Delayed cord clamping in preterm twin infants: a systematic review and meta-analysis.

Objective: To compare the effects of delayed cord clamping (DCC) versus early cord clamping (EDD) on all-cause in-hospital mortality and selected morbidities among preterm twin neonates.

Data Sources: A search of PubMed, Ovid Medline, Embase, Cochrane database, Web of Science and CINAHL was conducted in December 2023 for studies comparing DCC to ICC in preterm twin neonates.

Study Eligibility Criteria: Studies were deemed eligible if they included preterm twin neonates (< 37 weeks of gestation), compared delayed (≥ 30 seconds) vs early (<30 seconds) umbilical cord clamping at delivery and described at least one outcome of interest.

Butterflies and Ribbons: Supporting Families Experiencing Perinatal Loss in Multiple Gestation.

In neonatology, multiple pregnancies are common. Unfortunately, it is not rare for one baby to die. Communication with parents in these circumstances has been demonstrated to be sub-optimal.

Survival and Long-Term Outcomes of Children Who Survived after End-of-Life Decisions in a Neonatal Intensive Care Unit.

Objective: To investigate long-term outcomes of infants who survive despite life-and-death discussions with families and a decision to withdraw or withhold life-sustaining interventions (WWLST) in one neonatal intensive care unit.

Study Design: Medical records for neonatal intensive care unit admissions from 2012 to 2017 were reviewed for presence of WWLST discussions or decisions, as well as the 2-year outcome of all children who survived. WWLST discussions were prospectively recorded in a specific book; follow-up to age 2 years was determined by retrospective chart review.

Fragility and resilience: parental and family perspectives on the impacts of extreme prematurity.

Objectives: Extremely preterm babies have a significant risk of neurodevelopmental impairment (NDI). There has been little investigation regarding the impact of prematurity on families. The objective of this study was to explore parental perspectives regarding the impact of prematurity on themselves/their family.

Gratitude, fragility and strength: Perspectives of adults born preterm about prematurity.

Aim: The aim of the study was to explore how young adults thought that being born preterm had affected their lives.

Methods: Adult participants of a research cohort were questioned about their perspectives. Answers were analysed using mixed methods.

Pulmonary important outcomes after extremely preterm birth: Parental perspectives.

Aim: To describe pulmonary important outcomes (PIO) reported by parents of children born extremely preterm.

Methods: Over 1-year, all parents of children aged 18 months-7-years born <29 weeks' GA were asked regarding their perspectives. The proportion of parents who described PIO and the themes they invoked were examined.

Guilt and Regret Experienced by Parents of Children Born Extremely Preterm.

Objectives: To explore decisional regret of parents of babies born extremely preterm and analyze neonatal, pediatric, and parental factors associated with regret.

Study Design: Parents of infants born <29 weeks of gestational age, aged between 18 months and 7 years, attending neonatal follow-up were enrolled. Hospital records were reviewed to examine morbidities and conversations with parents about levels of care.

Epidemiology of post-hemorrhagic ventricular dilatation in very preterm infants.

Objective: To describe the incidence, trends, management's variability and short-term outcomes of preterm infants with severe post-hemorrhagic ventricular dilatation (sPHVD).

Methods: We reviewed infants <33 weeks' gestation who had PHVD and were admitted to the Canadian Neonatal Network between 2010 and 2018. We compared perinatal characteristics and short-term outcomes between those with sPHVD and those with mild/moderate PHVD and those with and without ventriculo-peritoneal (VP) shunt.

Avoidance of routine endotracheal intubation and general anesthesia for primary closure of gastroschisis: a systematic review and meta-analysis.

Purpose: Over the last few decades, several articles have examined the feasibility of attempting primary reduction and closure of gastroschisis without general anesthesia (GA). We aimed to systematically evaluate the impact of forgoing routine intubation and GA during primary bedside reduction and closure of gastroschisis.

Methods: The primary outcome was closure success.

Next generation sequencing in neonatology: what does it mean for the next generation?

Rapid whole genome sequencing (WGS) and whole exome sequencing (WES), sometimes referred to as "next generation sequencing" (NGS) are now recommended by some experts as a first-line diagnostic test to diagnose infants with suspected monogenic conditions. Estimates of how often NGS leads to diagnoses or changes in management vary widely depending on the population being studied and the indications for testing. Finding a genetic variant that is classified as pathogenic may not necessarily equate with being able to predict the resultant phenotype or to give a reliable prognosis.

The most immature infants: Is evidence-based practice possible?

Introduction: At extremely low gestational ages, preterm infants are markedly physiologically immature, thus their responses to common clinical interventions may differ from more mature preterm babies. This study was performed to describe the evidence base which is available to make care decisions for such infants.

Methods: A literature search of recent large neonatal randomized controlled trials (RCTs) was performed to determine the representation of infants <25 weeks of gestation, and whether it is clear if the overall results applied to the most immature infants.

The ethics of family integrated care in the NICU: Improving care for families without causing harm.

The philosophy of care in Neonatal Intensive care Units (NICU) has changed with increasing integration of families. We examined parents' and clinicians' perspective about Family Integrated Care (FiCare) in our quaternary NICU. We found that parents and clinicians reported many benefits for families.

Impact of Deferred Cord Clamping on Mortality and Severe Neurologic Injury in Twins Born at <30 Weeks of Gestation.

Objective: To determine whether deferred cord clamping (DCC) compared with early cord clamping (ECC) was associated with reduction in death and/or severe neurologic injury among twins born at <30 weeks of gestation.

Study Design: We performed a retrospective cohort study including all liveborn twins of <30 weeks admitted to a tertiary-level neonatal intensive care unit (NICU) in Canada between 2015 and 2018 using the Canadian Neonatal/Preterm Birth Network database. We compared DCC ≥30 seconds vs ECC <30 seconds.

Cerebral oxygen saturation and autoregulation during hypotension in extremely preterm infants.

Background: The impact of the permissive hypotension approach in clinically well infants on regional cerebral oxygen saturation (rScO) and autoregulatory capacity (CAR) remains unknown.

Methods: Prospective cohort study of blinded rScO measurements within a randomized controlled trial of management of hypotension (HIP trial) in extremely preterm infants. rScO, mean arterial blood pressure, duration of cerebral hypoxia, and transfer function (TF) gain inversely proportional to CAR, were compared between hypotensive infants randomized to receive dopamine or placebo and between hypotensive and non-hypotensive infants, and related to early intraventricular hemorrhage or death.

Hypotension in Preterm Infants (HIP) randomised trial.

Objective: To determine whether restricting the use of inotrope after diagnosis of low blood pressure (BP) in the first 72 hours of life affects survival without significant brain injury at 36 weeks of postmenstrual age (PMA) in infants born before 28 weeks of gestation.

Design: Double-blind, placebo-controlled randomised trial. Caregivers were masked to group assignment.

Intervention and Outcome for Neonatal Hypotension.

Many observational studies have shown that infants with blood pressures (BPs) that are in the lower range for their gestational age tend to have increased complications such as an increased rate of significant intraventricular hemorrhage and adverse long-term outcome. This relationship does not prove causation nor should it create an indication for treatment. However, many continue to intervene with medication for low BP on the assumption that an increase in BP will result in improved outcome.

Bovine Lactoferrin Supplementation Does Not Disrupt Microbiota Development in Preterm Infants Receiving Probiotics.

Objective: The aim of the study was to assess whether bovine lactoferrin (bLf) supplementation disrupts intestinal microbiota development in preterm infants less than 31 weeks gestational age receiving prophylactic probiotic administration.

Methods: Subjects were recruited from the LACUNA trial (ISRCTN66482337), designed to assess bLf safety. These subjects were randomized to daily receive either probiotic supplements or probiotics supplemented with 100 mg bLf mixed with their feeds (human milk or formula).