#150 - Journal Club - 📑 Long term effects of delayed cord clamping, seizure management, hydrocortisone for BPD, and long term outcomes of the OPTIMIST-A trial
Sep 17, 2023
01:30:22
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"The Incubator" podcast, in their latest episode, dives into several fascinating topics. They analyze a paper on delayed cord clamping and its impact on severe IVH and long-term neurodevelopmental outcomes. They also discuss the heterogeneous treatment effects of hydrocortisone for bronchopulmonary dysplasia or death among preterm infants. Additionally, they explore neonatal seizure management, the challenges of diagnosing and managing seizures with EEGs, and the long-term outcomes of the OPTIMIST-A trial. It's a must-listen for anyone in neonatal care!
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Quick takeaways
Delayed cord clamping can impact severe IVH and neurodevelopmental outcomes in neonates.
The use of phenobarbital as a first-line treatment for neonatal seizures has proven to be effective, with rare exceptions for infants with specific channelopathies.
Deep dives
Summary of the Journal Club on Neonatal Seizures and Nutrition
This summary covers two main topics discussed in a journal club. The first topic is neonatal seizures, specifically the special report from the ILAE Task Force on Neonatal Seizures. The report provides guidelines and consensus-based recommendations for the treatment of seizures in neonates, addressing questions such as first-line and second-line anti-seizure medicines. The second topic is neonatal nutrition, focusing on an entire issue of Clinics in Perinatology dedicated to evidence-based recommendations for neonatal nutrition. The issue covers various aspects of neonatal nutrition, including fluid and nutritional management, parental nutrition, human milk fortification, and nutrition for infants with congenital heart disease. Both topics provide valuable insights for neonatologists in managing these common issues.
First-line treatment for neonatal seizures
The first-line treatment for neonatal seizures is phenobarbital, which has been shown to be the most effective in controlling seizures for almost every baby. There are rare exceptions, such as infants with familial and inherited neonatal epilepsies caused by specific channelopathies.
Second-line treatment options and discontinuing anti-seizure medication
For second-line treatment, benzodiazepines like midazolam or lidocaine can be considered, depending on the etiology of the seizures. The decision to discontinue anti-seizure medication can be made after acute symptomatic seizures have ceased, regardless of MRI or EEG results. Staying on medication does not prevent the development of epilepsy, and discontinuing medication has been associated with better parent well-being.
What is the potential impact of delayed cord clamping on severe IVH and neurodevelopmental outcomes? We explore this and more in our latest episode. We kick things off with a deep dive into a riveting paper from the Archives of Disease in Childhood that scrutinizes the approaches to umbilical cord management and their effects on death and neurodevelopmental impairment.
We also discuss the heterogeneity of treatment effects of hydrocortisone by risk of bronchopulmonary dysplasia or death among extremely preterm infants in the National Institute of Child Health and Human Development Neonatal Research Network Trial with our EBNEO colleague Nic Bamat from CHOP.
Join us as we welcome Dr. Rene Shellhass, co-author of the recent paper on neonatal seizures, to discuss the six PICO questions from the paper and their implications for the neonatal community. We take a hard look at the use of EEGs in diagnosing and managing neonatal seizures and the challenges involved. To wrap things up, we highlight the long term outcomes of the OPTMIST-A trial —a must-listen for anyone involved in neonatal care. We guarantee you'll walk away from this episode with a lot of valuable insights, thank you all for listening.
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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