Neonatology
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Review Meta Analysis
Optimal oxygenation of extremely low birth weight infants: a meta-analysis and systematic review of the oxygen saturation target studies.
The optimal oxygen saturation for extremely low birth weight infants in the postnatal period beyond the delivery room is not known. ⋯ RRs for mortality and necrotizing enterocolitis are significantly increased and severe retinopathy of prematurity significantly reduced in low compared to high oxygen saturation target infants. There are no differences regarding physiologic bronchopulmonary dysplasia, brain injury or patent ductus arteriosus between the groups. Based on these results, it is suggested that functional SpO2 should be targeted at 90-95% in infants with gestational age <28 weeks until 36 weeks' postmenstrual age. However, there are still several unanswered questions in this field.
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Review Meta Analysis
Surfactant lavage therapy for meconium aspiration syndrome: a systematic review and meta-analysis.
Lung lavage with diluted surfactant has emerged as an innovative treatment for meconium aspiration syndrome (MAS). However, the treatment effect has not yet been fully established. ⋯ Lung lavage with diluted surfactant appeared to improve the clinical outcome in infants with MAS. Given that less than 100 infants were included in the two RCTs, the findings of this study may still be regarded as insufficient evidence. Further research will be needed to confirm the benefit as well as to refine the lavage technique.
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Review Meta Analysis
In search of the optimal oxygen saturation for extremely low birth weight infants: a systematic review and meta-analysis.
The optimal arterial oxygen saturation in the first weeks of life is unknown for immature newborn infants. ⋯ A low oxygen saturation approach reduces severe retinopathy of prematurity by 50%, i.e., from 20.9 to 9.5%, and bronchopulmonary dysplasia/lung problems by 25%, i.e., from 40.8 to 29.7%. Further randomized trials are needed to provide definite conclusions and to assess whether reducing oxygen saturation has an impact on mortality among very and extremely low birth weight infants.
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Review Meta Analysis Comparative Study
Volume-targeted versus pressure-limited ventilation for preterm infants: a systematic review and meta-analysis.
The causes of bronchopulmonary dysplasia (BPD) are multifactorial. Overdistension of the lung (volutrauma) is considered an important contribution. As an alternative to traditional pressure-limited ventilation (PLV), modern neonatal ventilators offer modes which can target a set tidal volume. ⋯ Compared with PLV, infants ventilated using volume-targeted ventilation had reduced death/BPD, duration of ventilation, pneumothoraces, hypocarbia and periventricular leukomalacia/severe intraventricular hemorrhage. Further studies are needed to assess neurodevelopmental outcomes.
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Review Meta Analysis
Probiotics reduce the risk of necrotizing enterocolitis in preterm infants: a meta-analysis.
Necrotizing enterocolitis (NEC) is the most common serious acquired disease of the gastrointestinal tract in preterm infants. Probiotic bacteria are live microbial supplements that colonize the gastrointestinal tract and potentially provide benefit to the host. ⋯ Enteral supplementation of probiotics reduces the risk of severe NEC and mortality in preterm infants. A large randomized controlled trial is required to investigate the benefit and safety profile of probiotics supplementation in ELBW infants.