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NIHR Signal Age of stored blood used for transfusions in critically ill children doesn’t affect outcomes
Using more recently-collected red blood cells for transfusions does not reduce organ dysfunction, infection or risk of death in critically ill children, compared with blood that has been stored for longer. This large, international trial included more than 1,500 children in paediatric intensive care units. The study provides robust evidence to support the continued practice of using the oldest compatible red blood cells within their use-by date. This is done to minimise the amount of donated b...
NIHR Signal Very small babies appear not to be affected by the rate of increasing milk feeds
A large-scale trial has found that the speed of increasing milk feed volumes in low birth weight or very low gestational age babies who are on intravenous feeding does not influence outcomes. This NIHR-funded study randomised preterm (below 32 weeks) or very low birth weight (less than 1,500g) babies to receive either daily milk feed increases in increments of 30ml per kilogram of bodyweight or 18ml per kilogram of bodyweight. After two years of follow up, there was no significant difference in...
NIHR Signal Antimicrobial central venous catheters do not reduce infections in pre-term babies
Central venous catheters (CVCs) impregnated with antimicrobial agents are no better than standard CVCs for avoiding bloodstream infection in pre-term babies. This NIHR-funded trial compared peripherally inserted CVCs that had been impregnated with a combination of the antifungal miconazole and the broad-spectrum antibiotic rifampicin, against standard non-antimicrobial-impregnated CVCs for preterm babies in intensive care. Rates of bloodstream infections were similar in both groups, and no diff...
NIHR Signal Does an antibacterial milk protein reduce infection in premature babies?
Lactoferrin, a protein found in human and cows milk, does not appear to protect premature infants from late-onset infections. When given to babies born before 32 weeks, their risk of acquiring infections, such as sepsis, was virtually the same as those in the control group, about 30%. Late-onset infections, those occurring 72 hours or more after birth, are a significant cause of illness and even death in newborns. Premature babies are particularly vulnerable. This very large UK based NIHR funde...
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...
NIHR Signal Delayed umbilical cord clamping reduces hospital mortality for preterm infants
Delays to clamping the umbilical cord of about a minute can reduce hospital mortality for preterm infants by around 32%. Delayed clamping also reduced the proportion of infants needing a blood transfusion by 10%. This review adds more precise data on survival from new trials including a large Australian trial (over 1,600 babies) to a previous Cochrane 2012 review of trails including 738 infants and provides new more precise data on the survival benefit. These findings are consistent with curre...
NIHR Signal Fewer large babies are born to pregnant woman with type 1 diabetes if their glucose was monitored continuously
Pregnant women with type 1 diabetes who used a continuous glucose monitoring system were half as likely to have a large baby compared with those using standard finger prick blood glucose measurements. Only 15% of infants needed intensive care admissions due to low blood glucose in the continuous glucose monitoring group, compared with 28% born to mothers in the standard finger prick control group. Pregnant women using continuous monitoring spent 7% more time in the target glucose range than tho...
NIHR Signal Blood test could shorten antibiotic treatment in newborns with suspected sepsis
Measuring procalcitonin levels in newborns with suspected sepsis in the first days of life reduced antibiotic duration by 10 hours compared with standard care. There was no increase in the risk of re-infection or death. Systemic infection can be rapidly life-threatening in newborn babies, so those with risk factors are often treated pre-emptively with intravenous antibiotics. If sepsis is not confirmed by blood culture the decision whether to discontinue antibiotics needs to be made, but result...
NIHR Signal Computerised interpretation of fetal heart rate during labour does not improve outcomes
Using a computerised decision-support system to interpret the outputs of continuous electronic fetal monitoring during labour does not show any advantages over clinicians interpreting the outputs themselves. This is the first trial to assess decision support of this kind. In this large NIHR-funded trial, rates of poor neonatal outcomes, caesarean sections and assisted deliveries were not affected by whether clinicians were alerted to potential problems by the decision-support system or by their...
NIHR Signal Induction of labour may be considered in pregnant women with a large baby
Induction of labour does not increase the risk of caesarean delivery in pregnant women with a larger than average baby. This is based on a review of four trials of 1190 women with a suspected large baby who were allocated either to have labour induced from 38 weeks or to watchful waiting. Induction did not increase the risk of most negative outcomes for the baby, such as bleeding in the brain, or mother, such as major tearing. However, these outcomes are rare, so a larger number of women would...
NIHR Signal A dose of corticosteroids benefits most women anticipating a preterm delivery
Giving corticosteroids to most women who are anticipating labour before completing 37 weeks of pregnancy helps reduce immediate health problems in the baby compared with placebo or no intervention. Deaths around the time of birth were reduced by 28% and babies were a third (34%) less likely to develop respiratory distress syndrome. A corticosteroid dose is already used for women who go into labour or if waters break before 37 weeks or where delivery is planned for other reasons. The drug accele...
NIHR Signal Fortified donor breast milk led to similar development for very-low-birthweight babies compared with formula milk
Providing very-low-birthweight babies with fortified human donor breast milk made no difference to their developmental neurological outcomes at 18 months compared with giving formula. This randomised controlled trial looked at 363 babies with birth weights of less than 1500g in neonatal intensive care units in Canada. When the mother’s own milk supply was limited, the babies were given either nutrient-enriched donor breast milk or formula developed for premature babies. There was no diffe...
NIHR Signal Skin-to-skin contact improves breastfeeding of healthy babies
Early skin-to-skin contact improves breastfeeding of healthy full-term babies. Skin-to-skin contact is the direct contact between a naked baby and the mother’s bare chest. It can occur before or after the baby is cleaned following birth. This review found that about a quarter more women who have this contact with their babies are still breastfeeding at one to four months after birth compared with those who don’t. The evidence that skin-to-skin contact may also help to stabilise the ...
NIHR Signal Antenatal corticosteroids reduce breathing problems in late preterm babies
Giving corticosteroids to women at risk of preterm birth at 34 weeks of pregnancy or later reduced the risk of severe breathing problems in the baby after birth from 1.9% to 1.1%. Steroids also reduced the risk for babies born by planned caesarean section after 37 weeks (so not premature). Steroids are known to be beneficial if given to pregnant women at risk of preterm birth before 34 weeks and are already advised for babies born by caesarean section. This meta-analysis of six large trials pro...
NIHR Signal Breastfeeding reduces crying during baby immunisation
Babies who were breastfed before and during routine childhood immunisations cried on average for 38 seconds less and had lower pain scores compared to babies not breastfed. This evidence review used data from 10 trials, with results for 1,066 babies, mostly between one and six months old, following their normal immunisation schedule. Immunisation levels in England are below recommended levels and falling. Pain from injections causes distress to babies and parents, and may put parents off bring...
NIHR Signal Supplementary feeding of preterm babies by cup rather than bottle helps breastfeeding success
For women who chose to breastfeed their preterm baby, supplementary feeds with a cup, compared with a bottle, led to improved breastfeeding rates at discharge and up to six months later. Preterm babies who are transitioning from being tube fed to breastfeeds have traditionally been given bottle feeds (of breast milk or formula) to supplement breastfeeding if the mother is unavailable or if additional feeds are thought necessary. This small Cochrane review found evidence that babies were more l...
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