Abhay Lodha

Human torovirus: a new virus associated with neonatal necrotizing enterocolitis.

AIMnToroviruses have been associated with gastroenteritis in both animals and humans. The aim of this study was to examine the fecal excretion of torovirus in infants with necrotizing enterocolitis (NEC).nnnMETHODSnWe reviewed all infants with NEC admitted to our tertiary care NICU over a 5-y period who had stool specimens sent for microbial culture and virology. Infants in the NICU during the same period with diagnoses other than NEC served as controls.nnnRESULTSnForty-four infants with NEC stages I-III were identified, and pathogenic organisms were identified in 27 (61%). Toroviruses were identified in stool cultures in 48% of patients with NEC, and 17% of the non-NEC controls (p<0.001). There was no significant difference in illness severity or mortality between the torovirus-positive and -negative infants with NEC.nnnCONCLUSIONnTorovirus should be added to the list of infectious agents associated with NEC in newborn infants. The exact role torovirus plays in the etiology and progression of NEC warrants further investigation.

An Economic Evaluation of Asthma Action Plans for Children with Asthma

The costs and effectiveness of asthma action plans for children were evaluated in a cross-sectional economic analysis. Direct health care and indirect costs, nights with symptoms, and asthma attacks were measured in 879 Ontario children with asthma. From a societal perspective, the total annual costs of the asthma action plan and the control groups were CDN

Intratracheal Administration of Budesonide‐Surfactant in Prevention of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants: A Systematic Review and Meta‐Analysis

6,948 and CDN

Pulmonary Haemorrhage Associated with Neonatal Neurological Disease

6,140 per patient, respectively. Health outcomes were similar. The difference in cost was attributable to greater medication and health services use in the intervention group. Prospective randomized trials are necessary to measure potential improvements in control of asthma using asthma action plans.

Parenteral Fish-Oil Lipid Emulsions in the Prevention of Severe Retinopathy of Prematurity: A Systematic Review and Meta-Analysis.

Despite the near universal adaptation of gentle mechanical ventilation, surfactant use and non‐invasive respiratory support, bronchopulmonary dysplasia (BPD) remains one of the most common respiratory morbidities in very low birth weight (VLBW) infants. Thus, the objective of this review was to evaluate the efficacy of intra‐tracheal administration of budesonide‐surfactant mixture in preventing bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants. MEDLINE, EMBASE, and PubMed were searched for randomized clinical trials in which intra‐tracheal administration of budesonide‐surfactant was used to prevent BPD in infants. The primary outcomes were BPD and composite outcome of death or BPD. Meta‐analysis of the two clinical trials revealed that infants who received intra‐tracheal instillation of budesonide‐surfactant mixture demonstrated 43% reduction in the risk of BPD (RR: 0.57; 95%CI: 0.43‐0.76, NNTu2009=u20095). Although mortality was not different between the groups (OR: 0.61; 95%CI: 0.34‐1.04), a 40% reduction was observed in the composite outcome of death or BPD in the budesonide‐surfactant group (RR: 0.60; 95%CI: 0.49‐0.74, NNTu2009=u20093). Thus, this review concludes that intra‐tracheal administration of budesonide‐surfactant combination was associated with decreased incidence of BPD alone or composite outcome of death or BPD in VLBW infants though there is a need for larger trials before it can be recommended as a standard of care.

Chorioamnionitis at birth does not increase the risk of neurodevelopmental disability in premature infants with bronchopulmonary dysplasia.

Pulmonary haemorrhage (PH) following a neurological insult is referred to as neurogenic pulmonary haemorrhage. This entity has not been described in neonates. We conducted a retrospective study of 50 neonates with PH, with and without a preceding neurological insult. Among 10/22 neonates with a preceding neurological insult, no other predisposing factor or factor associated with PH was identified. Although we speculate that in some neonates, PH may have a neurogenic origin, similar to that described in older patients, a more detailed prospective study is required. Such a prospective study requires sufficient patient numbers and clinical measures to permit a statistically powered analysis of the risk of developing a PH in those with and without neurological injury before we can confidently assert that a neurogenic injury has a causative role in PH.

Human torovirus: A new virus associated with neonatal necrotizing enterocolitis: Torovirus in necrotizing enterocolitis

Objective Omega‐3 fatty acids are vital for brain and retinal maturation. It is not clear if early use of &ohgr;‐3 fatty acids in the form of fish‐oil lipid emulsions (FLEs) prevents retinopathy of prematurity (ROP) in preterm infants. The aim of this meta‐analysis is to evaluate whether early administration of parenteral FLEs reduces ROP requiring laser therapy or severe ROP ≥stage 3 in preterm infants. Methods A literature search was performed to identify studies comparing parenteral FLEs with soybean‐based lipid emulsions (SLEs) in preventing ROP. The main outcome was incidence of severe ROP or ROP requiring laser therapy. Results Studies met the inclusion criteria (four RCTs and two observational studies). The pooled relative risk of ROP requiring laser therapy or severe ROP ≥ stage 3 in FLEs group was 0.47 [95% CI: 0.24‐0.90] and 0.40 [95% CI: 0.22‐0.76] in RCTs and observational studies, respectively. FLEs also reduced cholestasis; however, other secondary outcomes of bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), sepsis, intraventricular hemorrhage (IVH), and mortality were similar. Conclusion The use of FLEs may reduce the incidence of severe ROP or need for laser therapy in preterm infants. A large multicenter RCT is required to confirm this.

Respiratory Management of Extremely Preterm Infants: An International Survey

To compare preterm infants with no bronchopulmonary dysplasia (BPD), BPD with chorioamnionitis (BPDC) and BPD with no chorioamnionitis (BPDNC) for the association with neurodevelopmental disability (NDD) at three years corrected age.

Do preterm infants with a birth weight ≤1250 g born to single-parent families have poorer neurodevelopmental outcomes at age 3 than those born to two-parent families?

Aim: Toroviruses have been associated with gastroenteritis in both animals and humans. The aim of this study was to examine the fecal excretion of torovirus in infants with necrotizing enterocolitis (NEC). Methods: We reviewed all infants with NEC admitted to our tertiary care NICU over a 5‐y period who had stool specimens sent for microbial culture and virology. Infants in the NICU during the same period with diagnoses other than NEC served as controls. Results: Forty‐four infants with NEC stages I–III were identified, and pathogenic organisms were identified in 27 (61%). Toroviruses were identified in stool cultures in 48% of patients with NEC, and 17% of the non‐NEC controls (p<0.001). There was no significant difference in illness severity or mortality between the torovirus‐positive and ‐negative infants with NEC.

Severe congenital autoimmune neutropenia in preterm monozygotic twins: case series and literature review

Background: There are significant international variations in chronic lung disease rates among very preterm infants yet there is little data on international variations in respiratory strategies. Objective: To evaluate practice variations in the respiratory management of extremely preterm infants born at < 29 weeks’ gestational age (GA) among 10 neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of Neonates collaboration. Methods: A web-based survey was sent to the representatives of 390 neonatal intensive care units from Australia/New Zealand, Canada, Finland, Illinois (USA), Israel, Japan, Spain, Sweden, Switzerland, and Tuscany (Italy). Responses were based on practices in 2015. Results: Overall, 321 of the 390 units responded (82%). The majority of units within networks (40–92%) mechanically ventilate infants born at 23–24 weeks’ GA on continuous positive airway pressure (CPAP) with 30–39% oxygen in respiratory distress within 48 h after birth, but the proportion of units that offer mechanical ventilation for infants born at 25–26 weeks’ GA at similar settings varied significantly (20–85% of units within networks). The most common respiratory strategy for infants born at 27–28 weeks’ GA on CPAP with 30–39% oxygen with respiratory distress within 48 h after birth used by units also varied significantly among networks: mechanical ventilation (0–60%), CPAP (3–82%), intubation and surfactant administration with immediate extubation (0–75%), and less invasive surfactant administration (0–68%). Conclusions: There are marked variations but also similarities in respiratory management of extremely preterm infants between networks. Further collaboration and exploration is needed to better understand the association of these variations in practice with pulmonary outcomes.