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Neonatology

Acid Reflux Index Severity Alone Should Not Determine GERD Diagnosis
 Acid Reflux Index Severity Alone Should Not Determine GERD Diagnosis 150 150 Kevin Mayhood
By: Kevin Mayhood

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
By: Jeb Phillips

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
By: Mary Bates, PhD

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.

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
By: Jeb Phillips

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
By: Kevin Mayhood
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 633 Abbie Miller
By: Abbie Miller
Nurse with scrubs holding an infant

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 683 Abbie Miller
By: Abbie Miller
Baby laying in a wooden crib looking up at the camera

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
By: Kevin Mayhood
Infant laying on a white blanket

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
By: Jeb Phillips

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
By: Abbie Miller

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
By: Brianne Moore

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
By: Abbie Miller

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
By: Jeb Phillips

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
By: Jeb Phillips
A healthcare provider engages warmly with a young child, helping her with a small medical item.

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
By: Kevin Mayhood

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 683 Jeb Phillips
By: Jeb Phillips
side view of a newborn baby getting fed a bottle

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
By: Jeb Phillips

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
By: Kevin Mayhood

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
By: Jeb Phillips

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
By: Jeb Phillips

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
By: Kevin Mayhood

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
By: Jeb Phillips

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
By: Jeb Phillips

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
By: Jeb Phillips

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 788 Abbie Miller
By: Abbie Miller
Infant crying in women's arms.

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
By: Kevin Mayhood

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…

Better Care and Better Business
 Better Care and Better Business 150 150 Dave Ghose
By: Dave Ghose

The changing economics of health care are forcing hospitals to find solutions that are good for patients and for the bottom line. A puzzled neonatologist approached Richard McClead, MD, after he spoke at a conference in Boston. It was 2010, and Dr. McClead just finished detailing a new initiative at Nationwide Children’s Hospital to reduce the…

An Ethical Discussion of Parental Care Preference
 An Ethical Discussion of Parental Care Preference 150 150 Jan Arthur
By: Jan Arthur

Two infants with the same prognosis have parents with different preferences in terms of care. What should the medical team do? The article, “Two Infants, Same Prognosis, Different Parental Preferences,” published in the May 2015 issue of Pediatrics, presents a challenging ethical dilemma that brings into question the best interest standard and quality-of-life value judgments among…

Delayed Umbilical Cord Clamping May Benefit Some High-Risk Newborns
 Delayed Umbilical Cord Clamping May Benefit Some High-Risk Newborns 150 150 Jeb Phillips
By: Jeb Phillips

Recent studies show the practice can offer circulatory advantages for infants born extremely preterm or with critical congenital heart disease. The practice of immediate or early umbilical cord clamping after birth has been the norm since research in the 1950s and 1960s showed that most blood volume for full term babies was achieved “within the…

What Do DALYs Mean for Pediatrics?
 What Do DALYs Mean for Pediatrics? 150 150 Dave Ghose
By: Dave Ghose

An emerging, innovative metric could radically change childhood health policy. A new way of looking at illness is beginning to change how public health officials view life and death. The concept — called DALYs — offers a fuller view of disease that could have a big impact on pediatrics if embraced. Unlike death tolls —…

Conflicting Directions for BPD Treatment
 Conflicting Directions for BPD Treatment 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Treatment of bronchopulmonary dysplasia differs dramatically among institutions. But why does variation matter? Recent studies report extreme variation among hospitals ordering three common medications for chronic lung disease, or bronchopulmonary dysplasia, calling into question the appropriateness of their use and the reason for their prescription. “In the use of diuretics, inhaled bronchodilators and inhaled corticosteroids,…

Placental Transfusion Confusion
 Placental Transfusion Confusion 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Medical professional organizations cannot reach consensus regarding delayed cord clamping and umbilical cord “milking.” Nearly every relevant professional organization has its own recommendations for placental transfusion techniques known as delayed umbilical cord clamping and milking. But it’s unclear whether additional research will lead to consensus. The American Congress of Obstetricians and Gynecologists and American Academy of Pediatrics say there’s…

Study Finds Cow’s Milk is Added to Breast Milk and Sold to Parents Online
 Study Finds Cow’s Milk is Added to Breast Milk and Sold to Parents Online 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Deceptive Internet advertisements for human breast milk may put infants at risk. What do parents (and doctors) need to know about milk sharing? A study published yesterday on the safety of human breast milk bought over the Internet found that 10 percent of samples contained added cow’s milk. The discovery that purchased samples of human milk may…

Are We Properly Capturing the Maternal-Child Health Continuum?
 Are We Properly Capturing the Maternal-Child Health Continuum? 150 150 Irina Buhimschi
By: Irina Buhimschi

An obstetrician doing research at a children’s hospital may seem out of place. But not according to one clinician-scientist, who believes that maternal health and child health are inextricably intertwined. Traditionally, doctors divide into those who practice adult medicine and those who practice pediatrics. With the exception of family physicians, there is little crossover in…

Using Zinc for Growth Delays in Babies Born Preterm
 Using Zinc for Growth Delays in Babies Born Preterm 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Zinc supplementation in extremely low birth-weight (ELBW) infants with chronic lung disease improves weight gain and linear growth, according to a retrospective study performed at Nationwide Children’s Hospital. The study is one of the first to look at the association between zinc supplementation and growth in ELBW babies with chronic lung disease, also known as bronchopulmonary dysplasia.…

Evolution of an Atlas
 Evolution of an Atlas 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Adult brain atlases have existed for years. Why is it so crucial — and so difficult — to build one for preemies? Even experts need maps. They give perspective, scale and orientation. They can show both current location and the final destination. And in the world of premature brains, they can offer vital information about…