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Neonatology

When Should Breastfed Babies Be Supplemented?
 When Should Breastfed Babies Be Supplemented? 1024 575 Vanessa Shanks
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This question has received increasing attention in the last several years, especially when considering supplementation for late preterm and early term babies. As more hospitals focus on promoting and supporting breastfeeding, supplementation rates have decreased for infants in the newborn nursery. However, there has been increasing awareness from primary care providers who may see these…

Novel Intervention Helps Infants With Cerebral Palsy Develop Arm and Hand Function
 Novel Intervention Helps Infants With Cerebral Palsy Develop Arm and Hand Function 1024 683 Abbie Miller
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A new NIH-funded randomized controlled trial shows that an intervention combining a patented soft restraint harness, therapist coaching and parent training increases reach smoothness, fine motor skills and tactile sensation in the more-affected upper extremity. For the first time in infants with CP under 2, a clinical trial of this type of intervention was shown…

Prevention and Treatment of Early-Onset Sepsis in Newborns
 Prevention and Treatment of Early-Onset Sepsis in Newborns 1024 575 Mary Bates, PhD
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Continued surveillance is needed to monitor pathogen distribution and antibiotic resistance. Early-onset sepsis remains a potentially fatal condition among newborns, particularly pre-term infants. According to a new study published in JAMA Pediatrics, ongoing surveillance is required to optimize prevention and treatment strategies. The study included data from 18 centers of the Eunice Kennedy Shriver National Institute…

How a Network of Hospitals Reduced Average Age at Cerebral Palsy Diagnosis to 9.5 Months
 How a Network of Hospitals Reduced Average Age at Cerebral Palsy Diagnosis to 9.5 Months 1024 683 Katie Brind'Amour, PhD, MS, CHES
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In just one year, hospital teams working as part of a network to implement international cerebral palsy diagnosis guidelines successfully reduced average age at diagnosis from 19.5 months to 9.5 months. More than 50% of all eventual cerebral palsy (CP) cases spend time in the Neonatal Intensive Care Unit, making early CP evaluation a crucial…

Systems Analyses Unravel Clinical Phenotypes in Infants with Respiratory Syncytial Virus Infection
 Systems Analyses Unravel Clinical Phenotypes in Infants with Respiratory Syncytial Virus Infection 1024 575 Mary Bates, PhD
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RSV disease severity is influenced by innate immune responses, viral loads and patient age. Respiratory syncytial virus (RSV) is a leading cause of hospitalization in children, although most cases result in mild disease. To develop effective antivirals and vaccines, a better understanding of the different clinical, immunologic and virologic factors present in infants with mild…

Searching for a Predictive Biomarker of Pulmonary Hypertension in Babies With Bronchopulmonary Dysplasia
 Searching for a Predictive Biomarker of Pulmonary Hypertension in Babies With Bronchopulmonary Dysplasia 1024 575 Abbie Miller
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Pulmonary hypertension is high blood pressure in the lungs and is a comorbidity of bronchopulmonary dysplasia (BPD), which is the chronic lung disease of premature babies. When pulmonary hypertension is present in the context of BPD, the risk of death is significantly increased. As neonatologists continue to define the phenotype of severe BPD, Jennifer Trittmann, MD, MPH,…

THRIVING After Severe Bronchopulmonary Dysplasia
 THRIVING After Severe Bronchopulmonary Dysplasia 1024 731 Abbie Miller
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Meet Willow. She was born via emergency C-section at just 22 weeks. Doctors at the delivering hospital told Willow’s mom Cortney that her baby’s chances of survival were low. But after a long journey through the newborn intensive care unit (NICU) at Nationwide Children’s Hospital, Willow is a vivacious 4-year-old looking forward to starting kindergarten…

Timing Steroids to Maximize Lung Benefit and Avoid Brain Harm in Premature Infants
 Timing Steroids to Maximize Lung Benefit and Avoid Brain Harm in Premature Infants 1024 575 Mary Bates, PhD
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Nurse caring for infant in Neonatal Intensive Care Unit (NICU)

Treating infants early may decrease risk of lung disease with no added risk of neurodevelopmental impairment. Steroids are used to treat extremely premature babies with respiratory failure, yet they can be associated with delays in brain development. A recent study looked at the age of first steroid administration and the risks of lung disease and neurodevelopmental impairment…

What is the Association Between Kidney Injury and Fluid Balance in Premature Newborns?
 What is the Association Between Kidney Injury and Fluid Balance in Premature Newborns? 1024 575 Mary Bates, PhD
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Nurse caring for infant in Neonatal Intensive Care Unit (NICU)

A positive fluid balance is associated with acute kidney injury and worse outcomes in a new study of premature infants. According to new research, there is an association between fluid balance and outcomes in preterm newborns, with a negative fluid balance during the first week of life emerging as a potential therapeutic target. Premature infants…

Asymptomatic Infants With Congenital Cytomegalovirus May Still Have Detectable, Significant Abnormalities
 Asymptomatic Infants With Congenital Cytomegalovirus May Still Have Detectable, Significant Abnormalities 1024 575 Katie Brind'Amour, PhD, MS, CHES
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Color photo of Black father holding infant on shoulder in front of nursery background with clouds on the wall

More than half of high-risk CMV-positive newborns may have abnormalities not detected by a physical exam alone. A study in 34 infants with a normal physical exam despite a positive diagnosis of congenital cytomegalovirus (CMV) — a viral infection that can lead to neurodevelopmental delays and permanent hearing loss — found that in more than…

Link Found Between Respiratory Syncytial Virus Infection and Asthma
 Link Found Between Respiratory Syncytial Virus Infection and Asthma 800 533 Mary Bates, PhD
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RSV infection early in life increases risk of subsequent wheezing or asthma. Respiratory syncytial virus (RSV) is the leading cause of hospitalization in infants all over the world. It can lead to serious acute infections, and new research from Nationwide Children’s shows RSV infection can also have long-term health consequences. In a new study, researchers…

Percutaneous Occlusion Linked to Respiratory Improvements in Low-Weight Infants with PDA
 Percutaneous Occlusion Linked to Respiratory Improvements in Low-Weight Infants with PDA 1024 575 Abbie Miller
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Nurse caring for infant in Neonatal Intensive Care Unit (NICU)

Percutaneous occlusion for patent ductus arteriosus (PDA) in infants weighing less than 6 kg is associated with potential longer term improvements in respiratory health, research by investigators at Nationwide Children’s Hospital shows. “A new device for PDA closure recently approved by the FDA has potential to reduce the incidence of device-related complications. This important work…

Does Newborn Screening Lead to Life-Span Benefits?
 Does Newborn Screening Lead to Life-Span Benefits? 1024 678 Kevin Mayhood
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To find the answer, researchers suggest data systems to track long-term care and outcomes are needed. Newborns in the United States are screened for a list of diseases, a practice that saves or improves 13,000 lives annually, the Centers for Disease Control and Prevention estimates. But, a group of health experts who helped build the…

Rethinking Gastroesophageal Reflux Disease (GERD) in Infants
 Rethinking Gastroesophageal Reflux Disease (GERD) in Infants 150 150 Lauren Dembeck
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Novel use of existing technology points to other causes of GERD-like symptoms. While typically attributed to gastroesophageal reflux disease (GERD), supra-esophageal symptoms, such as cough, back arching and gagging, can be temporally associated with aerophagia, according to a new study by researchers at Nationwide Children’s Hospital. The findings come from the novel implementation of standard…

Improving Medication Dosing Consistency for Infants With Neonatal Abstinence Syndrome
 Improving Medication Dosing Consistency for Infants With Neonatal Abstinence Syndrome 150 150 Abbie Miller
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A quality improvement initiative effectively increases the percentage of infants dosed according to birth weight. From 2000 to 2009, prenatal maternal opiate use increased from 1.2 to 5.6 per 1,000 births, with up to 80% of in utero exposed infants requiring pharmacotherapy for neonatal abstinence syndrome (NAS). In Ohio, home of Nationwide Children’s Hospital, the exposure rate…

Surprise Finding in Respiratory Syncytial Virus Infection Viral Load Study
 Surprise Finding in Respiratory Syncytial Virus Infection Viral Load Study 150 150 Lauren Dembeck
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Understanding viral load dynamics can help inform treatment decisions Respiratory syncytial virus (RSV) lower respiratory tract infection is a leading cause of hospitalization and mortality in infants worldwide, but a licensed RSV vaccine has not yet been developed, in part due to the incomplete understanding of RSV pathogenesis. While investigating the relationship between RSV viral…

Family Support Linked to Resilience in Kindergarteners Born Preterm
 Family Support Linked to Resilience in Kindergarteners Born Preterm 150 150 Adelaide Feibel
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Despite known adverse outcomes associated with prematurity, a large minority of kindergarteners born preterm exhibit none of them. For years, medical researchers have dedicated countless hours to studying the adverse outcomes of premature births. But in their attempts to illuminate the incidence of cognitive, behavioral and learning deficits in preterm and low-birth-weight infants, researchers have…

Skin-to-Skin Care Safe for Infants After Surgery
 Skin-to-Skin Care Safe for Infants After Surgery 150 150 Mary Bates, PhD
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A quality improvement project shows that skin-to-skin care can be safely integrated into the treatment of infants who require surgery. Multiple barriers prevent routine skin-to-skin care for infants in the neonatal intensive care unit (NICU), particularly for infants requiring surgical consultation. A recent quality improvement project, published in the Journal of Pediatric Surgery, shows that routine…

Optimal Use of an FDA-Approved Device for PDA Closure in Infants
 Optimal Use of an FDA-Approved Device for PDA Closure in Infants 150 150 Mary Bates, PhD
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Randomized, controlled clinical trials are needed to answer questions regarding when and with whom to use the device. In January 2019, the US Food and Drug Administration approved a novel device for patent ductus arteriosus (PDA) closure in infants. The Amplatzer Piccolo Occluder is indicated for catheter-based closure of PDA in infants weighing more than…

CMV Testing: Why You Don’t Need Legislation to Make It a Good Idea
 CMV Testing: Why You Don’t Need Legislation to Make It a Good Idea 1024 575 Samantha Morsink
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CMV is the leading non-genetic cause of sensorineural hearing loss in infancy and childhood. Identification of newborns with congenital CMV infection can improve their outcomes by early intervention programs and/or antiviral treatment. Cytomegalovirus, or CMV, infects almost everyone at some point in time, and it is one of the most common congenital infections worldwide. While…

Swallowing Functions Remain Worse in Preterm Infants Even at Full-Term Equivalent Age
 Swallowing Functions Remain Worse in Preterm Infants Even at Full-Term Equivalent Age 150 150 Abbie Miller
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Preterm infants exerted greater effort than full-term infants to consume less than half the volume in a recent study led by researchers at Nationwide Children’s Hospital. Preterm infants face many challenges as they enter the world too soon. One of the biggest challenges is learning the coordination of the suck-swallow refex that allows them to…

What’s Next for NEC?
 What’s Next for NEC? 898 504 Abbie Miller
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Red. White. Black. These are the colors of necrotizing enterocolitis, or NEC. When surgeons open the distended abdomens of the tiny infants affected by NEC, they see a mottled mixture of red (inflamed), white (ischemic) and black (dead) tissue. Their first task is to assess whether or not there is enough viable tissue to save.…

Acid Reflux Index Severity Alone Should Not Determine GERD Diagnosis
 Acid Reflux Index Severity Alone Should Not Determine GERD Diagnosis 150 150 Kevin Mayhood
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ARI severity plays little role in symptom generation, but symptoms alone are unreliable for diagnosing gastroesophageal reflux disease, researchers say. However, a new study from the Neonatal and Infant Feeding Disorders Program at Nationwide Children’s Hospital shows that stomach acid alone doesn’t appear to have much to do with GERD at all, and responses to esophageal stimulation…

A Simple Measure to Help Early Detection of Hemiplegic Cerebral Palsy in Infants
 A Simple Measure to Help Early Detection of Hemiplegic Cerebral Palsy in Infants 150 150 Jeb Phillips
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An easily derived Hammersmith Infant Neurological Examination asymmetry score, in combination with the total HINE score, differentiates typically developing infants from those with hemiplegic CP. While cerebral palsy can now be diagnosed at 6 months of age – allowing for earlier interventions and better potential outcomes than ever before – evaluation can be difficult in…

Acid Suppression Should Not Be the First Treatment for Infants With Reflux
 Acid Suppression Should Not Be the First Treatment for Infants With Reflux 150 150 Mary Bates, PhD
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Gastroesophageal reflux (GER) is common in infants. Many show no symptoms more serious than agitation and frequent regurgitation, and most cases resolve on their own by the time the child is 1 year old.

Despite a paucity of well-controlled clinical trials, acid suppression medications are commonly prescribed for infants with GER. In a paper published in Pediatric Drugs, physician researchers from Nationwide Children’s Hospital review the data regarding acid suppressants for infants as well as clinical practice guidelines for how and when to use these medications.

Beyond Survival: Improving Social Development in Preterm Infants
 Beyond Survival: Improving Social Development in Preterm Infants 150 150 Mary Bates, PhD
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Prediction of Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension by Combining Clinical and Genetic Data
 Prediction of Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension by Combining Clinical and Genetic Data 150 150 Lauren Dembeck
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Prenatal Magnesium Sulfate May Not Reduce Cerebral Palsy Severity as Once Believed
 Prenatal Magnesium Sulfate May Not Reduce Cerebral Palsy Severity as Once Believed 1024 575 Jeb Phillips
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Improved neonatal care and earlier diagnosis and management may instead be reason for a decrease in cerebral palsy severity. A large randomized controlled trial showed in 2008 that when pregnant women at imminent risk of preterm delivery were given magnesium sulfate, their children had reduced rates of moderate or severe cerebral palsy. As a result…

Researchers Identify Proteins Triggering Imbalance of Cells in Chronic Lung Disease
 Researchers Identify Proteins Triggering Imbalance of Cells in Chronic Lung Disease 1024 575 Kevin Mayhood
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Illustration of lungs on blue silhouette of upper chest on black background

A protein that triggers an imbalance of mucous and ciliated cells in patients with chronic lung disease could be a target for treatments to restore airways. Many chronic lung diseases in children and adults have one thing in common: the airway lining that normally traps and sweeps out bacteria, viruses and diesel particulates stops functioning…

Neonatal Abstinence Syndrome: Transforming Care for Newborns and Their Families
 Neonatal Abstinence Syndrome: Transforming Care for Newborns and Their Families 1024 575 Abbie Miller
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If there’s a success story to be told at this point in the history of the opioid crisis, it’s in the newborn intensive care unit. From changing attitudes to standardizing treatment, clinical care for infants with neonatal abstinence syndrome (NAS) and their families is markedly different than it was 10 years ago.   CHANGING ATTITUDES…

What Happens When Opioid-Exposed Babies Go Home?
 What Happens When Opioid-Exposed Babies Go Home? 1024 575 Abbie Miller
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Black and white image of an unsmiling White woman holding a young, awake infant in the right third of the frame

Follow-up for babies with NAS or prenatal opioid exposure is essential for understanding risks and outcomes.

Feeding Difficulties in Opioid-Exposed Infants — Mechanics and Possible Causes
 Feeding Difficulties in Opioid-Exposed Infants — Mechanics and Possible Causes 1024 575 Kevin Mayhood
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A recent study suggests altered vagus nerve activity, creating resistance in the esophagus while swallowing. Infants exposed to opioids prenatally often show signs of gastroesophageal reflux disease. But a study by neonatologists at Nationwide Children’s Hospital found that feeding troubles are more likely due to excessive pressure and a lack of coordinated muscle contractions in…

The PDA Conundrum
 The PDA Conundrum 150 150 Jeb Phillips
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A patent ductus arteriosus is associated with increased morbidity and mortality, but common treatments are associated with poor outcomes as well. What is a neonatologist to do? Until the mid-2000s, most neonatologists were pretty sure they knew how to handle a patent ductus arteriosus (PDA) in an infant born preterm – it needed to be…

Can We Prevent Future Language Delays in the NICU?
 Can We Prevent Future Language Delays in the NICU? 150 150 Abbie Miller
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Researchers investigate the use of event related potentials to measure the effects of mother’s voice exposure on speech sound differentiation. Preterm infants are at high risk for neurosensory impairments and developmental delays, including hearing loss, which may have lasting consequences. Compared to babies born at term, preterm infants are twice as likely to have a…

Care Bundles Can Reduce Hospital-Acquired Pressure Injuries
 Care Bundles Can Reduce Hospital-Acquired Pressure Injuries 150 150 Brianne Moore
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Reliable implementation of care bundles reduces the number of serious hospital-acquired pressure injuries Hospital-acquired pressure injuries (PI) are a significant cause of preventable harm that can increase hospitalization costs and length of stay. Up to 27 percent of pediatric intensive care unit (PICU) patients and up to 23 percent of neonatal intensive care unit (NICU)…

On the Road to Eliminating RSV
 On the Road to Eliminating RSV 150 150 Abbie Miller
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With the recent publication of two papers, researchers shed light on factors that influence disease severity and immune response to respiratory syncytial virus infection in infants and young children. “RSV is a very common infection in infants and young children – almost everyone will be infected by age 2. In the United States, 2-3 percent…

Mapping the Journey to Optimal Health for NICU Graduates
 Mapping the Journey to Optimal Health for NICU Graduates 1024 683 Jeb Phillips
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Babies born preterm need ongoing, specialized care to help them thrive after discharge from the hospital. Innovative programs are being designed to ensure that they get that care. In the early 1980s, only 10 percent of infants born before 28 weeks of gestational age survived to be discharged from the hospital. By 2015, 65 percent…

Integrating Research Into the “Journeys”
 Integrating Research Into the “Journeys” 1024 683 Jeb Phillips
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Along with their work to build an innovative follow-up program, Nationwide Children’s faculty and staff members are international leaders in NICU follow-up research. A number of foundation and National Institutes of Health-funded follow-up studies are housed entirely or in part at the hospital, and The Research Institute at Nationwide Children’s is one of 17 member…

In Extremely Preterm Babies, SNAP-II Score Predicts Brain Impairments at Age 10
 In Extremely Preterm Babies, SNAP-II Score Predicts Brain Impairments at Age 10 150 150 Kevin Mayhood
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Measures taken in first 12 hours of life are associated with a host of deficits. Children born extremely preterm are known to be at increased risk of neurodevelopmental impairments, but not all babies born the same early date and weight are equal. Researchers have found that for children born at less than 28 weeks, a…

How to Solve Feeding Disorders Without a G-Tube
 How to Solve Feeding Disorders Without a G-Tube 1024 575 Jeb Phillips
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Babies in a neonatal intensive care unit must have a safe way of receiving nutrition in order to go home. Full oral feeding is ideal, of course. But for those patients with persistent difficulty feeding by mouth, there were two primary options before 2002 to guarantee nutrients by the time of discharge. Both had their…

Best Practices in Severe BPD Treatment
 Best Practices in Severe BPD Treatment 150 150 Jeb Phillips
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To help standardize care, the Bronchopulmonary Dysplasia Collaborative has published a comprehensive review of evidence-based approaches for treatment of patients with severe forms of the disease. Infants with severe bronchopulmonary dysplasia (BPD) have high risks of late morbidities and mortality, but the best ways to manage these vulnerable patients are still debated. In fact, it’s…

How a QI Intervention Lowered Breast Milk Errors in a Busy NICU
 How a QI Intervention Lowered Breast Milk Errors in a Busy NICU 150 150 Kevin Mayhood
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Bedside barcode scanners and dedicated milk preparation technicians helped drive the decline. A quality improvement (QI) initiative in the Neonatal Intensive Care Unit (NICU) at Nationwide Children’s Hospital has been associated with a substantial reduction in errors administering mother’s milk to these vulnerable infants. The total number of scanned errors declined from 97.1 per 1,000…

How to Reduce Necrotizing Enterocolitis in the NICU
 How to Reduce Necrotizing Enterocolitis in the NICU 150 150 Jeb Phillips
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A QI project with simple, inexpensive interventions significantly lowered the NEC rate in one of the country’s largest neonatal units. In 2011, a quality improvement team at Nationwide Children’s Hospital developed a short list of simple, economical strategies to limit necrotizing enterocolitis (NEC), one of the leading causes of morbidity and mortality in its associated…

Diagnosing GERD in Neonates? Be Cautious
 Diagnosing GERD in Neonates? Be Cautious 150 150 Jeb Phillips
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Gastroesophageal reflux disease is likely over-diagnosed in neonates, leading to unnecessary and harmful treatment. Approximately 10 percent of infants born preterm in the United States are diagnosed with gastroesophageal reflux disease (GERD). But it’s almost certain that not all of those babies actually have GERD, say neonatologists at Nationwide Children’s Hospital. The probable over diagnosis leads to…

One Dose Probiotic Biofilm Protects Against NEC
 One Dose Probiotic Biofilm Protects Against NEC 150 150 Kevin Mayhood
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Probiotic biofilm enables the beneficial bacteria to withstand stomach acid, promote microbial activity and decrease intestinal inflammation. A single dose of a probiotic biofilm grown on microspheres prevented or significantly reduced the severity of necrotizing enterocolitis (NEC) in animal models of the disease, researchers show. This delivery method not only appears to protect against NEC…

Often-Unreported MRI Finding May Indicate Neurodevelopmental Impairment in Premature Infants
 Often-Unreported MRI Finding May Indicate Neurodevelopmental Impairment in Premature Infants 150 150 Jeb Phillips
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Moderate-to-severe gyral maturation delay emerged as a significant predictor of overall neurodevelopmental delay in premature infants with extremely low birth weights Magnetic resonance imaging of the brain is increasingly used to predict neurodevelopmental outcomes in premature infants, but the existing systems of scoring those MRIs rely heavily on expert opinion. A recent study led by…

For Infants Born Very Preterm, Transcatheter Device Closure of Patent Ductus Arteriosus is Feasible
 For Infants Born Very Preterm, Transcatheter Device Closure of Patent Ductus Arteriosus is Feasible 150 150 Jeb Phillips
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Optimal timing of procedures and reduction of adverse events are avenues for future study. Approximately half of babies born at less than 32 weeks of gestational age have persistent patent ductus arteriosus (PDA), a condition associated with higher odds of death and respiratory morbidity. When doctors choose to close the ductus, a percutaneous approach is…

Despite Safety Concerns, Nearly 1 in 4 Babies in the NICU Receive Acid Suppressing Medications
 Despite Safety Concerns, Nearly 1 in 4 Babies in the NICU Receive Acid Suppressing Medications 150 150 Jeb Phillips
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While use is dropping overall as doctors heed warnings, acid suppressing medication originally formulated for older children and adults is still being given to nearly 25 percent of babies in the NICU. Since 2006, several published studies have associated the use of some acid suppression medications in hospitalized high-risk babies with infections, necrotizing enterocolitis and…

The Smallest Victims of the Opioid Crisis
 The Smallest Victims of the Opioid Crisis 1024 575 Abbie Miller
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Black and white photo of infant crying in hospital

Research, protocols and community connections lead to help infants with neonatal abstinence syndrome and their mothers. It’s a sound you’d never forget. The panicked, high-pitched cry of a newborn withdrawing from the drugs his mother took. All the sensations that drive an addict to use again and again just for the relief – shaking, vomiting,…

Weaning Babies with NAS Better and Faster
 Weaning Babies with NAS Better and Faster 150 150 Kevin Mayhood
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Protocol enables babies born addicted to opioids to be weaned off the drugs faster. Adoption of a strict protocol has enabled six regional perinatal centers across Ohio to wean babies exposed to opioids in utero off drugs faster, send them home sooner and lower the use of adjunctive drugs, new research shows. In response to the skyrocketing…