Reducing Benzodiazepine Exposure by Instituting a Guideline for Dexmedetomidine Usage in the NICU.

Background: Midazolam is a benzodiazepine sedative used in NICUs. Because benzodiazepine's effects include respiratory depression and potential detrimental developmental effects, minimizing exposure could benefit neonates. Dexmedetomidine is routinely used for sedation in older pediatric populations.

A retrospective study of neonatal case management and outcomes in rural Rwanda post implementation of a national neonatal care package for sick and small infants.

Background: Despite worldwide efforts to reduce neonatal mortality, 44% of under-five deaths occur in the first 28 days of life. The primary causes of neonatal death are preventable or treatable. This study describes the presentation, management and outcomes of hospitalized newborns admitted to the neonatal units of two rural district hospitals in Rwanda after the 2012 launch of a national neonatal protocol and standards.

Effect of Parent Presence During Multidisciplinary Rounds on NICU-Related Parental Stress.

Objective: To evaluate the effect of parent presence during multidisciplinary rounds on NICU-related parental stress.

Design: Quasi-experimental study.

Setting: University-affiliated, 24-bed NICU located within a children's hospital that admits infants from birth to 6 months of age.

Therapeutic hypothermia: treatment for hypoxic-ischemic encephalopathy in the NICU.

Baby M was born limp, blue, and without respiratory effort at 38 weeks gestation to a 38-year-old, gravida 5, para 1, woman. Delivery was vaginal after a rapid progression of labor leaving no opportunity for a cesarean section. No other complications were noted during labor but a large surge at delivery, later diagnosed as uterine rupture, initially raised concerns about placental abruption.

Placental pathology in asphyxiated newborns meeting the criteria for therapeutic hypothermia.

Objective: We sought to describe placental findings in asphyxiated term newborns meeting therapeutic hypothermia criteria and to assess whether histopathologic correlation exists between these placental lesions and the severity of later brain injury.

Study Design: We conducted a prospective cohort study of the placentas of asphyxiated newborns, in whom later brain injury was defined by magnetic resonance imaging.

Results: A total of 23 newborns were enrolled.

Can induced hypothermia be assured during brain MRI in neonates with hypoxic-ischemic encephalopathy?

Until now, brain MRIs in asphyxiated neonates who are receiving therapeutic hypothermia have been performed after treatment is complete. However, there is increasing interest in utilizing early brain MRI while hypothermia is still being provided to rapidly understand the degree of brain injury and possibly refine neuroprotective strategies. This study was designed to assess whether therapeutic hypothermia can be maintained while performing a brain MRI.

Donation after cardiac death: the potential contribution of an infant organ donor population.

Objective: To determine the percentage of deaths in level III neonatal intensive care unit (NICU) settings that theoretically would have been eligible for donation after cardiac death (DCD), as well as the percentage of these who would have been potential DCD candidates based on warm ischemic time.

Study Design: We conducted a retrospective study of all deaths in 3 Harvard Program in Neonatology NICUs between 2005 and 2007. Eligible donors were identified based on criteria developed with our transplantation surgeons and our local organ procurement organization.

Early versus late MRI in asphyxiated newborns treated with hypothermia.

Objective: The purposes of this feasibility study were to assess: (1) the potential utility of early brain MRI in asphyxiated newborns treated with hypothermia; (2) whether early MRI predicts later brain injury observed in these newborns after hypothermia has been completed; and (3) whether early MRI indicators of brain injury in these newborns represent reversible changes.

Patients And Methods: All consecutive asphyxiated term newborns meeting the criteria for therapeutic hypothermia were enrolled prospectively. Each newborn underwent one or two early MRI scans while receiving hypothermia, on day of life (DOL) 1 and DOL 2-3 and also one or two late MRI scans on DOL 8-13 and at 1 month of age.

Prone positioning can be safely performed in critically ill infants and children.

Objective: To describe the effects of prone positioning on airway management, mechanical ventilation, enteral nutrition, pain and sedation management, and staff utilization in infants and children with acute lung injury.

Design: Secondary analysis of data collected in a multiple-center, randomized, controlled clinical trial of supine vs. prone positioning.