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NIHR Signal C-reactive protein is not useful in diagnosing late-onset infection in newborns
The blood level of C-reactive protein (CRP), a marker indicating inflammation in the body, is not accurate enough alone to diagnose late-onset infection in newborn infants. Late-onset neonatal infection, occurring more than three days after birth, is potentially serious and is relatively common. Tests measuring the blood level of CRP are widely used by physicians to guide their decision on whether or not to start antibiotic treatment for suspected infection. This NIHR-funded review found 20 st...
NIHR Signal Brain scan may predict long-term disabilities in babies with brain injury
Magnetic resonance spectroscopy, a type of scan which shows brain biochemistry, could help predict whether there will be long-term effects of brain injury (encephalopathy) in new-born babies. It is usually done alongside an MRI. Researchers scanned 82 babies being treated for brain injury, using MRI and also magnetic resonance spectroscopy. One biomarker tested at seven days after birth, thalamic N-acetylaspartate, correctly identified all babies who went on to have adverse developmental outcom...
NIHR Signal Reconfiguring neonatal services balances survival chances against increased travel for families
Centralising services so that all babies are delivered in high-volume neonatal units could more than halvethe number of units from 161 to 72, meaning that more parents would need to travel above 30 minutes. However, ensuring that all very preterm and low birthweight babies are cared for in high-volume neonatal intensive care units would reduce mortality. NHS reconfiguration plans for neonatal services include closing smaller neonatal units to concentrate care where there are resources and speci...
NIHR Signal Premature babies have fewer complications if a lower platelet count is accepted
Fewer premature babies die or have major bleeding if platelet transfusions are withheld until platelet numbers drop to a lower level. At 28 days, death or new major bleeding occurred in 19% of neonates transfused when they had less than 25,000/mm3 platelets compared to 26% of neonates transfused when they had less than 50,000/mm3 platelets. This trial included 660 premature babies with low platelet counts. The results suggest that in the absence of actual bleeding, platelet transfusions may be...
NIHR Signal No benefit from monitoring antiepileptic drug levels in pregnancy
Regular monitoring of antiepileptic drug levels in pregnant women with epilepsy does not improve seizure control compared with clinical features-based monitoring. This NIHR-funded study was conducted across 50 UK hospitals and is the largest randomised trial in pregnant women with epilepsy. Just over 260 pregnant women with unstable antiepileptic drug levels were assigned to ongoing monthly blood checks or clinical features monitoring. There were no differences in seizures or other pregnancy ou...
NIHR Signal Testing oxygen levels of newborn babies helps find serious heart defects
Measuring oxygen levels in newborn babies as part of routine care can identify cases of critical congenital heart defects sooner than waiting until symptoms appear. If 10,000 babies were screened, pulse oximetry could correctly identify about 5 of the 6 expected asymptomatic cases and might miss one. This international research suggests there would be about 14 false alarms. Waiting until babies are at least 24 hours old minimises the number of these false positives. Babies with critical heart d...
NIHR Signal Oral ibuprofen may be an option for closing patent ductus arteriosus in premature babies
A high dose of oral ibuprofen was more likely to close a patent ductus arteriosus in premature babies when compared with standard doses of intravenous ibuprofen or indometacin. Before birth, a baby's lungs aren't needed for breathing. Most blood bypasses the lungs through a large vessel called the ductus arteriosus directly from the pulmonary artery into the aorta to supply the main circulation. Once born, blood flows through the lungs, and the ductus arteriosus usually closes in the fi...
NIHR Signal Balance of long-term benefits and risks of caesarean delivery explained
Caesarean delivery has immediate known benefits and risks for those women who need help in childbirth. This review measures the long-term outcomes for the mothers’ health, the links to a higher risk of childhood illness and the chance of problems with future pregnancies. The large review of 80 studies from high-income countries used data from nearly 30 million women and compared caesarean section with vaginal delivery. Caesarean delivery was associated with a lower risk of urinary inconti...
NIHR Signal Plastic wraps or bags keep pre-term infants warm immediately after birth
Cheap and simple plastic wrapping used in the first 10 minutes after birth helps pre-term and low birth weight infants avoid hypothermia. Infants treated in this way are likely to be warmer when admitted to neonatal intensive care than those treated according to standard care. Pre-term infants are most likely to benefit. Routine infant care usually involves ensuring the delivery room is warm, drying the infant immediately after birth, wrapping the infant in pre-warmed dry blankets and pre-warmi...
NIHR Signal Domperidone increases breast milk production in mothers of premature babies
The drug domperidone increases the amount of breast milk women produce. This review looked at its use for up to two weeks in women with premature babies being fed with expressed milk. Women had a moderate increase in breast milk of about 88ml a day, a clinically important increase for these small babies. Domperidone is an anti-sickness medication. It has not been widely used to increase breast milk because of unknown effectiveness and concerns that it can cause an irregular heart rhythm with lo...
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