INTENSIVE CARE

esearchers studied 189 adults born
between 1977 and 1982. One hundred
had been born prematurely, weighing
less than 1 kg, while the other 89 had
weighed more than 2.5 kg. All participants
completed standardized questionnaires
on health, education, employment, social
integration, sexuality and reproduction.
More than half of each group were
women. One in five of those born
premature had neurologic impairments. In
their mid-20s, the two groups had similar
life circumstances and achievement, and
at ages 29 to 36, educational achievement
and family and partner relationships were
still similar - but fewer premature adults
were employed or employed full time.
On average, the premature group was
making $20,000 less per year than the
term group. Half of the premature group
was never married or single, compared to
about a third of the full-term group, and
20 percent had never experienced sexual
intercourse compared to 2 percent of the
term group. More adults in the premature
group also reported being homosexual or
bisexual than in the term group, although
it’s not clear why that would be and
the sample of people in this study was
relatively small.
Life-saving Treatment Not Given to
All Moms
A steroid injection that prevents disability
and even death in premature babies is
only being administered to half of the
mothers who give birth prematurely in
hospital. The World Health Organization
conducted a study that has been
published in The Lancet, from May 2010
to December 2011. It examined the use
of antenatal corticosteroids, which cost
less than one US dollar each, and reduce
the risk of respiratory distress syndrome
in premature babies. The use of tocolytic
drugs to slow down labour and allow the
antenatal corticosteroids to work was
also studied. Using data from a WHO
Multicountry Survey, 29 countries and
over 300,000 births in 359 hospitals were
studied. It showed that only 52 percent
of women who gave birth at 26-34 weeks’
gestation and were eligible for the
injection actually received the treatment
while in labour. The rate varied between
countries as the majority studied were
of low-and-middle income. More so, only
18 per cent of women who could receive
both the antenatal corticosteroids and
tocolytic drugs were actually given them.
Drug Treatment Reduced for
Neonates
Use of a stringent protocol to treat
neonatal narcotic abstinence syndrome
(NAS) reduces the duration of opioid
exposure as well as the length of
hospital stay, according to a new study.
The benefits of a stringent protocol
are significant, regardless of the opioid
used for treatment. NAS is increasing
in prevalence in the US, and yet there
is currently no consensus with regard
to the best treatment drug or best taper
strategy for NAS management. The study
advances medical understanding of the
“best practice” for NAS management.
Eric S. Hall, PhD, from the Prenatal
Institute at Cincinnati Children’s Hospital
in Ohio, and colleagues present the
results of their cohort analysis in July
28 article in Pediatrics. The multicenter
cohort includes charted data from 547
pharmacologically treated infants and
is larger than any other previously
published study or meta-analysis. “Our
study identified key differences in NAS
management strategies that translated
into shorter opioid exposures and
reduced length of hospital stay. Results
indicate that the use of a stringent
weaning protocol, rather than the
particular opioid chosen for treatment,
was the most important predictor of
length of hospital stay and duration of
opioid treatment,” the authors write.
“Consistent with previous literature
describing improvements in pediatric
outcomes through standardization of
care, study results suggest that the
greatest impact on outcomes is achieved
through implementation and adherence
to a formalized NAS treatment protocol
with agreed-upon starting doses, explicit
instruction about dose escalation, and
strict weaning parameters,” the authors
explain. The study included only infants
who required opioid therapy (417
managed with an established weaning
protocol and 130 managed without an
established weaning protocol). After
the researchers accounted for hospital
variation, infants who received protocolbased
weans had a significantly shorter
duration of opioid treatment (17.7 vs 32.1
days; P < .0001) and shorter hospital stay
(22.7 vs 32.1 days;P = .004). Among those
who received protocol-based weaning,
the duration of opioid treatment and
length of stay were no different in infants
treated with morphine compared with
those treated with methadone. When the
authors analyzed the data from patients
who were treated with phenobarbital,
they found a longer duration of
phenobarbital administration in patients
treated with morphine compared with
those treated with methadone (P ≤ .002).
neonatal INTENSIVE CARE Vol. 29 No. 4 • Fall 2016 9