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NETWORKING ABOUT IVH
Heuchan and colleagues analyse the outcomes of 5712 infants of 24–30 weeks gestation who were admitted to 28 units in the Australian and New Zealand Neonatal Network from 1995 to 1997. The most important independent risk factors for major (Grade 3–4) IVH were gestational age, incomplete or no antenatal steroids, one minute Apgar score < 4, male gender, and transfer after birth. A similar network in the UK is long overdue.
ANTENATAL STEROIDS AND PVL—MORE OR LESS THE SAME
Preterm infants who received a complete course of antenatal steroids were less likely to have cerebral white matter lesions on ultrasound scans than infants who did not get a complete course. However, more infants died when antenatal steroids were not completed, leaving a similar proportion of survivors with white matter lesions in each group.
Now it seems that neonatologists should include Kawasaki disease in the differential diagnosis of fever in the neonatal period. A 12 day old infant with classical disease is reported.
DURATION OF POSTNATAL STEROID TREATMENT AND NEURODEVELOPMENTAL OUTCOME —MORE OR LESS THE SAME
A 42 day course of dexamethasone in ventilated preterm infants was associated with more rapid weaning from respiratory support than repeated short pulses but there was no long term advantage. Differences in respiratory status did not persist to term. At 17 months corrected age there was no difference in neurodevelopmental outcome, growth, or blood pressure. Half the survivors in each group had moderate or severe disability. High risk groups or high risk treatments?
PASS THE SALT
Depletional hyponatraemia in the early weeks of life is common in preterm infants. Al-Dahhan and colleagues suggest that failure to provide adequate supplementation may have long term consequences. Follow up at 12 years of 37 babies in a sequential cohort study of sodium supplementation in preterm infants suggests that inadequate salt intake in the early weeks of life may predispose to adverse neurodevelopmental outcome more than 10 years later.
NEWBORN SCREENING FOR DUCHENNE MUSCULAR DYSTROPHY
As the number of tests for which newborn screening is feasible goes up, the difficulty of providing adequate information and support to families opting to accept testing increase. Parsons and colleagues describe the experiences of parents in a carefully implemented newborn screening programme for Duchenne muscular dystrophy. Most parents were in favour of screening. Earlier diagnosis did not appear to damage the mother-baby relationship. The test results influenced reproductive planning before the birth of further affected infants.
Insulin is present in breast milk at four times its concentration in maternal blood. Animal studies suggest that it may promote gut development and function. A small pilot study suggests that similar effects are feasible in human infants. Placebo controlled data are required to strengthen the hypothesis.
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