Patterns of physical and neurologic development in preterm children.

OBJECTIVE: To evaluate the influence of medical complications, gestational age, gender, ethnicity, and socioeconomic status on the changes in anthropometric measures and severity of neurologic impairment from 6 to 54 months of age in premature and term infants. STUDY DESIGN: This study was a prospective longitudinal study to determine predictors of patterns of growth and neurologic outcome in low-risk (n=137) and high-risk (n=96) preterm infants compared to full-term infants (n=136). Growth modeling analyses were used to evaluate factors that might influence patterns of physical growth and changes in neurologic status. RESULTS: Medical risk level was a predictor of height and head circumference at 30 months and neurologic outcome. Gender was a predictor of weight gain. Medical risk level and gender predicted 13.8% and 32% of the variance in head circumference and neurologic scores, respectively. CONCLUSION: Medical complications after birth and gender are stronger influences than gestational age on patterns of growth and neurologic outcome.

Epidemiology and diagnosis of health care-associated infections in the NICU.

Health care-associated infections in the NICU are a major clinical problem resulting in increased morbidity and mortality, prolonged length of hospital stays, and increased medical costs. Neonates are at high risk for health care-associated infections because of impaired host defense mechanisms, limited amounts of protective endogenous flora on skin and mucosal surfaces at time of birth, reduced barrier function of neonatal skin, the use of invasive procedures and devices, and frequent exposure to broad-spectrum antibiotics. This statement will review the epidemiology and diagnosis of health care-associated infections in newborn infants.

Strategies for prevention of health care-associated infections in the NICU.

Health care-associated infections in the NICU result in increased morbidity and mortality, prolonged lengths of stay, and increased medical costs. Neonates are at high risk of acquiring health care-associated infections because of impaired host-defense mechanisms, limited amounts of protective endogenous flora on skin and mucosal surfaces at time of birth, reduced barrier function of their skin, use of invasive procedures and devices, and frequent exposure to broad-spectrum antibiotic agents. This clinical report reviews management and prevention of health care-associated infections in newborn infants.

Premedication for nonemergency endotracheal intubation in the neonate.

Endotracheal intubation is a common procedure in newborn care. The purpose of this clinical report is to review currently available evidence on use of premedication for intubation, identify gaps in knowledge, and provide guidance for making decisions about the use of premedication.

Early surfactant for neonates with mild to moderate respiratory distress syndrome: a multicenter, randomized trial.

OBJECTIVE: We studied the efficacy and safety of electively providing surfactant to preterm infants with mild to moderate respiratory distress syndrome (RDS) not requiring mechanical ventilation. STUDY DESIGN: A 5-center, randomized clinical trial was performed on 132 infants with RDS, birth weight >or=1250 grams, gestational age or=40% for >or=1 hour, and no immediate need for intubation. Infants were randomly assigned to intubation, surfactant (Survanta, Ross Laboratories, Columbus, Ohio) administration, and expedited extubation (n=65) or expectant management (n=67) with subsequent intubation and surfactant treatment as clinically indicated. The primary outcome was duration of mechanical ventilation. RESULTS: Infants in the surfactant group had a median duration of mechanical ventilation of 2.2 hours compared with 0.0 hours for control infants, since only 29 of 67 control infants required mechanical ventilation (P=.001). Surfactant-treated infants were less likely to require subsequent mechanical ventilation for worsening respiratory disease (26% vs 43%, relative risk=0.60; 95% CI, 0.37, 0.99). There were no differences in secondary outcomes (duration of nasal continuous positive airway pressure, oxygen therapy, hospital stay, or adverse outcomes). CONCLUSIONS: Routine elective intubation for administration of surfactant to preterm infants >or=1250 grams with mild to moderate RDS is not recommended.