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Joint Workshop: Periviable Birth Report of a Joint Workshop by the Eunice Kennedy Shriver NICHD, SMFM, and ACOG


This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation) and the treatment options for the newborn infant. This article is being published concurrently in the May 2014 issue (vol. 123, no. 5) of Obstetrics & Gynecology and the May 2014 issue (vol. 210, no. 5) of the American Journal of Obstetrics and Gynecology, as well as in the Journal of Perinatology.

Journal of Perinatology article »

Joint Workshop: Periviable Birth
Report of a Joint Workshop by the Eunice Kennedy Shriver NICHD, SMFM, and ACOG.


This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation) and the treatment options for the newborn infant. This article is being published concurrently in the May 2014 issue (vol. 123, no. 5) of Obstetrics & Gynecology and the May 2014 issue (vol. 210, no. 5) of the American Journal of Obstetrics and Gynecology, as well as in the Journal of Perinatology.

Journal of Perinatology article »

Featured Presentations

Featured Article

Chylothorax in Infants and Children


A recent State of the Art review article in Pediatrics discusses the causes and management of chylothorax in infants.

Read the article »

MOC Part IV: Breast Feeding in the NBICU

Do you still need Part IV points for MOC?

The AAP has developed a Part IV MOC module for neonatologists and pediatricians aimed increasing breast feeding in infants-with a focus on infants in the NBICU. This module is free for all AAP Section members.  This module uses the CQI process and patient data from your NBICU to improve breast feeding rates. 

Log in to the ABP website and search under Part 4 Activities for Breast Milk Use PIM »

American Board of Pediatrics »

New Webpage for Current Literature in Neonatology


We have recruited several Associate Editors to find the best articles of interest for neonatologists each month.  This webpage will feature several articles and links-with occasional commentary.  Look back here soon!

Association between Postnatal Dexamethasone for Treatment of Bronchopulmonary Dysplasia and Brain Volumes at Adolescence in Infants Born Very Preterm


A study by Cheong and the Victorian Infant Collaborative Study Group published in the Journal of Pediatrics compared brain volumes in adolescents who were born extremely preterm (<28 weeks gestation) who had received postnatal dexamethasone, to determine if there was a postnatal dexamethasone dose–
response effect on brain volumes  They found extremely preterm adolescents who received postnatal dexamethasone in the newborn period had smaller total brain tissue volumes than those who did not receive postnatal dexamethasone, particularly white matter, thalami, and basal ganglia. Vulnerability of brain tissues or structures associated with postnatal dexamethasone varies by structure and persists into adolescence.

Journal of Pediatrics »

Late Outcomes of a Randomized Trial of High-Frequency Oscillation in Neonates


In a recent study in the NEJM by Zivanovic et al, 319 adolescents who had been born before 29 weeks of gestation and had been enrolled in a multicenter, randomized trial that compared HFOV with conventional ventilation immediately after birth were evaluated for lung function and respiratory health, health-related quality of life, and functional status, as assessed with the use of questionnaires completed when the participants were 11 to 14 years of age. The primary outcome was forced expiratory flow at 75% of the expired vital capacity (FEF75). Those who had undergone HFOV, as compared with those who had received conventional ventilation, had superior lung function at 11 to 14 years of age, with no evidence of poorer functional outcomes.

New England Journal of Medicine »

MOC ELBW and Hypothermia


The Perinatal Section has developed a Part IV MOC module for neonatologists aimed at reducing hypothermia in ELBW infants.  This module is free for all AAP Section members.

These authors aimed to attain admission temperatures in the target range of 36°C to 38°C in>90% of inborn VLBW neonates through implementation of a thermoregulation bundle. This quality improvement project extended over 60 consecutive months, using sequential plan–do–check–act cycles. They found this thermoregulation bundle resulted in sustained improvement in normothermia rates during delivery room stabilization of VLBW newborns.

Decreasing Hypothermia During Delivery Room Stablization ».

American Board of Pediatrics »

Call for Associate Editors for SOPPe Neonatal Webpage


The SOPPe Website Committee is interested in recruiting several neonatologists to help locate timely articles of interest and of high quality for neonatologists in the current literature.  Please send your CV and a brief sentence to Renate Savich.

Scottsdale Spring Meeting

April 4-6, 2014
Workshop on Perinatal Practice Strategies-Innovation with Evidence


Hands-On Workshop
The Workshop on Perinatal Practice Strategies was created to provide a forum for addressing practice issues in neonatal/perinatal medicine.  This year the meeting will also feature a workshop on advanced neonatal resuscitation using high fidelity simulation, lead by members of the AAP NRP and HBB Steering committees.  All participants will have hands on experience and learn development of scenarios, communication skills and debriefing techniques.

 You should attend the workshop if you are a:
• Practicing neonatologist
• NICU medical director or division chief
• Teaching program director
• Resident or fellow
• Advanced practice nurse
• Other pediatric professional responsible for the delivery of care to the fetus and newborn

Registration »
Brochure »

Perinatal Section Awards:  Call for Nominees


Selection committees for three national awards from the Section on Perinatal Pediatrics of the American Academy of Pediatrics are now accepting nomination materials.  All nominations and supporting documentation must be received by March 14th, 2014.

The Apgar Award honors an individual whose career has had a significant and continuing influence on the well-being of newborn infants.

Call for Apgar Nominees »

The National Neonatal Education Award honors an individual who has made outstanding contributions to education in neonatal-perinatal medicine.

Call for Education Award Nominees »

The Landmark Award honors an individual who has made a seminal contribution, which has had a major impact on Neonatal-Perinatal practice.

Call for Landmark Award Nominees »

The January 2014 issue of Pediatrics has published several Policy Statements and Clinical Reports by the Committee on Fetus and Newborm of great interest to neonatologists.

Respiratory Support in Preterm Infants at Birth »
Use of Inhaled Nitric Oxide in Preterm Infants »
Surfactant Replacement Therapy for Preterm and Term Neonates »

Catheter Dwell Time and CLABSIs in Neonates With PICCs: A Multicenter Cohort Study


To determine whether the daily risk of central line-associated bloodstream infections (CLABSIs) increases over the dwell time of peripherally inserted central catheters (PICCs) in high-risk neonates, a multicenter retrospective cohort study by Milstone et al in Pediatrics found the average predicted daily risk of CLABSIs after PICC insertion increased during the first 2 weeks after PICC insertion and remained elevated for the dwell time of the catheter. There was an increased risk of CLABSIs in neonates with concurrent PICCs and the incidence of Gram-negative CLABSIs was greater in PICCs with dwell times >50 days. The authors concluded clinicians should review PICC necessity daily, optimize catheter maintenance practices, and investigate novel CLABSI prevention strategies in PICCs with prolonged dwell times.

Read More »

Perinatal Asphyxia with Hyperoxemia within the First Hour of Life Is Associated with Moderate to Severe Hypoxic-Ischemic Encephalopathy

 

In a recent Journal of Pediatrics publication by Kapadia et al, to determine whether early hyperoxemia in neonates with severe perinatal acidemia is associated with the development of hypoxic-ischemic encephalopathy (HIE), infants with perinatal acidosis with a PaO2 measurement during the first hour of life, were divided into infants with hyperoxemia (PaO2 >100 mmHg) and those without hyperoxemia (PaO2 <100 mmHg). Infants with hyperoxemia had a higher incidence of HIE than those without hyperoxemia and admission hyperoxemia was associated with a higher risk of HIE. Among neonates with HIE, admission hyperoxemia was associated with abnormal brain magnetic resonance imaging findings. The judicious use of oxygen during and after resuscitation is warranted according the authors.

Read the article »

Active Cooling Improves Transport of Infants With Hypoxic-Ischemic Encephalopathy


Newborns with hypoxic-­ischemic encephalopathy (HIE)
do better with active cooling during transport in a recent Pediatrics publication by Chaudhary et al. Servo-­controlled active cooling during transport of full-­term infants with HIE improved their temperature stability and reduced their transfer time in comparison to passive cooling, researchers said. All babies cooled using the active approach were within the target temperature range when they arrived at the regional unit for treatment, versus 39% of the passively controlled infants.

Read the article »

Noninvasive Ventilation - Is NIPPV better?


In a study by Kirpalani et al, of more than 1,000 premature infants to reduce the risk of BPD, outcomes (death or BPD) and complication rates were not significantly different between those who received nasal continuous positive airway pressure (CPAP) and those who received nasal intermittent positive-pressure ventilation (NIPPV). Both methods yielded nearly the same rates of conversion to intubation and mechanical ventilation, researchers wrote in the New England Journal of Medicine.

Full article »

Pediatric and Neonatal Interfaciltity Transport: 

Report from a National Consensus Conference


The practice of pediatric/neonatal interfacility transport continues to expand.Transport teams have evolved into mobile ICUs capable of delivering state-of-the-art critical care during pediatric and neonatal transport. The following article details changes in the practice of interfacility transport over the past decade and expresses the consensus views of leaders in the field of transport medicine, including the American Academy of Pediatrics’ Section on Transport Medicine.

Read the study »

PDA and Enteral Feeding


A recent study in the Journal of Pediatrics by Clyman et al tested the hypothesis that infants who are just being introduced to enteral feedings will advance to full enteral nutrition at a faster rate if they receive “trophic” (15 mL/kg/d) enteral feedings while receiving indomethacin or ibuprofen treatment for patent ductus arteriosus.  They found infants required less time to reach the feeding volume end point if they were given “trophic” enteral feedings when they received indomethacin or ibuprofen treatments.

Read the article »

A Randomized, Masked, Placebo-Controlled Study of Darbepoetin Alfa in Preterm Infants

Dr. Ohls

A recent study in Pediatrics by Ohls et al, evaluated a novel erythropoiesis stimulating agent (ESA), darbepoetin alfa, in preterm infants to determine if transfusion needs were decreased compared to placebo, with less frequent dosing than erythropoietin. 

Review by Dr. Ohls »
Read the article »

Global Health for the Neonatal Intensivist


Plastic Bags at Resuscitation - Low Cost Yet Effective

Hypothermia contributes to neonatal mortality and morbidity, especially in preterm and low birth weight infants in developing countries. Plastic bags covering the trunk and extremities of very low birth weight infants reduces hypothermia. This study found placement of preterm/low birth weight infants inside a plastic bag at birth compared with standard thermoregulation care reduced hypothermia without resulting in hyperthermia, and is a low cost, low-technology tool for resource-limited settings.

Read the Pediatrics article »

Oxygen Saturation Ranges for Preemies
Still Controversial


Two recent large international randomized controlled trials published in JAMA and NEJM to determine the safest oxygen saturations for pre term infants have come to different conclusions. The BOOST II trial found that “Targeting an oxygen saturation below 90% with the use of current oximeters in extremely pre term infants was associated with an increased risk of death.” In contrast, the Canadian Oxygen Trial found “In extremely pre term infants, targeting oxygen saturations of 85% to 89% compared with 91% to 95% had no significant effect on the rate of death or disability at 18 months.”

Read the BOOST II publication »
NEJM editorial »
Read the COT publication »
JAMA editorial »

NEW! Mock Malpractice Trial at NCE


This Mock Malpractice Trial will take place on Sunday, October 27 from 1:30pm - 4:30pm.  The case will deal with resuscitation in the delivery room.  The audience will be the jury and will render a verdict at the end of the trial. The participant will be updated in newborn resuscitation and will learn techniques in answering questions posed by both plaintiff and defense attorneys.

More information »

New Guidelines for Calcium and
Vitamin D Supplementation for Premature Infants From AAP


A recent AAP clinical report provides neonatologists with new recommendations for nutritional supplementation of premature infants.  The report includes information on in hospital assessment and management of these infants.

Read the clinical report »

Safety and Efficacy of Early Parenteral Lipid and High-Dose Amino Acid Administration to Very Low Birth Weight Infants


As neonatologists, we are concerned about providing optimal nutrition after birth for our tiniest babies.  A recent study published in the Journal of Pediatrics from the Netherlands found “In VLBW infants, the administration of parenteral AA combined with lipids from birth onwards improved conditions for anabolism and growth, as shown by improved nitrogen balance. Greater levels of AA administration did not further improve the nitrogen balance but led to increased AA oxidation. Early lipid initiation and high-dose AA were well tolerated.”

Read the article »
Read the editorial »

Guidance on Management of Asymptomatic Neonates
Born to Women With Active Genital Herpes Lesions


Herpes simplex virus (HSV) infection of the neonate is uncommon, but genital herpes infections in adults are very common. Thus, although treating an infant with neonatal herpes is a relatively rare occurrence, managing infants potentially exposed to HSV at the time of delivery occurs more frequently. The risk of transmitting HSV to an infant during delivery is determined in part by the mother’s previous immunity to HSV. The algorithm does not address the approach to asymptomatic neonates delivered to women with a history of genital herpes but no active lesions at delivery.

Read the full Clinical Report here »

New Policy Statement on the Screening Examination of Premature Infants for Retinopathy of Prematurity

This statement revises a previous statement on screening of pre term infants for retinopathy of prematurity (ROP) that was published in 2006. ROP is a pathologic process that occurs only in immature retinal tissue and can progress to a tractional retinal detachment, which can result in functional or complete blindness. This statement presents the attributes on which an effective program for detecting and treating ROP could be based, including the timing of initial examination and subsequent reexamination intervals.

Read the Full Policy Here »

Global Health for the Neonatologist

Featured Speaker at Scottsdale Spring Meeting


Dr Waldemar Carlo will be speaking at the L. Joseph Butterfield Lecture on “How to Save One Million Perinatal Lives Per Year: Helping Babies Breathe and Essential Newborn Care Training Programs."

International Membership in the Section on Perinatal Pediatrics


In the spring of 2012, the Section membership voted to extend membership to physicians involved in perinatal and neonatal care around the globe. This is an important step forward in the Section, and we hope you will consider joining us or letting your international colleagues know about this opportunity.

Read the membership flyer for more information »

ABP MOC Part IV Module Available


The Perinatal Section has developed a Performance Improvement Module to fulfill Part 4 of Maintenance of Certification.  This PIM was developed by SoPPe members Patrick Carroll, Richard Powers, William Carey, and Munish Gupta in partnership with the ABP. This is the first PIM produced by the AAP that is focused specifically on neonatal care. This module, available at no cost to Section members, is related to admission temperature of the ELBW to the NBICU.  More modules are in development and will be available soon.

The PIM can be found at the ABP site by searching Part 4 activities for "Preterm Admission Temperature."

ABP website (PIM access requires individual ABP login) »

Perinatal Pediatrics Spring Workshop

The Leadership Course for Everyone – Scottsdale 2013


The Spring Workshop is the conference specifically designed to facilitate leadership amongst all of our members.  Utilizing plenary sessions, workshops, and unstructured time in the Arizona sunshine, neonatologists at any stage of training and at any level of interest will find opportunities to become better leaders and better physicians.
Throughout the workshop, the thread of “leadership – by everyone, everywhere, all the time” will be evident.  Even if you only see yourself as a leader in the most limited sense, we think you will find plenty here to help you become a better clinician and professional.

Spring Workshop brochure »

New COFN Statement on Levels of Care

                     

Provision of risk-appropriate care for newborn infants and mothers was first proposed in 1976. This updated policy statement provides a review of data supporting evidence for a tiered provision of care and reaffirms the need for uniform, nationally applicable definitions and consistent standards of service for public health to improve neonatal outcomes. Facilities that provide hospital care for newborn infants should be classified on the basis of functional capabilities, and these facilities should be organized within a regionalized system of perinatal care.

Read the Policy Statement here »

Outcomes at 7 years for babies who developed neonatal necrotising enterocolitis: the ORACLE Children Study


A recent article in Arch Dis Fetal Neonatal Ed demonstrates continued significant long-term consequences of both gut function and neurodevelopmental outcomes after NEC.

Read the article here »

Raising Awareness: Late Preterm Birth and Non-Medically
Indicated Inductions Prior to 39 Weeks


The National Child and Maternal Health Program offers an online educational module, Raising Awareness: Late Preterm Birth and Non-Medically Indicated Inductions Prior to 39 Weeks, that addresses the science behind medical recommendations to schedule elective deliveries on or after 39 weeks’ gestation.

More information »

 

Global Health for the Neonatologist


Many neonatologists and trainees have indicated an interest in actively participating in Global Health Initiatives. This is also a strategic aim of the Perinatal Section. For the next few months, we will feature different organizations and possibilities that are of interest for neonatologists.

To start, here is a link to the AAP Section on International Child Health (SOICH) with a listing of available projects.

SOICH website »

Helping Babies Breathe

Dr. Gina M. Trachimowicz, TECaN Treasurer/Secretary, recently interviewed Dr. Kamath-Rayne, a reviewer for the HBB curriculum, and a Master Trainer, who is collaborating on several studies of HBB around the world. Following is an interview about her involvement with HBB.

Interview »

Newborn Male Circumcision

The American Academy of Pediatrics  published an updated policy statement and technical report on newborn male circumcision. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure's benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV.

Read the Policy Statement »
Technical Report »

Raising Awareness: Late Preterm Birth and Non-Medically
Indicated Inductions Prior to 39 Weeks


The National Child and Maternal Health Program offers an online educational module, Raising Awareness: Late Preterm Birth and Non-Medically Indicated Inductions Prior to 39 Weeks, that addresses the science behind medical recommendations to schedule elective deliveries on or after 39 weeks’ gestation.

More information »

Pediatric Minimally Invasive Surgery


This article discusses the potential benefits and challenges of minimally invasive surgery for infants and small children, and discusses why pediatric minimally invasive surgery is not yet the surgical default or standard of care. Minimally invasive methods offer advantages such as smaller incisions, decreased risk of infection, greater surgical precision, decreased cost of care, reduced length of stay, and better clinical information. But none of these benefits comes without cost, and these costs, both monetary and risk-based, rise disproportionately with the declining size of the patient.

Read the article here »

Neurodevelopmental Outcomes in Children with Congenital Heart Disease:  Evaluation and Management


A recent Scientific Statement in Circulation from the American Heart Association (and approved by the AAP) reviews the available literature on surveillance, screening, evaluation, and management strategies and puts forward a scientific statement that comprehensively reviews the literature and creates recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease (CHD) population.

Read the Statement »

Committee on Fetus & Newborn


The American Academy of Pediatrics is oneof the most powerful medical and political forces advocating for children in the United States. One of the ways we do this is through policy statements concerning the care of children, statements that often directly impact our practices. A Policy Statement, a statement of advocacy, direction, or a public health position, drives the Academy’s activities and represents our stance on particular issues, expresses a definite course of action, and should contain recommendations. A Technical Report is based on literature review and data analysis but does not include recommendations. A Clinical Report offers guidance for the pediatrician in the clinical setting, addressing best practices and state of the art medicine, and does not include recommendations. The Committee on the Fetus and Newborn (COFN) studies issues and current advances in fetal and neonatal care and then makes recommendations regarding neonatal practice, especially those related to the medical management and care of the newborn infant.

COFN collection of policy statements »

Maintenance of Certification

Are you wondering how to get those Part 2 points for Maintenance of Certification? The American Board of Pediatrics has seminal articles (6 each year) listed under Part 2. All you need to do is read the articles and then answer questions from the ABP website. Better yet, read them with your group as a Journal Club and discuss the articles-then answer the questions! 10 points are awarded for each year!

Articles for 2010 (available for MOC until December 31, 2012), 2011 and 2012 »

New AAP Statement on Neonatal Drug Withdrawal


From the Lead Author, Dr. Mark Hudak: The past decade has witnessed an alarming increase in the number of newborn infants who suffer through withdrawal from a variety of opioid drugs (narcotics). Prenatal exposure to these drugs may occur in the setting of maternal abuse of illicit substances (e.g., heroin) or in situations where the mother is receiving suprvised treatment for addiction with drugs such as methadone or buprenorphine. But more and more frequently, infants are being affected by exposure in the womb to prescription painkillers. In many cases, these powerful drugs are being ordered by phsyciains to treat pain associated with a chronic maternal condition, but sometimes mothers obtain these drugs surreptitiously.

The revised AAP clinical report "Neonatal Drug Withdrawal," appearing in the February 2012 Pediatrics, outlines steps that clnicians and hospitals can take to identify and monitor infants exposed to opioids and other drugs of addiction. The report also updates information from the medical literature about current treatment options for neonatal opioid withdrawal and highlights the need for further research to develop treatments that are safer and more effective and that will result in shorter treatment time and hospital stay. Reducing the number of cases of neonatal opioid withdrawal will require a partnership of the medical community with government and other health organizations to educate women and providers about this problem, to identify alternative pain management options during pregnancy, and to eliminate non-prescribed access to powerful painkillers. The AAP also expanded the report to address the management of infants and children who acquire a dependency on opioids and/or benzodiazepines in the course of hospital treatment (e.g., extended extracorporeal life support) for an acute critical illness

Neonatal Drug Withdrawal Clinical Report »

Follow-up Care of the Premature Infant Toolkit


This multidisciplinary, electronic, interactive toolkit with a web-based interface was developed with the support of MedImmune to help improve the care and outcome of premature infants. Ronald L. Ariagno, MD, FAAP (pictured) and John J. LaBella, MD, FAAP served as co-chairs. It is intended for the pediatrician and other healthcare providers to assist in the transition of the premature infant from hospital to outpatient care, to facilitate accurate transfer of pertinent patient information and to help provide evidence-based practical measures for consideration in the care of the premature infant from birth to 12 months corrected age. There are 6 sections: Introduction, Discharge Planning, Outpatient Follow-up Care, Parent/Caregiver, Tools, and References.

Access it here »

Therapy for Neonatal Sepsis with IVIG
Shown Not to Be Effective


This study, published in the New England of Medicine, at 113 hospitals in 9 countries, enrolled 3,493 infants receiving antibiotics for suspected or proven serious infection. They were randomly assigned to receive 2 infusions of either polyvalent IgG immune globulin or matching placebo 48 hours apart. The primary outcome was death or major disability at the age of 2 years.

RESULTS: there was no significant between-group difference in the rates of the primary outcome and no significant differences in the rates of secondary outcomes.

Read the entire article here »

Early Onset Neonatal Sepsis: The Burden of Group B
Streptococcal and E. coli Disease Continues


A recent publication from the NICHD Neonatal Research Network investigated early onset sepsis in neonatal ICU patients. The study concluded:

  • In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease. GBS remains the most frequent pathogen in term infants, and E coli the most significant pathogen in preterm infants. Missed opportunities for GBS prevention continue. Prevention of E coli sepsis, especially among preterm infants, remains a challenge.

Read the full report here »

Standard Terminology for Fetal, Infant, and Perinatal Deaths


Deaths occurring to fetuses in utero and infants shortly after birth are important events. Although we as neonatal care providers work diligently to prevent and intervene in adverse perinatal events, we often fail to diligently report them or report them well. Understanding the causes of these events, how these events may affect certain populations, and their potential risk factors begins with accurately defining cases. What we report in our delivery rooms and hospitals provide the basis of information for local quality improvement activities, city, county, regional, and state perinatal mortality reviews, and national statistics. Therefore reliable and accurate information is critical to understanding the causes and informing the solutions for fetal, infant, and perinatal deaths.

Read the Clinical Report from the Committee on Fetus & Newborns »

Forrest Bird, Inventor of Baby Bird
Ventilator & 2010 Pioneer Award Winner


Dr Forrest Bird turned 90 years old this year and celebrated his birthday with a large bash inviting the entire community of Sandpoint, Idaho, about 50 US and Canadian aviators, members of the military, and enough physicians to staff a medium-sized urban hospital. It was a great day to acknowledge Dr Bird's contribution to the health of children worldwide with the presentation of the Pioneer Award from the Section on Perinatal Pediatrics.

Dr Bird's medical career, inventions and more photos »

August Larry Jung – Neonatology Pioneer,
Innovator, Outdoorsman and Artist


August Larry Jung, MD, a pioneer who trained the first generation of neonatologists, died of heart disease at age 75 on January 3, 2011. In grief, Larry’s 100 year-old mother died 7 days later. Larry opened the first NICU in the Intermountain West on July 1, 1968, after completing a 6 month fellowship at the Colorado Premature Center under the tutelage of the visionary and gifted Dr. Lula O. Lubchenco. He is greatly missed by all who knew him.

Learn more about Dr. Jung’s pioneering work in the early days of Neonatology »

The Management of Hypotension in the
Very Low Birth Weight Infant

Guideline for Practice

Developed by Lyn Vargo, PhD, RN, NNP-BC, and Istvan Seri, MD, PhD, this guideline from the National Association of Neonatal Nurses (NANN) focuses on the challenging topic of clinical management of systemic hypotension in the very-low-birth-weight infant during the first 3 days of postnatal life. Published in 2011 and endorsed by the American Academy of Pediatrics.

Read the full guideline »

Oxygen Saturation Targets for Extremely Premature Infants


A brief report in the New England Journal of Medicine from the BOOST II Trial indicates the study was closed early after a joint safety analysis showed higher survival rates at 36 weeks post menstrual age in infants born less than 28 weeks who were randomly assigned to the oxygen saturation target of 91-95% rather than the 85-89% group.

What do you do in YOUR nursery? Let us know »

Read the brief report »

Robin Sequence: From Diagnosis to Development of an Effective
Management Plan


A recent review article on Robin Sequence in Pediatrics highlights the embryology, diagnosis and management of these patients with complex airway issues. Learn the latest surgical and non-surgical management of these "at-risk" neonatal patients. Outstanding and informative pictures accompany the article.

Read the full article »

NIH Consensus Statement on Inhaled
Nitric Oxide for Premature Infants


A recent NIH Consensus Development Conference Statement published in Pediatrics addresses the use of iNO in premature infants to improve outcomes, including chronic lung disease. Although experimental models have shown encouraging results on the effect of iNO on enhanced lung growth and decreased lung inflammation, the conference found the combined results from 14 randomized controlled trials in infants 34 weeks or less showed equivocal effects on pulmonary outcomes, survival, and neurodevelopmental outcomes.

Read the full statement »

New Guidelines for Screening and Management of Neonatal Hypoglycemia


This month, Pediatrics has published revised guidelines for neonatal hypoglycemia. Written by the Committee on the Fetus and Newborn, the committee notes: "it is a pragmatic approach to a controversial issue for which evidence is lacking but guidance is needed." This clinical report provides a practical guide for the screening and subsequent management of neonatal hypoglycemia (NH) in at-risk preterm (34-36 6/7 weeks' gestational age) and term infants.

Read the full report »

Bevacizumab: Effective Therapy for Zone 1, Stage 3+ Retinopathy of Prematurity (ROP)


In a landmark study of 150 infants with stage 3+ ROP published in the February 17th New England Journal of Medicine, intravitreal treatment with bevacizumab (Avastin) was shown to be superior to laser treatment among infants with zone 1, but not zone 2, disease. An additional benefit of this therapy is, unlike laser treatment, it was associated with preservation of growth of retinal vessels after treatment.

Learn more »

2011 Perinatal Pediatrics Spring Workshop
Networking Opportunities


The 2011 Spring Workshop promises to be a refreshing opportunity to learn more about the practice of neonatology in a relaxing and informative setting. Topics covered include global neonatology, health care reform and what it means for neonatologists, racial disparity and birth outcome, and new information about MOC.

Friday Night Reception - 6:30-7:30pm
Everyone is invited to mingle with colleagues and faculty.
Sponsored by Abbott Nutrition

Work/Life Balance Discussion for Junior Faculty and Fellows
12:45pm on Saturday
Several junior faculty and fellows requested an opportunity to talk to each other about Work/Life Balance issues as they embark on their careers. As a follow-up to the workshop on Work/Life Balance, we have set aside space (and lunch!*) for people to discuss with each other some of their concerns, frustrations and solutions. Please join us for what promises to be an insightful discussion! There is no cost to attend this group. Please let us know if you are interested through FaceBook or LinkedIn.
Sponsored by Mead Johnson Nutrition

View the Spring Workshop 2010 Presentations »

Workshop meeting brochure »

New NRP Recommendations


The American Heart Association and the International Consensus on Cardiopulmonary Resuscitation recently published new neonatal resuscitation guidelines. Included in the new guidelines are recommendations are updated algorithms with emphasis on CPAP and positive pressure ventilation.

Highlights include:

  • Deletion of meconium from initial assessment
  • Changes in recommendation for 100% oxygen
  • Stronger indications of when to intubate
  • Stronger recommendations of two-thumb chest compressions
  • Use of pulse oximetry when using exygen in resuscitation

New NRP guidelines »

2010 NCE SoPPe Meeting Highlights


The section's educational meeting in San Francisco was informative, successful, and fun, starting with the Merenstein lecture given by Michael Harrison, MD of UCSF, on fetal intervention surgery. The Friday night poster session had over 70 posters and was well attended.

Saturday, we held a joint session with the Section on Cardiology and Sunday, focused on the ELBW infant. Jacqueline Noonan, MD, gave an entertaining presentation on the history of pediatric and neonatal cardiology. Another highlight was an outstanding talk by Alan Jobe, MD, on ventilation strategies for the ELBW infant.

NCE 2010 Presentations »

NCE 2010 Photos »

NCE 2010 Abstracts »

The Prevention of Perinatal Group B Strep


Recently released guidelines from the CDC highlight that Group B strep remains the leading cause of early-onset neonatal sepsis in the US.

Key changes in the 2010 guidelines:

  • expanded recommendations on lab methods for the identification of GBS,
  • clarification of the colony-count threshold required for reporting GBS in the urine of pregnant women,
  • updated algorithms for GBS screening and intrapartum chemoprophylaxis for women with preterm labor or preterm premature rupture of membranes,
  • a change in the recommended dose of penicillin-G for chemoprophylaxis,
  • updated prophylaxis regimens for women with penicillin allergy, and
  • a revised algorithm for management of newborns with respect to risk for early-onset GBS disease.

Download the clinical guidelines »

New ACGME Duty Hour Recommendations


Tom Nasca, MD, recently published the new resident and fellow ACGME Duty Hours Recommendations in the New England Journal of Medicine. "The aim of these standards was to promote high quality learning and safe care in teaching institutions." These new recommendations may have significant implications for your institution, your newborn intensive care unit, or your practice with new hires.

The New Recommendations on Duty Hours from the ACGME Task Force »

NICHD Cochrane Reviews


Did you know that you can access all of the NICHD Cochrane Reviews in one place? You can click on the link to the right under Useful Links or below to access their website.

The Neonatal Cochrane Reviews are systematic reviews of randomized controlled trials of interest to neonatologists. There are several new and updated reviews including studies of banked human milk, oral lactoferrin for the treatment of sepsis, and the timing of surgery for CDH. These reviews make it easier to use evidence-based medicine to guide our clinical practices.

Cochrane Neonatal Reviews »

Latest Outcomes of Extremely Preterm Infants


A recent report presents data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network on care of and morbidity and mortality rates for very low birth weight infants, according to gestational age (GA). The infants were extremely low GA (22–28 weeks) and very low birth weight (401–1500 g) who were born at network centers between January 1, 2003, and December 31, 2007. The authors concluded that “Although the majority of infants with GAs of >24 weeks survive, high rates of morbidity among survivors continue to be observed."

Read the full article here: Pediatrics 2010;126:443–456 »

New Preemie Growth Curves Proposed

Intrauterine growth curves for preterm infants are limited by small, older, homogeneous samples; non-US data; combined genders; a lack of length and head circumference curves; and/or are based on different samples for weight, length and head circumference curves. The new intrauterine growth curves created and validated in a new study (Olsen, et al Pediatrics 2010;125:e214-e244) using a contemporary, large, racially diverse US sample provide clinicians and researchers with an updated tool for growth assessment in US NICUs.

Read the Pediatrics article »

New preemie growth curves »


New ACGME Duty Hour Recommendations


Tom Nasca, MD, recently published the new resident and fellow ACGME Duty Hours Recommendations in the New England Journal of Medicine. "The aim of these standards was to promote high quality learning and safe care in teaching institutions." These new recommendations may have significant implications for your institution, your newborn intensive care unit, or your practice with new hires.

The New Recommendations on Duty Hours from the ACGME Task Force »

SUPPORT Trial Results


Two recent articles published in the New England Journal of Medicine (NEJM) and presented at the PAS meeting report on the results from the NICHD Neonatal Research Network SUPPORT Trial (Surfactant, Positive Pressure, and Oxygenation Randomization Trial). These studies compared

  • intubation and surfactant treatment vs. CPAP initiated in the delivery room and
  • targeted oxygen saturation of 85 to 89% vs. 91 to 95%
    in 1,316 babies born at 24-27 6/7 weeks.

The primary outcomes were death or bronchopulmonary dysplasia, or death or ROP.

For more information about the study results »

To access the full text of the articles, click below to get to the NEJM web site.

Early CPAP versus Surfactant in Extremely Preterm Infants »

Target Ranges of Oxygen Saturation in Extremely Preterm Infants »

Perinatal Section launches strategic plan


The newly developed Section on Perinatal Pediatrics strategic plan emphasizes the Section's commitment to advocacy and value to members.  The plan identifies four new areas of focus for the Section in the next five years and proposes some initial steps.  The strategic domains and first steps include:

Education:

  • Creation of the new Web site
  • Reconfiguration of Section educational venues to incorporate cutting-edge technologies and integrate adult learning theory

Global Health:

  • Broaden global outreach of the Section to partner with other organizations to improve perinatal health worldwide
  • Provide mechanisms to link members interested in global health with opportunities
  • Educational Modules for Residents and Fellows on Global and Community Health

Leadership:

  • Identify new leaders in Neonatal-Perinatal Medicine and foster leadership development among trainees and young neonatologists
  • Offer programs aimed at strengthening the skills of existing leaders

Quality: 

  • Collaborate with quality-oriented organizations to explore the possibility of creating a Council on Perinatal Quality
  • Develop and make widely available tools and teaching modules on quality

Learn more about the Section Strategic Plan »
Read the Strategic Plan Progress Report, October 2008 »
Read the results of the Member Survey »

Important Resuscitation Coding Corrections

An error in CPT 2009 regarding 99465, a code for attendance at delivery, is causing denial of your codes for attendance at delivery with resuscitation.

What should you do? »

March of Dimes' Symposium on Quality Improvement
to Prevent Prematurity


In October, 2009, this Symposium brought together a multidisciplinary group to discuss quality improvement as an essential component in the strategy to prevent prematurity, promote health, and save costs.The Symposium explored the state of quality initiatives to prevent preterm birth and developed an action agenda to decrease the rate of preterm births that are not inevitable or medically necessary.

Slides and audio of the Symposium provided by the Clinical Directors Network »

Exploring & Evaluating Practices in Neonatal-Perinatal Medicine

New from the Committee on Practice

Making the transition from residency and fellowship training into practice is difficult and challenging, whether the move is to the familiar realm of academia or to a world of private practice, professional corporate, or hospital-employed neonatology. The Perinatal Section's Committee on Practice has developed these materials to assist fellows in their career planning, and interviewing with, and evaluation of, practices.

Pediatricians considering the role of neonatology in their community setting may also find these discussions enlightening as they negotiate a mutually-supportive relationship. Neonatal divisions and practice groups evaluating the scope of their practices and the duties assumed by practice associates will likewise find these materials helpful, especially if expanding their scope of practice responsibilities, enlarging their patient base, or adding/replacing an associate.

Outline of Exploring & Evaluating Practices in Neonatal-Perinatal Medicine »

Neonatal Scale Predicts Developmental Problems Later in Childhood

A neonatal scale was better at predicting developmental problems in children up to preschool age than gestational age and socioeconomic status, according to a study in Pediatrics. The Neonatal Intensive Care Unit Network Neurobehavioral Scale includes measures of ability to follow animate and inanimate auditory and visual stimuli, hypertonic responses, lethargy, and arousal and stress levels.

Medscape - Free Registration »

State of the Art in Conventional Mechanical Ventilation

Despite a shift to noninvasive respiratory support, mechanical ventilation remains an essential tool in the care of critically ill neonates. This review examines the special challenges of ventilating the extremely low birth weight infants that now constitute an increasing proportion of ventilated infants, attempts to provide a simple functional classification of ventilator modes and addresses the key aspects of synchronized ventilation modes.

Review by Martin Keszler, MD »

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Several studies have shown that use of premedications for elective neonatal intubation is effective and safe, provides adequate pain control, and also reduces the time and number of attempts taken to intubate. Use of premedications also minimizes cardiorespiratory and hormonal changes associated with awake intubation. Despite this evidence in support of pain control in neonates, several studies continue to report that awareness, assessment, and management of procedural pain in newborns is still inadequate, and considerable variations occur from nursery to nursery and provider to provider in the management of pain associated with intubation in the newborn.

Article by Kumar Praveen, MD »

Full text of the Clinical Report »

National Association of Neonatal Nurses Issues Statement on Human Milk and Breastfeeding

Mother's milk and breastfeeding are important aspects of optimal care of newborns, especially those who are born preterm or with other serious conditions. The unique nutritional and immunological benefits of human milk make it an integral component of care of infants in the newborn intensive care unit. NANN has issued a statement strongly supporting human milk and breastfeeding.

View the NANN statement»

New AAP Immunization Web Site

The AAP is pleased to announce the creation of a new, comprehensive online resource for pediatricians and families that addresses the topic of immunizations. This new site replaces the Childhood Immunization Support Program Web site and contains information about vaccine-preventable diseases, vaccine safety information, and tools and resources to help pediatricians effectively and efficiently administer immunizations in their offices.

Access through the AAP Web site »

Breastfeeding Residency Curriculum Online Resource Available

A free online resource, developed by the American Academy of Pediatrics, helps residents develop confidence and skills in breastfeeding care and includes: presentations on breastfeeding management, clinical cases and evaluation
and tracking tools.

Breastfeeding Residency Curriculum for residents and program directors »

PDAs in Infants: To Close or Not to Close?

In preterm neonates with a patient ductus arteriosus (PDA), the standard of care has been to attempt to close the defect. Yet some experts have asked whether we need to treat PDA in most preemies. If we are to resolve the condition, there are various methods and protocols for treatment and even prevention; how do outcomes for PDA closure vary by treament strategy? Dr. Darshak Sanghavi, chief of pediatric cardiology and assistant professor of pediatrics at the University of Massachusetts Medical School, lays out the important points of discussion on PDA closure with host, Dr. Jennifer Shu.

Listen to podcast »

Surgeon General's Conference Outlines Agenda
to Prevent Preterm Birth

Experts convened by the National Institutes of Health for the Office of the Surgeon General met in June and released an agenda for activities in the public and private sectors to reduce the nation's rate of preterm birth. The agenda calls for a national system to better understand the occurence of preterm birth and a national education program to help women reduce their chances of giving birth prematurely. The agenda also calls for improved methods for estimating the age of the fetus, and studies to identify biomarkers which would signal the beginning of preterm labor.

Learn more »

AAP Section on Breastfeeding Develops Hospital Template to Enhance Breastfeeding Success


Maternity hospital practices such as free formula, pacifiers, and poor breastfeeding counseling may undermine successful breastfeeding. The AAP Section on Breastfeeding has developed a template to help hospitals develop and implement practices designed to optimize breastfeeding success.

Learn more »

NICHD Workshops Address Two Important Neonatal Issues: Hypoglycemia & Hospital-Acquired Infection

NICHD Neonatal Hypoglycemia Workshop

Recognizing the common occurrence of neonatal hypoglycemia and the potential for insufficient glucose supply to injure the developing brain, as well as a need to support research to fill the missing gaps in knowledge about neonatal hypoglycemia and its clinical implications, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) convened a workshop, held September 8-9, 2008. A diverse group of experts participated.

NICHD Neonatal Hospital-Acquired Infection Workshop

Hospital-acquired or nosocomial infection occurs at high rates in the Newborn Intensive Care Unit (NICU) and often leads to significant morbidity and mortality. Up to 50% of extremely low birth weight infants develop infection in the NICU. This conference, held August 7-8, 2008, reviewed the existing information with respect to antenatal, perinatal and neonatal management including short term and long term morbidity and mortality for infants with hospital acquired infections. Approximately 20 invited investigators, including international experts, assisted in exploring this important agenda.

Learn more about these NICHD workshops »
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