Achieved Oxygenation Saturations and Outcome in Extremely Preterm Infants.

Infants in the Neonatal Oxygenation Prospective Meta-analysis trials were randomized to SpO targets of 85% to 89% or 91% to 95%. Group allocation was masked. Different outcomes are likely partially attributable to differences in achieved SpO.

Pulse Oximeter Saturation Targeting and Oximeter Changes in the Benefits of Oxygen Saturation Targeting (BOOST)-II Australia and BOOST-II UK Oxygen Trials.

Infants in the Australian and UK Benefits of Oxygen Saturation Targeting-II trials treated using revised oximeters spent more time within their planned pulse oximeter saturation target ranges than infants treated using the original oximeters (P < .001). This may explain the larger mortality difference seen with revised oximeters.

Identification of a human neonatal immune-metabolic network associated with bacterial infection.

Understanding how human neonates respond to infection remains incomplete. Here, a system-level investigation of neonatal systemic responses to infection shows a surprisingly strong but unbalanced homeostatic immune response; developing an elevated set-point of myeloid regulatory signalling and sugar-lipid metabolism with concomitant inhibition of lymphoid responses. Innate immune-negative feedback opposes innate immune activation while suppression of T-cell co-stimulation is coincident with selective upregulation of CD85 co-inhibitory pathways.

The twists and turns of neonatal oxygen therapy.

Although supplemental oxygen is one of the commonest treatments in neonatal medicine, the evidence base for deciding which newborns need it, and what is the appropriate dose remains weak. Clinical research in this area is difficult because it requires clinicians to depart from established practice and, in the case of oxygen therapy, the stakes seem far higher to them than for other investigational treatments. Consequently, beyond the knowledge that extreme hyperoxia and hypoxia are harmful, the middle ground remains uncertain for both preterm and term infants.

Provision of servo-controlled cooling during neonatal transport.

Introduction: Therapeutic hypothermia is a time critical intervention for infants who have experienced a hypoxic-ischaemic event. Previously reported methods of cooling during transport do not demonstrate the same stability achieved in the neonatal unit. The authors developed a system which allowed provision of servo-controlled cooling throughout transport, and present their first year's experience.

Normative values of substance P and neurokinin A in neonates.

Background: Substance P (SP) and neurokinin A (NKA) are neuropeptides that have been researched as pain markers in adults, as they are involved in transmission and modulation of pain signals. There is a potential role for them as neurochemical markers of pain in neonates, but this has never previously been investigated.

Aim: To establish normative values of SP and NKA in neonates.

Respiratory strategies for preterm infants at birth.

Neonatologists treating extremely premature infants in the delivery room are faced with many dilemmas, not least how best to support their breathing. A balance must be struck between helping those infants who need it and not applying potentially harmful treatments to infants who might not need them. Crucial to this process is being able to identify infants who might benefit.

Quantitative assessment of human whole blood RNA as a potential biomarker for infectious disease.

Infection remains a significant cause of morbidity and mortality especially in newborn infants. Analytical methods for diagnosing infection are severely limited in terms of sensitivity and specificity and require relatively large samples. It is proposed that stringent regulation of the human transcriptome affords a new molecular diagnostic approach based on measuring a highly specific systemic inflammatory response to infection, detectable at the RNA level.

Initial ventilation strategies during newborn resuscitation.

Ventilation alone is usually effective in most neonatal resuscitation episodes. A review of the evidence underpinning recommendations for methods and devices for providing initial ventilation during newborn resuscitation was conducted. Self-inflating bags, flow-inflating (anesthesia) bags, and T-piece devices all may be used to provide effective ventilation after birth, with none clearly superior.