#152 - đ Journal Club - New TPN Guidelines, transfusion and NIRS, prophylaxis for VUR, Predictive ability of the Bayley III and more...
Oct 1, 2023
01:24:46
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This podcast delves into cutting-edge research and innovative practices in neonatal medicine. Topics include antibiotic prophylaxis for infants with severe vesicoureteral reflux, perinatal risk factors for neonatal sepsis, correlation between Bailey scores and cognitive outcomes in preterm babies, tissue oxygenation after transfusion, and consequences and challenges of prematurity.
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Quick takeaways
Continuous antibiotic prophylaxis can prevent secondary kidney damage in infants with severe vesicoureteral reflux.
Clear and sensitive communication is crucial when delivering poor prognoses to parents of infants in neonatal care.
Deep dives
Transfusion and Tissue Oxygenation in Preterm Infants
This study examined tissue oxygenation using near infrared spectroscopy (NIRS) in preterm infants after transfusion. They found that transfusion was associated with increases in cerebral and mesenteric saturation, suggesting improved tissue oxygenation. There was no significant difference in tissue oxygenation between infants transfused at higher or lower hemoglobin thresholds. These findings suggest that NIRS may provide valuable information on tissue oxygenation and guide transfusion decisions in preterm infants.
Improving Transfusion Practices Based on Near Measures
A podcast episode discusses how tissue oxygenation of the brain and mesenteric region improved after transfusion, regardless of the hemoglobin threshold group. However, a cerebral saturation below 50% may be associated with adverse outcomes. The episode suggests further investigation and the adoption of individualized transfusion guidelines based on cerebral near measures.
Navigating Diagnostic Uncertainty in End-of-Life Care
This podcast episode explores the challenges of communicating with parents in cases where a clear diagnosis is unavailable, but the prognosis is poor. It highlights the importance of providing clear communication, acknowledging parental emotions, and supporting parents during end-of-life care. The episode emphasizes the need for clinicians to be sensitive, avoid euphemisms, and ensure that parents understand that they are not responsible for their infant's condition.
Can you imagine the world of neonatal medicine from the lens of cutting-edge research and innovative practices? This week, we unpack the complexities of neonatal care, shining a light on the vital role of antibiotic prophylaxis in preventing secondary kidney damage for infants with severe VUR. We review a landmark study published in the New England Journal of Medicine, focusing on the use of continuous antibiotic prophylaxis for infants with severe vesicoureteral reflux. Not stopping there, we dissect the methodology, delve into the results, and ponder on the implications of this ground-breaking research.
We also enter the intriguing realm of neonatal sepsis and enteral feeding in very low birth weight infants. Using guidelines from pediatricians and nephrologists, we scrutinize perinatal risk factors and the captivating findings of a meta-analysis published in the Journal of Maternal, Fetal and Neonatal Medicine. We explore the discrepancy between ordered vs administered enteral feeds, and the crucial need to include the entire NICU team to achieve better outcomes.
In the final chapters, we tackle the tough topic of neurodevelopmental outcomes following preterm birth and the associated challenges in prognosis delivery. You'll hear from recent paper discussing insightful views on delivering prognoses and balancing clinical and epidemiologic reasoning with clear communication. Join us as we weave through the intricate tapestry of neonatal care, illuminating the long-term consequences of extreme premature birth and exploring the perspectives of those with firsthand experience of prematurity. Tune in to this enlightening and educational journey into neonatal care on The Incubator.
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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