Journal of perinatology : official journal of the California Perinatal Association
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Randomized Controlled Trial Clinical Trial
Physical activity combined with massage improves bone mineralization in premature infants: a randomized trial.
Osteopenia of prematurity is a known source for morbidity in preterm infants. Premature infants have shown favorable outcomes in response to massage and physical activity. Whether such intervention can stimulate bone formation or decrease bone resorption is yet to be determined. ⋯ A combined massage and physical activity protocol improved bone formation (PICP) but did not affect bone resorption (Pyd). Pyd increased over time in both groups, possibly due to continuous bone resorption and Ca mobilization.
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Inhaled nitric oxide (iNO) is a potent and selective pulmonary vasodilator that decreases pulmonary resistance, and improves ventilation-perfusion matching, thereby improving oxygenation and reducing the need for more invasive therapies. Despite the efficacy of iNO at reducing the use of extracorporeal membrane oxygenation, significant concern remains over the potential toxicity from oxidative derivatives and methemoglobinemia. At present, there is no universal agreement on the lowest effective starting dose. Reported initial doses in the neonatal literature have ranged from 1 to 80 ppm. ⋯ There is significant variation in the starting dose of iNO between centers. Our retrospective study shows no evidence that higher doses improve outcome. A low concentration of iNO (<18 ppm) should be considered to minimize the potential toxicity of methemoglobin. Furthermore, a well-designed, prospective trial should be undertaken to further define the optimal starting dose.
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To assess whether advances in neonatal care in the last decade have altered the outcome of very-low-birth-weight (VLBW) infants after cardiopulmonary resuscitation (CPR) in the neonatal intensive care unit (NICU). ⋯ Survival rate for the infants who require CPR in the NICU remains extremely poor. This poor outcome needs to be discussed with parents and the option of the "do not resuscitate" (DNR) order may be appropriate for these infants, especially for those infants with multiple organ failure unresponsive to therapy.