Facilitating discharge from hospital of the healthy term infant.

This statement provides guidance for health care providers to ensure the safe discharge of healthy term infants who are born in hospital and who are ≥37 weeks' gestational age. Hospital care for mothers and infants should be family-centred, with healthy mothers and infants remaining together and going home at the same time. The specific length of stay for newborn infants depends on the health of their mother, infant health and stability, the mother's ability to care for her infant, support at home, and access to follow-up care. Many mother-infant dyads are ready to go home 24 h after birth. Parent or guardian education and assessment of discharge readiness are important components of discharge planning. Each infant must have an appropriate discharge plan, including identification of the infant's primary health care provider and assessment by a health care provider 24 h to 72 h after discharge.

Imaging the term neonatal brain.

Brain imaging is important for the diagnosis and management of sick term neonates. Although ultrasound and computed tomography may provide some information, magnetic resonance imaging is now the brain imaging modality of choice because it is the most sensitive technique for detecting and quantifying brain abnormalities and does not expose infants to radiation. This statement describes the principles, roles and limitations of these three imaging modalities and makes recommendations for appropriate use in term neonates. The primary focus is the brain of term infants with neonatal encephalopathy, many of whom are diagnosed with hypoxic-ischemic encephalopathy.

Letter to the Editor - Re: Canadian Pediatrics Society position statement on newborn circumcision: a risk-benefit analysis revisited.

EDITORIAL.

Management of term infants at increased risk for early-onset bacterial sepsis.

Early-onset neonatal bacterial sepsis (EOS) is sepsis occurring within the first 7 days of life. This statement provides updated recommendations for the care of term (≥37 weeks' gestational age) newborns at risk of EOS, during the first 24 hours of life. Maternal Group B streptococcus (GBS) colonization in the current pregnancy, GBS bacteriuria, a previous infant with invasive GBS disease, prolonged rupture of membranes (≥18 hours) and maternal fever (temperature ≥38°C) are the factors most commonly associated with EOS. These risk factors are additive; the presence of more than one factor increases the likelihood of EOS. At present, there is no laboratory test, including white blood cell indices, that has sufficient sensitivity to allow clinicians to safely rule out EOS. All unwell infants with clinical signs suggesting sepsis must be treated empirically with antibiotics, once cultures have been taken. The management of well-appearing, at-risk term infants depends on the number of risk factors (including maternal GBS colonization) and whether maternal intrapartum antibiotic prophylaxis for GBS was used. In some cases, management should be individualized. Careful assessment and observation of these at-risk infants are a fundamental component of appropriate care.

Retinopathy of prematurity: An update on screening and management.

Retinopathy of prematurity is a proliferative disorder of the developing retinal blood vessels in preterm infants. The present practice point reviews new information regarding screening and management for retinopathy of prematurity, including the role of risk factors in screening, optimal scheduling for screening examinations, pain management, digital retinal photography and antivascular endothelial growth factor therapy.

La rétinopathie du prématuré est un trouble prolifératif qui touche les vaisseaux sanguins de la rétine en développement des nourrissons prématurés. Le présent point de pratique traite de nouvelles données sur le dépistage et la prise en charge de la rétinopathie du prématuré, y compris le rôle des facteurs de risque dans le dépistage, le moment optimal pour effectuer les examens de dépistage, la prise en charge de la douleur, la rétinographie numérique et le traitement par anti-facteur de croissance de l'endothélium vasculaire.

Factors associated with car seat test failure in late preterm infants: A retrospective chart review.

BACKGROUND: Professional organizations recommend car seat testing of preterm infants before discharge from hospital. Late preterm infants (LPIs, 34(0/7) to 36(6/7) weeks' gestational age) are at the greatest risk for failure, despite often being well. OBJECTIVE: To determine the incidence of car seat testing failure in LPIs and associative factors. METHODS: A retrospective chart review was performed of inborn LPIs admitted to all levels of newborn care between July 1, 2012 and June 30, 2013. Data collected included maternal demographics, labour and delivery history, and neonatal course. Data were analyzed using backward logistic regression. RESULTS: A total of 511 charts were reviewed and 367 LPIs were eligible for inclusion. Of the 313 LPIs tested (mean [± SD] gestational age 36 weeks ±6 days and birth weight 2614±405 g), 80 (26%) failed (95% CI 21% to 31%). Most failed due to desaturations (≥2) of <88% for ≥10 s (n=33 [41%]). Multiple gestation was associated with failure (adjusted OR 2.45 [95% CI 1.44 to 4.18]; P=0.001), and there was a trend toward statistical significance for the variable postnatal age (0.996 [95% CI 0.99 to 1.00]; P=0.05). Infants who passed their car seat test had higher postnatal ages than those who failed (mean difference 39.4 h [95% CI 12.7 h to 66.0 h]; P=0.004). CONCLUSION: Twenty-six percent of LPIs failed car seat testing. Ideally, infants should be tested after an appropriate transitional period. The authors identified factors that may be important in designing future, prospective studies in this area. Future research should evaluate the clinical significance of car seat testing and resource utilization.

HISTORIQUE: Les organisations professionnelles recommandent de vérifier les sièges d'auto des nourrissons prématurés avant leur congé de l'hôpital. Les nourrissons peu prématurés (NPP; de 340/7 à 366/7 semaines d'âge gestationnel) risquent le plus d'échouer cette vérification, même s'ils sont souvent en bonne santé. OBJECTIF: Déterminer l'incidence d'échec de la vérification des sièges d'auto chez les NPP, ainsi que les facteurs s'y associant. MÉTHODOLOGIE: Les chercheurs ont procédé à l'analyse rétrospective des dossiers de NPP nés à l'hôpital et admis à tous les niveaux de soins des nouveau-nés entre le 1er juillet 2012 et le 30 juin 2013. Les données colligées incluaient les renseignements démographiques sur la mère, les données sur le travail et l'accouchement et l'évolution néonatale. Les chercheurs ont analysé les données à l'aide de la régression logistique rétrograde. RÉSULTATS: Les chercheurs ont examiné 511 dossiers, et 367 NPP étaient admissibles à l'inclusion. Des 313 NPP vérifiés (âge gestationnel moyen [± ÉT] de 36 semaines ±6 jours et poids de naissance de 2 614±405 g), 80 (26 %) ont échoué (95 % IC 21 % à 31 %), la plupart à cause d'une désaturation (≥2) de moins de 88 % pendant au moins 10 s (n=33 [41 %]). La gestation multiple s'associait à un échec (RC rajusté 2,45 [95 % IC 1,44 à 4,18]; P=0,001), et on remarquait une tendance vers une signification statistique de la variable d'âge postnatal (0,996 [95 % IC 0,99 à 1,00]; P=0,05). Les nourrissons pour qui la vérification du siège d'auto ne posait pas de problème avaient un âge postnatal plus avancé que ceux qui l'échouaient (différence moyenne de 39,4 h [95 % IC 12,7 h à 66,0 h]; P=0,004). CONCLUSION: Vingt-six pour cent des NPP échouaient la vérification du siège d'auto. Dans l'idéal, il faudrait vérifier les nourrissons après une période transitoire pertinente. Les chercheurs ont déterminé des facteurs susceptibles d'être importants pour concevoir de futures études prospectives dans ce domaine. De futures recherches devraient évaluer la signification clinique de la vérification des sièges d'auto et l'utilisation des ressources.

Newborn male circumcision.

The circumcision of newborn males in Canada has become a less frequent practice over the past few decades. This change has been significantly influenced by past recommendations from the Canadian Paediatric Society and the American Academy of Pediatrics, who both affirmed that the procedure was not medically indicated. Recent evidence suggesting the potential benefit of circumcision in preventing urinary tract infection and some sexually transmitted infections, including HIV, has prompted the Canadian Paediatric Society to review the current medical literature in this regard. While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.

Au Canada, la circoncision néonatale est moins fréquente depuis quelques décennies. Ce changement est considérablement influencé par les recommandations antérieures de la Société canadienne de pédiatrie et de l'American Academy of Pediatrics, qui ont toutes deux conclu que l'intervention n'était pas indiquée sur le plan médical. Selon des données probantes à jour, la circoncision préviendrait les infections urinaires et certaines infections transmises sexuellement, y compris le virus de l'immunodéficience humaine (VIH), ce qui a incité la Société canadienne de pédiatrie à analyser les publications scientifiques récentes sur le sujet. Bien qu'elle puisse constituer un avantage pour certains garçons de populations à haut risque et dans des situations où l'intervention pourrait atténuer ou traiter des maladies, la Société canadienne de pédiatrie ne recommande pas la circoncision systématique des nouveau-nés.

The interfacility transport of critically ill newborns.

The practice of paediatric/neonatal interfacility transport continues to expand. Transport teams have evolved into mobile intensive care units capable of delivering state-of-the-art critical care during paediatric and neonatal transport. While outcomes are best for high-risk infants born in a tertiary care setting, high-risk mothers often cannot be safely transferred. Their newborns may then have to be transported to a higher level of care following birth. The present statement reviews issues relating to transport of the critically ill newborn population, including personnel, team competencies, skills, equipment, systems and processes. Six recommendations for improving interfacility transport of critically ill newborns are highlighted, emphasizing the importance of regionalized care for newborns.

Le transport interhospitalier des nouveau-nés et des enfants continue de prendre de l'expansion. Les équipes de transport se sont transformées en unités de soins intensifs mobiles en mesure de prodiguer des soins intensifs de pointe à ces populations pendant le transport. L'évolution des nouveau-nés à haut risque est plus favorable dans un établissement de soins tertiaires, mais bien souvent, les mères à haut risque ne peuvent pas être transférées en toute sécurité. Leur nouveau-né devra peut-être être transporté vers un établissement offrant un niveau de soins plus avancé après la naissance. Le présent document de principes traite des enjeux liés au transport des nouveau-nés gravement malades, y compris le personnel, les compétences et les habiletés de l'équipe, l'équipement, les systèmes et les processus. Sont présentées six recommandations pour améliorer le transport interhospitalier des nouveau-nés gravement malades, qui font ressortir l'importance des soins régionaux pour les nouveau-nés.

Guidelines for the Management of Extremely Premature Deliveries: A Systematic Review.

BACKGROUND AND OBJECTIVES: Available data on survival rates and outcomes of extremely low gestational age (GA) infants (22-25 weeks' gestation) display wide variation by country. Whether similar variation is found in statements by national professional bodies is unknown. The objectives were to perform a systematic review of management from scientific and professional organizations for delivery room care of extremely low GA infants. METHODS: We searched Embase, PubMed, and Google Scholar for management guidelines on perinatal care. Countries were included if rated by the United Nations Development Programme's Human Development Index as "very highly developed." The primary outcome was rating of recommendations from "comfort care" to "active care." Secondary outcomes were specifying country-specific survival and considering potential for 3 biases: limitations of GA assessment; bias from different definitions of stillbirths and live births; and bias from the use of different denominators to calculate survival. RESULTS: Of 47 highly developed countries, 34 guidelines from 23 countries and 4 international groups were identified. Of these, 3 did not state management recommendations. Of the remaining 31 guidelines, 21 (68%) supported comfort care at 22 weeks' gestation, and 20 (65%) supported active care at 25 weeks' gestation. Between 23 and 24 weeks' gestation, much greater variation was seen. Seventeen guidelines cited national survival rates. Few guidelines discussed potential biases: limitations in GA (n = 17); definition bias (n = 3); and denominator bias (n = 7). CONCLUSIONS: Although there is a wide variation in recommendations (especially between 23 and 24 weeks' GA), there is general agreement for comfort care at 22 weeks' GA and active care at 25 weeks' GA.

Hematological parameters immediately after birth in twins and higher order multiples.

OBJECTIVE: To develop reference values for hematological parameters in twins and higher order multiple births immediately after birth and compare them with values from singletons. STUDY DESIGN: In this retrospective matched cohort study, hematological parameters immediately after birth from multiples, and gestation- and sex-matched singletons born between 2007 and 2009 were obtained. Infants born with maternal or fetal conditions known to affect hematological values were excluded. Data were compared using Student t-test, chi-square test, and nonparametric tests as appropriate. RESULTS: Three hundred sixty-three multiples were matched with 363 singletons. Multiples had lower birth weights and higher rate of conception by in-vitro fertilization than singletons. Mean (SD) hemoglobin (171 ± 24 vs. 167 ± 23 g/L; p = 0.04) was marginally higher but nucleated red cells were 30% lower (1.7 ± 2.6 vs. 2.6 ± 3.9 10(9)/L, p < 0.01) in multiples. Total white blood cells (WBCs) were 14% lower, absolute neutrophils 30% lower, monocytes 31% lower, basophils 28% lower, and immature WBC 56% lower in multiples. CONCLUSION: Mean hemoglobin was higher, whereas total WBC, absolute neutrophils, monocytes, and eosinophils were significantly lower in multiples compared with singletons. These differences in WBC and neutrophil counts should be considered when interpreting hematological parameters in multiples.

Risk Factors and Outcomes of Late-Onset Bacterial Sepsis in Preterm Neonates Born at < 32 Weeks' Gestation.

OBJECTIVE: This study aims to identify the incidence, risk factors, and outcomes of late-onset sepsis in preterm neonates in Canadian neonatal intensive care units (NICUs). STUDY DESIGN: This retrospective analysis included preterm infants born at < 32 weeks' gestation and admitted to 29 NICUs in the Canadian Neonatal Network during the years 2010 and 2011. Infants were classified into three groups: no infection, gram-positive infection, and gram-negative infection. Late-onset sepsis was defined as positive blood and/or spinal fluid cultures after 3 days of birth. Risk factors and the primary outcome of mortality or bronchopulmonary dysplasia (BPD) were compared between the groups. RESULTS: Out of the 7,509 neonates, 6,405 (85%) had no infection, 909 (12%) had gram-positive, and 195 (3%) had gram-negative infections. Lower gestation, higher Score for Neonatal Acute Physiology, version II scores, the presence of central catheters for > 4 days, parenteral nutrition for > 7 days, and prolonged duration of nothing by mouth were associated with late-onset sepsis. After controlling for confounders, the odds ratio (OR) of mortality/BPD were higher in infants who had gram-negative (OR 2.79, 95% confidence interval [CI] 1.96-3.97) and gram-positive (OR 1.44, 95% CI 1.21-1.71) sepsis as compared with no infection. CONCLUSIONS: Bacterial late-onset sepsis in very preterm neonates was associated with mortality and BPD. Neonates with gram-negative sepsis had the highest risk of adverse outcomes as compared with gram-positive sepsis or no sepsis.

Red blood cell transfusion in newborn infants.

Red blood cell transfusion is an important and frequent component of neonatal intensive care. The present position statement addresses the methods and indications for red blood cell transfusion of the newborn, based on a review of the current literature. The most frequent indications for blood transfusion in the newborn are the acute treatment of perinatal hemorrhagic shock and the recurrent correction of anemia of prematurity. Perinatal hemorrhagic shock requires immediate treatment with large quantities of red blood cells; the effects of massive transfusion on other blood components must be considered. Some guidelines are now available from clinical trials investigating transfusion in anemia of prematurity; however, considerable uncertainty remains. There is weak evidence that cognitive impairment may be more severe at follow-up in extremely low birth weight infants transfused at lower hemoglobin thresholds; therefore, these thresholds should be maintained by transfusion therapy. Although the risks of transfusion have declined considerably in recent years, they can be minimized further by carefully restricting neonatal blood sampling.

La transfusion de culot globulaire est un élément important et fréquent des soins intensifs néonatals. Le présent document de principes traite des méthodes et des indications pour transfuser des culots globulaires au nouveau-né, d'après une analyse bibliographique. Les principales indications de transfusion sanguine au nouveau-né sont le traitement aigu du choc hémorragique périnatal et la correction récurrente de l'anémie de la prématurité. Le choc hémorragique périnatal exige l'administration immédiate de fortes quantités de culots globulaires, mais il faut tenir compte des effets d'une transfusion massive sur d'autres composants sanguins. Grâce à des essais cliniques sur les transfusions en cas d'anémie de la prématurité, il est désormais possible de compter sur des lignes directrices, même s'il reste beaucoup d'incertitude. D'après des données dont la qualité de preuves est faible, l'atteinte cognitive pourrait être plus grave au suivi chez les nouveau-nés d'extrême petit poids à la naissance qui sont transfusés à des seuils d'hémoglobine bas. Il faut donc maintenir ces seuils par thérapie transfusionnelle. Même si les risques de transfusion ont diminué considérablement ces dernières années, on peut les réduire encore davantage en limitant soigneusement les ponctions capillaires néonatales.

Going home: Facilitating discharge of the preterm infant.

At the time of discharge home, parents of preterm infants in the neonatal intensive care unit often feel apprehensive and may question their ability to care for their baby. The well-planned, comprehensive discharge of a medically stable infant helps to ensure a positive transition to home and safe, effective care after discharge. This statement provides guidance in planning discharge of infants born before 34 weeks' gestational age from tertiary and community settings. Discharge readiness is usually determined by demonstration of functional maturation, including the physiological competencies of thermoregulation, control of breathing, respiratory stability, and feeding skills and weight gain. Supporting family involvement and providing education from the time of admission improve parental confidence and decrease anxiety. Assessing the physical and psychosocial discharge environment is an important part of the discharge process. The clinical team is responsible for ensuring that appropriate investigations and screening tests have been completed, that medical concerns have been resolved and that a follow-up plan is in place at the time of discharge home.

Au moment du congé à domicile, les parents de nourrissons prématurés qui séjournent à l'unité de soins intensifs néonatals se sentent souvent pleins d'appréhension et peuvent remettre en question leur aptitude à s'occuper de leur bébé. La démarche de congé complète et bien planifiée d'un nourrisson stable sur le plan médical contribue à garantir une transition positive vers la maison et des soins efficaces et sécuritaires après le congé. Le présent document de principes permet d'orienter la planification du congé des nourrissons nés avant 34 semaines d'âge gestationnel dans un hôpital général ou de soins tertiaires. L'aptitude au congé est généralement déterminée par la démonstration d'une maturation fonctionnelle, y compris les compétences physiologiques de thermorégulation, de contrôle de la respiration, de stabilité respiratoire et de capacité à s'alimenter ainsi que de prise de poids. Si on soutient la participation de la famille et qu'on l'éduque dès le début de l'hospitalisation, les parents gagnent en confiance et se sentent moins anxieux. Pendant le processus de congé, il est important d'évaluer le milieu physique et psychosocial où vivra le nourrisson. L'équipe clinique est responsable de s'assurer que les examens et les tests de dépistage ont été effectués, que les préoccupations médicales sont résolues et qu'un plan de suivi est en place au moment du congé à domicile.

Impact of late preterm and early term infants on Canadian neonatal intensive care units.

OBJECTIVE: To examine the short-term morbidities, mortality, and use of neonatal intensive care unit (NICU) resources for late preterm, early term, and term infants. STUDY DESIGN: Infants born between 34 and 40 weeks of gestation and admitted to a Canadian NICU in 2010 were designated late preterm (340/7 to 366/7 weeks), early term (370/7 to 386/7 weeks), or term (390/7 to 406/7 weeks). Mortality, short-term morbidities, and resource utilization were compared between the three groups using chi-square tests and analysis of variance. RESULTS: Among 6,636 included infants, 44.2% (n = 2,935) were late preterm, 26.2% (n = 1,737) early term, and 29.6% (n = 1,964) term. Term infants were more likely to require resuscitation at birth and had lower Apgar scores than late preterm and early term infants (p < 0.001). Length of stay and need for respiratory support decreased with increasing gestational age; however, the proportion of hospital days that intensive care was required increased. CONCLUSION: The greatest impact of late preterm infants is on NICU bed occupancy, whereas for term infants it is on intensity of care. Early term infants experience greater rates of some complications than term, demonstrating that risk persists for these infants. These findings have important implications for NICU resource planning and practice.

Impact of late preterm birth on neonatal intensive care resources in a tertiary perinatal center.

OBJECTIVE: To examine delivery indications, short-term morbidities, and use of resources for late preterm infants admitted to the neonatal intensive care unit (NICU) at a tertiary perinatal center. STUDY DESIGN: Data for 1137 inborn infants 340/7 to 366/7 weeks' gestational age discharged between July 2004 and December 2009 were collected from an electronic NICU database. Birth information was obtained from maternal charts. RESULTS: Forty-two percent of late preterm infants were admitted to the NICU. Their mean ( ± standard deviation) birth weight was 2347 ± 569 g; 15.1% were small for gestational age, 35.5% were multiples, and 17.8% had an antenatally diagnosed anomaly. Most births (52%) occurred following spontaneous rupture of membranes or labor. Cesarean section rate was 56.8%. Mortality rate was 1.2%. Most frequent morbidities were transient tachypnea (18.8%), cardiac or other congenital anomaly (16.8%), and respiratory distress syndrome (7.4%). Although 41.5% received ventilatory support, duration was short (1.1 ± 3.1 days). Mean length of NICU stay was 8.1 ± 9.3 days with 38% transferred to community hospitals before discharge. CONCLUSION: For many late preterm infants admitted to the NICU, the duration of intensive therapy was short and some required no interventions. One impact of late preterm birth was bed occupancy.

Kangaroo care for the preterm infant and family.

Kangaroo care (KC) is the practice of skin-to-skin contact between infant and parent. In developing countries, KC for low-birthweight infants has been shown to reduce mortality, severe illness, infection and length of hospital stay. KC is also beneficial for preterm infants in high-income countries. Cardiorespiratory and temperature stability, sleep organization and duration of quiet sleep, neurodevelopmental outcomes, breastfeeding and modulation of pain responses appear to be improved for preterm infants who have received KC during their hospital stay. No detrimental effects on physiological stability have been demonstrated for infants as young as 26 weeks' gestational age, including those on assisted ventilation. Mothers show enhanced attachment behaviours and describe an increased sense of their role as a mother. The practice of KC should be encouraged in nurseries that care for preterm infants. Information is available to assist in developing guidelines and protocols.Kangaroo care (KC) is the practice of skin-to-skin contact between infant and parent. In developing countries, KC for low-birthweight infants has been shown to reduce mortality, severe illness, infection and length of hospital stay. KC is also beneficial for preterm infants in high-income countries. Cardiorespiratory and temperature stability, sleep organization and duration of quiet sleep, neurodevelopmental outcomes, breastfeeding and modulation of pain responses appear to be improved for preterm infants who have received KC during their hospital stay. No detrimental effects on physiological stability have been demonstrated for infants as young as 26 weeks' gestational age, including those on assisted ventilation. Mothers show enhanced attachment behaviours and describe an increased sense of their role as a mother. The practice of KC should be encouraged in nurseries that care for preterm infants. Information is available to assist in developing guidelines and protocols.

La méthode kangourou (MK) désigne la pratique qui consiste à mettre le nourrisson peau contre peau avec son parent. Dans les pays en développement, il est démontré que, pour les nourrissons de petit poids de naissance, la MK réduit la mortalité, les maladies graves, les infections et la durée des hospitalisations. La MK est également bénéfique aux nourrissons prématurés des pays à revenu élevé. La stabilité cardiorespiratoire et la thermostabilité, l'organisation du sommeil et la durée du sommeil paisible, les issues neurodéveloppementales, l'allaitement et la modulation des réponses à la douleur semblent être plus positives chez les prématurés qui profitent de la MK pendant leur hospitalisation. On n'a relevé aucun effet néfaste sur la stabilité physiologique des nourrissons dès 26 semaines d'âge gestationnel, même lorsqu'ils étaient sous ventilation assistée. Les mères présentent des comportements d'attachement plus marqués et une meilleure perception de leur rôle de mère. Il faudrait favoriser la pratique de la MK dans les pouponnières qui soignent des nourrissons prématurés. Les auteurs fournissent de l'information pour contribuer à l'élaboration de lignes directrices et de protocoles.

Visual development of human milk-fed preterm infants provided with extra energy and nutrients after hospital discharge.

BACKGROUND: Human milk (HM) is the optimal way to nourish preterm low birth weight (LBW) infants after hospital discharge. However, there are few data on which to assess whether HM alone is sufficient to address hospital-acquired nutrition deficits, and no adequately powered studies have examined this question using neurodevelopment as an outcome. The purpose of this work was to determine whether adding extra energy and nutrients to the feedings of predominantly HM-fed LBW infants early after discharge improves their visual development. Visual development was used in this study as a surrogate marker for neurodevelopment. METHODS: At discharge, 39 predominantly HM-fed LBW infants (750-1800 g, 1288 ± 288 g) were randomized to receive human milk alone (control) or around half of the HM received daily mixed with a multinutrient fortifier (intervention) for 12 weeks. Grating acuity (ie, visual acuity) and contrast sensitivity were assessed using sweep visual-evoked potential tests at 4 and 6 months corrected age. RESULTS: At 4 and 6 months corrected age, intervention infants demonstrated higher grating acuity compared to those in the control group (intervention: 7.8 ± 1.3 and 9.7 ± 1.2 [cycles/degree] vs control 6.9 ± 1.2 and 8.2 ± 1.3, P = .02). Differences in contrast sensitivity did not reach statistical significance (P = .11). CONCLUSION: Adding a multinutrient fortifier to a portion of the expressed breast milk provided to predominantly HM-fed LBW infants early after discharge improves their early visual development. Whether these subtle differences in visual development apply to other aspects of development or longer term neurodevelopment are worthy of future investigation.

Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants.

Postnatal corticosteroids have been used for prevention and treatment of neonatal chronic lung disease (CLD) (also know as bronchopulmonary dysplasia), a significant cause of mortality and morbidity in preterm infants. As both dexamethasone and hydrocortisone administration within the first seven days of life is associated with an increased risk of cerebral palsy, early postnatal corticosteroid therapy is not recommended to prevent CLD. After seven days of life, dexamethasone has been shown to decrease the rate of CLD at 36 weeks' postmenstrual age with less impact on neurodevelopmental outcome. No trials have examined whether the benefits of corticosteroids outweigh the adverse effects for infants at high risk of, or with, severe CLD. While routine dexamethasone therapy of all ventilated infants is not recommended, clinicians may consider a short course of low-dose dexamethasone for individual infants at high risk of or with severe CLD. There is no evidence that hydrocortisone is an effective or safe alternative to dexamethasone and little evidence to support routine use of inhaled corticosteroids for prevention or treatment. Inhaled corticosteroids may be considered as an alternative to dexamethasone for treating individual infants with severe CLD. This revision replaces a statement published jointly with the American Academy of Pediatrics in 2002.