Tip 21a: maternal diabetes

~5% of all pregnancies involve women with diabetes.

Nearly 90% of these are due to gestational diabetes.

Reference: National Institute for Health and Care Excellence (2015).  Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NG3. London: NICE.

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Tip 20: ADEPT

ADEPT is the Abnormal Doppler Enteral Prescription Trial (2012, 404 babies). The main finding was that there was no benefit to delayed initiation of feeds (5 – 6 days of age) vs. early initiation of feeds (24 – 48h age) in preterm babies <32/40 or <1500g.

References:

Leaf, A. et. al. 2012. Early or delayed enteral feeding for preterm growth-restricted infants: a randomized trial. Pediatrics; 129(5): :e1260-8. 

Morgan, J., Young, L., McGuire, W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birthweight infants. Cochrane Database Syst Rev. 2014;(12):CD001970.

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Tip 19b: congenital rubella syndrome

In the presence of maternal infection, transmission is ~50% in the first month of pregnancy, reducing to 10% in the third month of pregnancy.

Reference: Rennie & Roberton’s Textbook of Neonatology, 5th Ed, 2005. London: Churchill.

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Tip 19a: congenital rubella syndrome

The classical trial of congenital rubella syndrome consists of: cataracts, deafness and congenital heart defects (especially pulmonary stenosis).

Other features include: microcephaly, developmental delay, jaundice, thrombocytopenia and osteitis.

Reference: Rennie & Roberton’s Textbook of Neonatology, 5th Ed, 2005. London: Churchill.

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Tip 18: blood pressure

As a rough guide, the 5th centile mean arterial blood pressure (mmHg) of a preterm infant is equal to the gestational age in weeks.

The 50th centile is +10mmHg. The 95th centile is another +10mmHg.

Reference: Rennie & Roberton’s Textbook of Neonatology, 5th Ed, 2005. London: Churchill.

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Tip 17b: antenatal steroids

Treatment with antenatal corticosteroids in preterm babies is associated with an overall reduction in:

  • perinatal death (RR 0.72, 95% CI 0.58 to 0.89)
  • neonatal death (RR 0.69, 95% CI 0.59 to 0.81)
  • RDS (RR 0.66, 95% CI 0.56 to 0.77)
  • intraventricular haemorrhage (RR 0.55, 95% CI 0.40 – 0.76)
  • NEC (RR 0.50, 95% CI 0.32 – 0.78)
  • systemic infections in the first 48 hours of life (RR 0.60, 95% CI 0.41 – 0.88).

There was no obvious difference in chronic lung disease, death in childhood or neurodevelopment delay.

The studies included in this Cochrane review cover a wide range of gestational ages from 24+0 to 36+6. Some sub-group analysis shows a greater benefit for <35+0, and limited or no effect for >34+0.

References:

Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD004454.

National Institute for Health and Care Excellence (2015). Preterm labour and birth. NICE guideline NG25. London: NICE.

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August Changeover

Thinking of you all today as you either start a new job or work hard to care for your patients while the newbies have induction.

Please email me any feedback and tell incomers to neonatal medicine about Neonatal Tips!

All the best,

Hazel 🙂

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