Massage for promoting growth and development of preterm and/or low birth-weight infants.

Background: It has been argued that infants in Neonatal Intensive Care Units are subject both to a highly stressful environment - continuous, high-intensity noise and bright light - and to a lack of the tactile stimulation that they would otherwise experience in the womb or in general mothering care. As massage seems to both decrease stress and provide tactile stimulation, it has been recommended as an intervention to promote growth and development of preterm and low-birth weight infants.

Objectives: To determine whether preterm and/or low birth-weight infants exposed to massage experience improved weight gain and earlier discharge compared to infants receiving standard care; to determine whether massage has any other beneficial or harmful effects on this population.

Intravenous immunoglobulin for suspected or subsequently proven infection in neonates.

Background: Congenital and nosocomial infections are important causes of neonatal morbidity and mortality. Maternal transport of immunoglobulins to the fetus mainly occurs after 32 weeks gestation and endogenous synthesis does not begin until several months after birth. Administration of intravenous immunoglobulin provides IgG that can bind to cell surface receptors, provide opsonic activity, activate complement, promote antibody dependent cytotoxicity, and improve neutrophilic chemo luminescence.

Intravenous immunoglobulin for preventing infection in preterm and/or low-birth-weight infants.

Background: Nosocomial infections continue to be a significant cause of morbidity and mortality among preterm and/or low birth weight infants. Maternal transport of immunoglobulins to the fetus mainly occurs after 32 weeks gestation and endogenous synthesis does not begin until several months after birth. Administration of intravenous immunoglobulin provides IgG that can bind to cell surface receptors, provide opsonic activity, activate complement, promote antibody dependent cytotoxicity, and improve neutrophilic chemo luminescence.

Inositol for respiratory distress syndrome in preterm infants.

Background: Inositol is an essential nutrient required by human cells in culture for growth and survival. Inositol promotes maturation of several components of surfactant and may play a critical role in fetal and early neonatal life.

Objectives: To assess the effectiveness/safety of supplementary inositol in preterm infants with RDS in reducing adverse neonatal outcomes.

Meta-analysis of the effects of endothelin receptor blockade on survival in experimental heart failure.

Background: Although an initial study of endothelin receptor blockade reported positive findings, subsequent experiments and clinical trials in humans found little or no benefit.

Methods: We applied meta-analytic methods to assess the methodologic rigor of preclinical studies of endothelin blockade and to quantitatively evaluate the totality of evidence regarding the effect of endothelin receptor blockers in experimental heart failure. A total of 396 animals were assigned to control and 594 were assigned to experimental therapy in the pooled analysis.

Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis.

Objective: To review outcomes in randomised controlled trials comparing hydralazine against other antihypertensives for severe hypertension in pregnancy.

Study Design: Meta-analysis of randomised controlled trials (published between 1966 and September 2002) of short acting antihypertensives for severe hypertension in pregnancy. Independent data abstraction by two reviewers.

Procedural pain in newborns at risk for neurologic impairment.

In the past decade, our knowledge of pain in newborn infants has advanced considerably. However, infants at significant risk for neurologic impairment (NI) have been systematically excluded from almost all research on pain in neonates. The objectives of this study were to compare: (a).

Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants.

Background: Patent ductus arteriosus (PDA) with significant left to right shunt in preterm infants increases morbidity and mortality. Early closure of the ductus arteriosus may be achieved pharmacologically using cyclooxygenase inhibitors, or by surgery. The efficacy of both treatment modalities is well established.

Continuous negative extrathoracic pressure or continuous positive airway pressure for acute hypoxemic respiratory failure in children.

Background: Acute hypoxemic respiratory failure (AHRF) is an important cause of mortality and morbidity in the pediatric age group. Despite varied etiologies and different population characteristics the aims of therapy are to achieve adequate oxygenation and ventilation. Positive pressure ventilation is currently the standard of care.

Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants.

Background: A patent ductus arteriosus (PDA) often complicates the clinical course of preterm infants and increases the risk of intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), chronic lung disease (CLD) and death. The standard treatment to close a PDA is indomethacin. Its use is associated with renal, gastrointestinal and cerebral side-effects.

Ibuprofen for the treatment of a patent ductus arteriosus in preterm and/or low birth weight infants.

Background: A patent ductus arteriosus (PDA) complicates the clinical course of preterm infants, increasing their risks of developing chronic lung disease (CLD), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH). Indomethacin is used as standard therapy to close a PDA, but is associated with reduced blood flow to the brain, kidneys and gut. Ibuprofen, another cyclo-oxygenase inhibitor, may be as effective with fewer side effects.

Inhaled versus systemic corticosteroids for the treatment of chronic lung disease in ventilated very low birth weight preterm infants.

Background: Chronic lung disease (CLD) remains a serious and common problem among very low birth weight infants despite the use of antenatal steroids and postnatal surfactant therapy to decrease the incidence and severity of respiratory distress syndrome. Corticosteroids have been widely used to treat or prevent CLD due to their anti-inflammatory properties. However, the use of systemic steroids has been associated with serious short and long term adverse effects.

Central hemodynamic responses during serial exercise tests in heart failure patients using implantable hemodynamic monitors.

Introduction: Exercise testing is commonly used in patients with congestive heart failure for diagnostic and prognostic purposes. Such testing may be even more valuable if invasive hemodynamics are acquired. However, this will make the test more complex and expensive and only provides information from isolated moments.

Serious perinatal complications of non-proteinuric hypertension: an international, multicentre, retrospective cohort study.

Objective: To determine the proportion of births complicated by either a pre-existing or a gestational non-proteinuric hypertension, presenting at <34 weeks' gestation, and the associated incidence with 1 or more serious perinatal complications or birth weight <3rd centile for gestational age.

Methods: A retrospective chart review was conducted in 5 international centres, from 1998 to 2002, where "tight" control (normalization) of blood pressure (BP) is the norm. International Classification of Diseases (ICD) codes were used to identify women who delivered at > or =20 weeks' gestation, with any hypertensive disorder of pregnancy.

The benefit of preterm birth at tertiary care centers is related to gestational age.

Objective: The purpose of this study was to examine the relationship between gestational age and outcomes of outborn versus inborn preterm infants.

Study Design: Multivariable logistic regression analysis was used to examine gestational age-specific, risk-adjusted outcomes of 2962 singleton infants who were born at <32 weeks of gestation who were admitted to 17 Canadian neonatal intensive care units from 1996 through 1997.

Results: The risk-adjusted incidence was significantly (P <.

Inhaled versus systemic corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates.

Background: Chronic lung disease (CLD) remains an important cause of mortality and morbidity in preterm infants despite the administration of antenatal corticosteroids, surfactant replacement therapy and other advances in neonatal intensive care. There is increasing evidence from cellular and biochemical research that inflammation plays an important role in the pathogenesis of CLD. Thus, interventions aimed at reducing or modulating the inflammatory process may reduce the incidence or severity of CLD.

Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit.

Background: The need for sedation for neonates undergoing uncomfortable procedures in the neonatal intensive care unit (NICU) has often been overlooked. Proper sedation may reduce stress and avoid complications during procedures such as mechanical ventilation. Midazolam is a short acting benzodiazepine that has been increasingly used in the NICU.

Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates.

Background: Preterm and acutely ill term neonates who are hospitalized in a neonatal intensive care unit are subjected to multiple frequent invasive and painful procedures aimed at improving their outcome. Although several trials to determine the efficacy of sucrose for managing procedural pain in preterm and acutely ill term neonates have been developed, these have generally lacked methodological rigor and have not provided clinicians with clear practice guidelines.

Objectives: To compare the efficacy and safety of three interventions for relieving procedural pain associated with heel lances in preterm and term neonates, and to explore the influence of contextual factors including sex, severity of illness, and prior painful procedures on pain responses.

The effectiveness of premedication for endotracheal intubation in mechanically ventilated neonates. A systematic review.

Implications For Practice: Extrapolating information from the adult and pediatric literature suggests that awake intubation is probably inappropriate in most neonates. Because premedication attenuates the physiologic responses to intubation, its use is recommended. Adequately skilled staff who have a full understanding of the potential benefits and harms of the interventions used should perform intubation and the administration of premedication in neonates.

Knowledge translation and evidence-based perinatal/neonatal health care.

Knowledge translation is the process of bridging the gap between the overwhelming amount of research data/information/evidence and its critical appraisal, synthesis, dissemination, and application as knowledge by influential role models. Knowledge translation includes ongoing surveillance of the results of the implementation of new knowledge. By conducting research that is driven by relevant, well-defined questions and by using the most powerful study designs available, researchers generate valid new information that can later be translated into knowledge and applied in the clinical setting.

Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.

Context: North American cesarean delivery rates have risen dramatically since the 1960s, without concomitant improvements in perinatal or maternal health. A Cochrane Review concluded that continuous caregiver support during labor has many benefits, including reduced likelihood of cesarean delivery.

Objective: To evaluate the effectiveness of nurses as providers of labor support in North American hospitals.

Multiple versus single courses of antenatal corticosteroids for preterm birth: a pilot study.

Objectives: (1) To determine the feasibility of a multicentre, randomized, double-masked, placebo-controlled trial to investigate the effects of multiple courses of antenatal corticosteroids (ACS), more than 7 days following the initial course of ACS therapy, on perinatal or neonatal mortality or neonatal morbidity. (2) To determine the risk of complications that would require discontinuation of ACS therapy. (3) To determine if multiple courses of ACS have an effect on the concentrations of plasma cortisol and adrenocorticotropin hormone (ACTH) in cord blood and in maternal blood immediately following delivery, compared to a single course of ACS.

The Newborn Individualized Developmental Care and Assessment Program is not supported by meta-analyses of the data.

Objectives: To systematically review the effectiveness of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) as compared with conventional care to improve long-term neurodevelopmental outcomes or short-term medical and neurodevelopmental outcomes in preterm and/or low birth weight infants.

Study Design: With the use of standard systematic review methodology, all randomized, controlled trials (RCTs) and prospective cohort studies evaluating in-hospital developmental care based on the framework of NIDCAP in preterm and/or low birth weight infants were identified. The quality of the RCTs was assessed.