#157 - Journal Club - π Feeding protocol, treatment of pneumonia, transcatheter closure of the PDA and more
Oct 29, 2023
01:20:17
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Daphna, an expert in neonatal literature, joins Dr. Ben Korsha in this episode of Journal Club. They discuss topics such as feeding protocols in premature infants, treatment of pneumonia in the NICU, transcatheter closure of the PDA, and challenges faced by academic neonatologists. They also touch on probiotic products, clinical findings in pneumonia and sepsis, and high expectations in neonatal units.
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Quick takeaways
Percutaneous closure of patent ductus arteriosus (PDA) in infants less than two kilograms is safe and effective, with a high success rate and effective closure documented up to three years.
There is a shift towards transcatheter closure of PDA in premature infants, with a decrease in surgical closure and an increase in transcatheter closure.
Academic neonatologists face challenges such as increasing workload, administrative burdens, and financial inequities, highlighting the need for adequate compensation and support.
Deep dives
Percutaneous closure of patent ductus arteriosus in infants less than two kilos
This study assesses the safety and feasibility of percutaneous closure of the patent ductus arteriosus (PDA) in infants less than two kilograms. The study finds that percutaneous PDA closure is safe and effective, with a high procedural success rate and effective closure documented up to three years. The study highlights the shift towards transcatheter closure and the potential benefits of earlier intervention. Further research is needed to determine the impact on long-term outcomes.
Trends in procedural closure of patent ductus arteriosus in infants born at 22-30 weeks gestation
This study examines trends in procedural closure of patent ductus arteriosus (PDA) in premature infants. The study finds a decrease in surgical closure and an increase in transcatheter closure of PDA. The use of pharmacologic treatment for PDA also decreased over time. The study highlights the need for further research to assess the impact of these practice changes on clinical outcomes in preterm infants.
Academic neonatologists at the brink of extinction?
This paper discusses the challenges faced by academic neonatologists, including increasing workload, administrative burdens, and financial inequities. It highlights the need for adequate compensation and support for clinical, research, and teaching activities. The paper calls for further research and evaluation to address these issues and improve the work environment for academic neonatologists.
Percutaneous PDA closure in infants under 2 kilos is safe and successful
Percutaneous closure of patent ductus arteriosus (PDA) in infants weighing less than 2 kilos is found to be highly successful, with a device successfully implanted in 97.6% of cases. The procedure carries a low risk of major adverse events, occurring in 3.8% of cases, and the composite outcome of technical failure or major adverse event occurs in only 5.3% of patients. The study confirms that percutaneous PDA closure is a feasible and safe option for infants in this weight range, even for those weighing as little as 700 grams.
Impact of case volume and procedural factors on outcomes
The study highlights the importance of case volume and procedural factors in determining outcomes. Hospitals with higher annual case volumes demonstrate lower incidence of the composite outcome and major adverse events. Procedural success depends on various factors, such as route of access (venous access being preferred), shorter procedural duration, and certain device characteristics. The findings emphasize the need for collaboration between neonatologists, hemodynamics specialists, and interventional cardiologists to ensure ongoing quality improvement and to establish regional high-volume centers of excellence for improved outcomes.
Journal Club is back! Daphna and I reviewed some of the latest papers published in the neonatal literature. This week, we talk about feeding protocols, treatment of pneumonia, transcatheter PDA closure, and much more.
As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.
Enjoy!
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