet pregnancy is described, in which the diagnosis of in utero growth restriction is questioned after postnatal suspicion of superfetation, by using neurosonography and ophthalmic examination to aid gestational age assessment.

The mode of delivery of parenteral multivitamins influences nutrient handling in an animal model of total parenteral nutrition.

Background: Very low birthweight preterm infants receive early total parenteral nutrition (TPN) to optimize protein balance. Adding multivitamins (MVP) to the lipid emulsion (MVP+LIP) rather than to the amino acid+dextrose moiety of TPN (AA+MVP) limits the effects of light exposure on lipid peroxidation and vitamin loss.

Aim: Compare the effects of the mode of delivery of MVP on nutrient handling and indices of oxidant stress.