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Tocolytics for preterm premature rupture of membranes

Preterm premature rupture of membranes (PPROM) accounts for one‐third of preterm births. Infants who are born before 37 weeks may suffer from problems related to prematurity, including death. Medications that aim to stop labor are often given in an attempt to prevent preterm birth. It is unclear whether these medications should be used in women with PPROM. This review of eight studies (involving 408 women) found that these medications do not effect perinatal death, but do increase latency and may increase maternal (e.g., chorioamnionitis) and neonatal morbidity (e.g., five‐minute Apgar of less than seven and increased need for ventilation of the neonate).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Massage for promoting growth and development of premature and low birth‐weight infants

In utero, infants are exposed to physical stimulation. This raises the question whether gentle physical massage helps babies born before 37 weeks gestation or weighing less than 2500 grams (5.5 pounds) to develop after birth, and if it can improve their behaviour. The review only included randomized controlled trials, studies in which a group of babies received massage and was compared with a similar group which did not. The authors searched the medical literature and contacted experts and found 14 studies. In most of these studies babies were rubbed or stroked for about 15 minutes, three or four times a day, usually for five or ten days. Some studies also included "still, gentle touch", in which nurses put their hands on babies but did not rub or stroke them. On average, the studies found that when compared to babies who were not touched, babies receiving massage, but not "still, gentle touch", gained more weight each day (about 5 grams). They spent less time in hospital, had slightly better scores on developmental tests and had slightly fewer postnatal complications, although there were problems with how reliable these findings are. The studies did not show any negative effects of massage. Massage is time consuming for nurses to provide, but parents can perform massage without extensive training.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Extubation from low‐rate intermittent positive airway pressure versus extubation after a trial of endotracheal continuous positive airway pressure in intubated preterm infants

There is no evidence that time on endotracheal CPAP (continuous low pressure rather than intermittent breaths from the ventilator) before taking preterm babies off a ventilator helps them adjust to breathing on their own. Babies in neonatal intensive care often need help to breathe, sometimes via an endotracheal tube (through the windpipe) connected to a mechanical ventilator. It was thought that it might help a baby adjust to breathing after ventilation if there was a period of CPAP (continuous positive airways pressure) before extubation (coming off the ventilator). However, there have also been concerns that this may create too much work for the baby, and may cause harm. This review found that a trial of CPAP before extubation does not improve the baby's ability to breathe on their own.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Venepuncture versus heel lance for blood sampling in term neonates

In most countries, a blood sample from newborn babies is needed for screening tests. A heel lance is the standard way of taking blood, but it is a painful procedure with no optimal method of pain relief known. This review of trials found evidence that venepuncture, when done by a trained practitioner, caused less pain than heel lance. The use of a sweet tasting solution given to the baby prior to the event reduced pain further. The evidence included outcome measures using pain scales, how long the baby cried and how the mother rated their baby's pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Breastfeeding or breast milk for procedural pain in neonates

Breastfeeding provides pain relief for newborn babies undergoing painful procedures. Medicine for pain relief is commonly given for major painful procedures, but may not be given for minor painful procedures such as blood sampling (by heel prick or venepuncture). There are different forms of non‐pharmacological strategies that may be used to reduce pain in babies, such as holding, swaddling them, sucking on a pacifier, or giving sweet solutions (such as sucrose or glucose). Different studies done in babies have shown that breastfeeding is a good way to reduce the pain babies feel when subjected to minor painful procedures. These studies have been done in full‐term babies and they have shown that breastfeeding is effective by demonstrating that it reduces babies' crying time and reduces different pain scores that have been validated for babies. Breast milk given by syringe has not shown the same efficacy as breastfeeding itself. No studies have been done in premature babies, and so new studies are needed to determine if the use of supplemental breast milk in these small babies is effective in reducing their pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Opioids for neonates receiving mechanical ventilation

There is insufficient evidence to recommend routine use of opioids (e.g. morphine) to reduce pain in newborn babies (full‐term or preterm) with breathing difficulties on breathing machines. Breathing machines, which are widely used for newborn full‐term and preterm babies with breathing problems, may cause babies pain. Since newborn babies are very sensitive to pain ‐ which may have a bad effect on future development ‐ pain‐reduction with drugs (including opioids such as morphine) might be very important. This review found no evidence for routine use of opioids for newborns on breathing machines. Although relief of pain was variable, opioids were no better or worse for babies (in terms of death, strokes, future development, duration of ventilation or hospital stay) than other drugs or placebo. Further research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Local anaesthetic eye drops for prevention of pain in preterm infants undergoing screening for retinopathy of prematurity

Infants born less than 1500 g or less than 32 weeks are at increased risk of retinopathy of prematurity, a potentially blinding eye condition, and so have routine ophthalmological assessment. This process is a recognised source of pain and discomfort for preterm infants. This review highlights that retinopathy of prematurity is a painful examination and that instillation of local anaesthetic eyedrops immediately prior to examination of the eye is associated with a reduction in pain scores, as assessed by validated pain scores. Ongoing research is required to determine the optimum local anaesthetic eyedrop and other potentially important methods of reducing pain, including swaddling, and sucrose.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Sucrose for analgesia in newborn infants undergoing painful procedures

Healthcare professionals need strategies to reduce newborn babies' pain. Sucrose (sugar) provides pain relief for newborn babies having painful events such as needles or heel pricks. Pain medicine is usually given for major painful events (such as surgery), but may not be given for more minor events (such as taking blood or needles). Pain medicine can be used to reduce pain but there are several other methods including sucking on a pacifier (dummy) with or without sucrose. Researchers have found that giving sucrose to babies decreases their crying time and behaviours such as grimacing. More research is needed to determine if giving repeated doses of sucrose is safe and effective, especially for very low birthweight infants or infants on respirators.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Skin‐to‐skin (Kangaroo Care) with newborns cuts down procedural pain

Newborns wearing only a diaper being held next to their mother's bare chest is referred to as skin‐to‐skin contact and is also sometimes called Kangaroo Care because of its similarity to the way kangaroo mothers care for their young. Newborns, especially those who must spend time in the Neonatal Intensive Care Unit, must have various tests and procedures as part of their care, for example, heel stick, vein puncture, and injections. Giving analgesic drugs for these procedures can often pose problems so that alternatives to drugs must be found. Kangaroo Care appears to reduce the pain response to these frequent procedures, although few studies could be combined to provide strong evidence. As far as it has been reported, Kangaroo Care is safe. Nineteen studies were examined which showed that signs of pain, with a combination of physical and behavioural signs, support the use of Kangaroo Care. Physiological indicators of pain, such as heart rate, did not show a significant difference. Although we believe that Kangaroo Care is effective the size of the benefit may not be large.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants

The ductus arteriosus is a blood vessel that connects the aorta and pulmonary artery. The ductus arteriosus is normally present in the fetus. It allows the majority of the output of the right side of the heart to bypass the lungs and supply the body of the fetus and placenta in‐utero. In most term infants the patent ductus arteriosus (PDA) closes within days of birth, first by contraction of a muscular layer to achieve functional closure and then by endothelial remodeling. If the ductus arteriosus persists, blood is shunted from the aorta to the pulmonary circulation, which can cause overloading of the pulmonary circulation and reduced perfusion of the brain, gut and kidneys. In preterm infants, closure may be delayed or fail to occur, due in part to circulating vasodilatory prostaglandins. Indomethacin inhibits prostaglandin synthesis and it is used to treat PDA in preterm infants. Although indomethacin is successful in closing the PDA in the majority of cases, the ductus will re‐open in up to 35% of infants who initially respond to the drug and a more prolonged course of indomethacin has been studied to achieve higher rates of ductal closure. Important side effects of indomethacin include renal dysfunction, decreased platelet aggregation, and necrotizing enterocolitis (NEC). Where indomethacin fails, the ductus arteriosus may be surgically ligated if clinically indicated. Five randomized trials are included in this review. These studies were published between 1988 and 2000 and included a total of 431 preterm and low birth weight infants. Indomethacin was given intravenously in four trials and orally in one, in total amounts of 0.6 to 1.6 mg/kg for the prolonged course (six to eight doses) and 0.3 to 0.6 mg/kg for the short course (two to three doses). There was no significant benefit of prolonged indomethacin administration on failure of the PDA to close after completion of allocated treatment (four studies, 361 infants). Prolonged course of indomethacin compared to the short course did not reduce the rate of PDA re‐opening after initial closure (three studies, 322 infants), rate of PDA re‐treatment (five studies, 431 infants), or ligation rate (four studies, 310 infants). The prolonged course was associated with decreased incidence of renal function impairment (three studies, 318 infants). However, a prolonged indomethacin course increased the risk of NEC (four studies, 310 infants). The number of deaths was no different.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Smart Health Choices: Making Sense of Health Advice

This book aims to help consumers and practitioners develop the skills to assess health advice – and hopefully to make decisions that will improve the quality of their care. For some people, making better-informed decisions could be life saving. We hope that it will be useful if you are struggling to come to terms with an illness or injury, and the best ways of managing it. Or you may simply want to lead a healthier life, and may be wondering how to make sense of the often conflicting flood of health information that deluges us every day, through the media, and from our friends and health practitioners.

Hammersmith Press.

Version: 2008
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Hydralazine for pulmonary hypertension in low birth weight infants with chronic lung disease

In premature infants, pulmonary arterial hypertension (PAH) associated with chronic lung disease (CLD) is associated with high mortality rate. With the exception of oxygen supplementation, no specific interventions have been established as an effective treatment for PAH in premature infants with CLD. Vasodilators could be effective treatments to reduce pulmonary arterial pressure, but little has been proven regarding their clinical effectiveness and concern remains regarding adverse effects. This review found no trials of the use of hydralazine for low birth weight infant with PAH related to CLD. However, since hydralazine is inexpensive and potentially beneficial, randomised controlled trials are recommended.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Fat supplementation of human milk for promoting growth in preterm infants

enterocolitis).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Doxapram treatment for apnea in preterm infants

Doxapram stimulates breathing. However, there is not enough evidence to know if it is helpful in premature infants with apnea. Infant apnea is a pause in breathing of greater than 20 seconds. This can be harmful to the developing brain and cause dysfunction of the gastrointestinal tract or other organs. Drugs such as doxapram are thought to stimulate breathing and are given to reduce apnea. The review of one small trial found that apnea might be reduced in the first few days after treatment, but there were not enough infants studied to know if this was a significant effect. There is no evidence from this trial on longer term effects or less common adverse effects. More research is needed on the effectiveness, potential harm and long‐term benefits or adverse effects of these drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Multicomponent fortified breast milk for promoting growth in preterm infants

Babies born at full term (40 weeks) get all their nutritional needs from breast milk. Babies born early (preterm) have different needs and grow very rapidly. Those fed breast milk may need extra supplements. The review of trials found evidence that adding nutritional supplements to breast milk leads to short term improved growth and possibly also bone formation. The review found no evidence of long‐term benefits or adverse effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Corticosteroids for HELLP syndrome in pregnancy

Pre‐eclampsia is a serious complication of pregnancy characterized by high blood pressure with protein in the urine and sometimes progression to seizures (fits). HELLP syndrome is a more severe form of pre‐eclampsia which can cause problems with liver function, blood clotting, and low platelets. HELLP may be diagnosed during pregnancy or after giving birth and is associated with ill health for the mother including liver hematoma, rupture, or failure; pulmonary edema; renal failure and death. Infant health may also be poor, primarily due to premature birth and growth restriction.This review examined the effect of treating women with HELLP syndrome using corticosteroids (which can reduce inflammation). The results of this review did not indicate that there was a clear effect on the health of pregnant women when treated with corticosteroids, or their babies. Corticosteroids did appear to improve some components of the women's blood tests, but it is not clear that this had an effect on their overall health. The review identified 11 randomized controlled trials involving 550 women that compared corticosteroid (dexamethasone, betamethasone, or prednisolone) given during pregnancy, just after delivery or in the postnatal period, or both before and after birth, with placebo or no treatment. Two further trials showed that there was no clear difference between dexamethasone and betamethasone on the substantive clinical outcomes for women or their infants. Dexamethasone did improve maternal platelet count and some biochemical measures to a greater extent than betamethasone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Protein supplementation of human milk for promoting growth in preterm infants

Not enough evidence to show the effect of protein supplementation of breast milk for promoting growth in preterm babies. Breast milk is the best source of nutrition for full‐term babies but babies born preterm (before 37 weeks) have different nutritional needs. It is possible that premature breast milk may not meet all these needs. Preterm infants need more protein but also use up protein more quickly than full‐term babies. The review of trials found that adding protein to breast milk increases short‐term weight gain and body growth. However, too much protein given in formula can cause problems with infant development in the longer term. More research is needed to find the safest and most effective levels of protein supplementation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Carnitine supplementation of parenterally fed neonates

Not enough evidence that carnitine supplements improve weight gain in parenterally fed newborns. Preterm newborns (born before 37 weeks) frequently need extra nutritional supplements parenterally (given other ways than by the mouth). Carnitine is an amino acid found in both breast milk and infant formulas but is not routinely given parenterally. It helps fatty acids to convert into energy and helps in growth. The review of trials found not enough evidence to show any benefit of parenteral carnitine supplements on weight gain or lipid tolerance in preterm newborns. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Intermittent regimens of iron supplementation during pregnancy

Anaemia is a frequent condition during pregnancy, particularly among women from developing countries who have insufficient iron intake to meet increased iron needs. Traditionally, pregnancy anaemia has been prevented with the provision of daily iron supplements, however, it has recently been proposed that if women take supplements less often, such as once or twice weekly rather than daily, this might reduce side effects and increase acceptance and adherence to supplementation. In this review we assess the benefits and harms of intermittent (i.e. one, two or three times a week on non‐consecutive days) oral supplementation with iron or iron+folic acid or iron+vitamins and minerals for pregnant women.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Postnatal thyroid hormones for preterm infants with transient hypothyroxinaemia

A systematic overview of randomised trials does not provide sufficient evidence to determine whether thyroid hormone treatment of preterm infants with transiently low thyroid hormone levels results in changes in neonatal outcomes or reductions in developmental impairments. Extremely premature infants frequently have transiently low thyroid hormone levels in the first weeks after birth. These low thyroid hormone levels are associated with an increased incidence of complications and death in the newborn period and longer term developmental impairments. Thyroid hormone therapy might prevent these problems. One small trial comparing thyroid hormone treatment to no treatment of infants with transiently low thyroid hormone levels reported no benefit from treatment of these infants. However, this is insufficient evidence to determine if thyroid hormone treatment is effective. Further research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

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  • Premature infant
    A premature infant is a baby born before 37 completed weeks of gestation (more than 3 weeks before the "due date").
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