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analysis confirms results of a 2010 US study led by Dr Judith
Chung. For the new study, the researchers analyzed data from
20,554 very premature infants delivered at 165 hospitals with
neonatal units across the UK. About 4.5 percent of them died
in the hospital. Infants were 32 percent less likely to die if they
were admitted to high-volume neonatal units compared to lowvolume
units, the researchers found. The earliest preemies, those
born before 27 weeks of pregnancy, benefited the most from
high-volume units. Those babies had half the odds of dying when
they were treated in neonatal units that handle a high number
of premature births, compared to low-volume units, the study
published in BMJ Open found.
Hospital Banks on Donor Milk
The Children’s Hospital of Philadelphia (CHOP) announced it
will develop a non-profit milk bank to provide donor human milk
for hospitalized infants at the Hospital’s Main Campus, with the
goal of opening in late summer of 2015. CHOP will develop the
bank in cooperation with the Human Milk Banking Association
of North America, a professional organization that sets the
standards and guidelines for non-profit donor milk banking in
North America. Once open, it will be one of the only non-profit
milk banks located inside a freestanding children’s hospital in
the United States. At CHOP, more than four out of five infants
discharged from the Hospital’s intensive care units are receiving
human milk. The Hospital has used donor human milk since 2006
for at-risk infants to supplement a mother’s own milk supply if
it is insufficient or if the mother is unable to provide milk for
her infant. This milk is ordered from an HMBANA-certified milk
bank, where it is processed and pasteurized in accordance with
safebaby neonatal intensive care 2016.pdf 1 3/14/2016 12:17:27 PM
stringent safety guidelines, and then shipped to CHOP. There
are 17 association milk banks throughout the US and Canada.
At CHOP, many mothers choose to become human milk donors
and CHOP facilitates the donation process in partnership with
a HMBANA milk bank. In order to become a HMBANA donor,
the mother must meet strict donor criteria to ensure that she is
healthy and the milk is safe. Donors must complete a medical
history and lifestyle questionnaire and obtain the approval of
their healthcare provider prior to donating milk, as well as have
a blood test to screen for diseases including HIV, hepatitis B
and syphilis. HMBANA-approved donors are volunteers and are
uncompensated. These same guidelines will be followed in the
future; however, the process will be completed at CHOP and
the donated milk will be pasteurized and processed for CHOP’s
inpatient infant population.
Optimal Oxygen Levels Unclear
It remains uncertain whether to use lower or higher oxygen
levels for resuscitating infants born at or before 28 weeks of
gestation, according to a recent meta-analysis. Researchers say
they found no apparent differences in the overall risk of death
or other common preterm morbidities in infants randomized
to either 0.3 or less or 0.6 or more fraction of inspired oxygen
(FiO2). However, Dr Ju Lee Oei of the Royal Hospital for
Women in Randwick, Australia, and colleagues caution that
the mixed study designs and analyses used in the selected
studies “emphasize the need for more data” before definitive
recommendations can be made. “Pure (100%) oxygen has been
an integral component of newborn resuscitation for decades,
but air (21% oxygen) is now used to resuscitate full-term or
near-term babies due to a risk of oxidative injury and stress with
100% oxygen,” Dr Oei said. “Very preterm babies, however, are
physiologically very different to full-term babies. Many have
immature lungs and will continue to need some amount of
supplemental oxygen after birth,” she explained. In the absence
of guidelines, “clinicians now overwhelmingly favor using less
(under 30%) oxygen, even air, to resuscitate preterm babies.”
For their analysis, the researchers reviewed information on
randomized controlled trials reported in multiple databases
and meeting abstracts over the past 25 years. They included 504
infants from eight randomized studies (low oxygen=251, high
oxygen=253) conducted between 2005 and 2014. The team found
no significant differences between the groups in the relative
risk of bronchopulmonary dysplasia (0.88), intraventricular
hemorrhage (0.81), retinopathy of prematurity (0.82), patent
ductus arteriosus (0.95), necrotizing enterocolitis (1.61), and
overall mortality (0.99). However, they noted that “the overall
estimates of effect have wide confidence intervals, which are
consistent with substantial benefit or harm.”
Placentas Get a Bad Rap
Scientists at the UCSF Medical Center in San Francisco are
studying placentas in an effort to unlock more potential benefits.
The placenta is a disk of tissue attached to the uterine lining on
one side and to the umbilical cord on the other, which grows
from the embryo’s cells, not the mother’s. It is sometimes called
the afterbirth: It comes out after the baby is born, usually
weighing about a pound, or a sixth of the baby’s weight. It
provides oxygen, nourishment and waste disposal, doing the job
of the lungs, liver, kidneys and other organs until the fetal ones
kick in. Dr Susan Fisher, a professor of obstetrics, gynecology
and reproductive sciences, and other researchers have studied
the placenta for decades, but she said: “Compared to what we
should know, we know almost nothing. It’s a place where I think
we could make real medical breakthroughs that I think would be
12 neonatal INTENSIVE CARE Vol. 29 No. 4 • Fall 2016