Maternal and child health

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Maternal and child health

Anjali Kulkarni a,*, Harsh Sharma b

aConsultant Neonatologist, Apollo Centre for Advanced Pediatrics, Indiab SpR Neonates, Royal London Hospital, Barts and NHS Trust, UK

Available online 23 January 2013

COMMENT

Necrotising enterocolitis is one of the commonest causes of mortality and morbidity in preterm/vlbw babies. Several studies

have been conducted over the years to find out the correlation with avoidable risk factors like volume/type of feeds, infection,

blood transfusions etc. The role of probiotics has been a matter of debate and there is very little published data on this subject.

This study highlights the possibility of reducing the risk of NEC with prophylactic probiotics.

Double-blind, randomised clinical assay to evaluate the efficacy of probiotics in preterm newborns weighing less than

1500 g in the prevention of necrotising enterocolitis. Fernandez-Carrocera Luis Alberto, Solis-Herrera Aide, Cabanillas-Ayon

Marisol, Gallardo-Sarmiento Rocıo Beatriz, Garcıa-Perez Carmina Sarisol, Montano-Rodrıguez Rosalba, Echaniz-AvilesMaria

Olga Leticia. Arch Dis Child Fetal Neonatal Ed. 2013;98:F5eF9. Published Online First: 3 May 2012.

Background: A randomised, double-blind clinical trial was undertaken in order to assess the effectiveness of probiotics in

the prevention of necrotising enterocolitis (NEC) in newborns weighing <1500 g.

Methods: We studied a group of 150 patients who were randomised in two groups after parental consent was obtained, to

receive either a daily feeding supplementationwith amultispecies probiotic (Lactobacillus acidophilus, Lactobacillus rhamnosus,

Lactobacillus casei, Lactobacillus plantarum, Bifidobacterium infantis, Streptococcus thermophilus) 1 g per day plus their regular

feedings or to receive their regular feedings with nothing added (control group), over the period of January 2007 through June

2010. Clinicians in care of the infants were blinded to the group assignment.

Results: The primary outcome was the development of NEC. Both groups were comparable, with no differences during

hospitalisation, including the type of nutrition received. Blood cultures obtained from cases that developed sepsis did not

reveal lactobacillus or Bifidobacteria growth. No differences were detected in terms of NEC risk reduction (RR: 0.54, 95% CI

0.21e1.39) although we did observe a clear trend in the reduction of NEC frequency in the studied cases: 6 (8%) versus 12

(16%) in the control group. When the combined risk of NEC or death was calculated as a post hoc analysis, we found

a significantly lower risk (RR: 0.39, 95% CI 0.17e0.87) for the study group.

Conclusions: Probiotics may offer potential benefits for premature infants and are a promising strategy in the reduction of

the risk of NEC in preterm newborns.

* Corresponding author. Indraprastha Apollo Hospital, Neonatology, Mathura Road, Sarita Vihar, New Delhi 110044, India. Tel.: þ919811121326.

E-mail address: dr.kulkarnianjali@gmail.com (A. Kulkarni).

Available online at www.sciencedirect.com

journal homepage: www.elsevier .com/locate/apme

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0976-0016/$ e see front matterhttp://dx.doi.org/10.1016/j.apme.2013.01.002

COMMENT

Congenital diaphragmatic hernia has a very high mortality and morbidity particularly in resource poor settings. Although

several centers have the surgical and neonatal expertise, preoperative stabilisation and assessment have an important role in

the final outcome. This study provides important assessment criteria in these newborns and should help in counseling the

family regarding the outcome of such cases.

COMMENT

Bronchiolitis is a very common cause of respiratory distress in infancy. These babies have a disproportionate degree of

breathlessness with very few auscultatory or radiological findings. Although not specific for the illness, the above-mentioned

therapies would certainly help in reducing the anxiety in parents as well as the stay in hospital.

Does a highest pre-ductal O2 saturation <85% predict non-survival for congenital diaphragmatic hernia? Yoder BA, Lally

PA, Lally KP, The Congenital Diaphragmatic Hernia Study Group. Journal of Perinatology. 2012;32:947e952.

Objective: To analyze operative repair, extracorporeal membrane oxygenation (ECMO) and survival rates based on highest

pre-ductal oxygen saturation (Pre-O2 SAT) in a large infant cohort reported to Congenital Diaphragmatic Hernia Study Group

Registry between 2000 and 2010.

Study design: Analyzed data included gestational age, birth weight, defect side and size, repair, ECMO use, survival and

highest reported PaO2 and Pre-O2 SAT in first 24 h of life. We excluded 614 infants due to severe anomaly. Pre-O2 SAT data

were available for 1672 infants.

Result: Among infants with highest Pre-O2 SAT value <85%, survival (24/105 ¼ 23%) and repair (55/105 ¼ 52%) rates were

significantly decreased compared with infants with higher values. Survival increased to 44% for infants with highest Pre-O2

SAT<85% who underwent operative repair. Of these, 83% (20/24) required ECMO support compared with 15% (144/961) of

survivors with Pre-O2 SAT>99% (P < 0.001). The lowest reported Pre-O2 SAT with survival was 32% and for survival without

ECMO was 52%.

Conclusion: A reported highest Pre-O2 SAT<85% in the first 24 h of life was not uniformly fatal; but survival of infants with

Pre-O2 SAT<85% was associated with high ECMO use and prolonged hospitalisation.

Current therapy for bronchiolitis. Nagakumar Prasad, Doull Iolo. Arch Dis Child. 2012;97:827e830.

Bronchiolitis is a common, self-limiting, seasonal viral respiratory tract infection in infancy accounting for the majority of

hospital admissions in this age group. Supportive care is the mainstay of treatment, concentrating on fluid replacement,

gentle suctioning of nasal secretions, prone position (if in hospital), oxygen therapy and respiratory support if necessary.

There is a long history of pharmacological agents offering no benefit in acute bronchiolitis. More recently, nebulised epi-

nephrine has been demonstrated to offer short-term benefits, while two stratagems have shown promise in decreasing risk

of hospitalisation and length of hospital stay. The combination of oral dexamethasone with nebulised epinephrine

potentially decreases the need for hospitalisation, while nebulised 3% hypertonic saline mixed with a bronchodilator de-

creases the length of hospitalisation. Although both stratagems appear safe and well tolerated, their role in clinical practice

remains unclear.

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