Drs. Myra Wyckoff @UTSWNews and Jonathan Wyllie provide an update on @Ilcor_org guidelines for neonatal life support #HotTopicsNeo2020 #neoEBM
Here is a link to the summary of updated guidelines: ahajournals.org/doi/10.1161/CI…
Recommendation (weak) against routine direct laryngoscopy and tracheal suctioning for non-vigorous newborn infants delivered through meconium-stained amniotic fluid
For sustained inflation, @Ilcor_org provide a weak recommendation against sustained inflation for preterm infants based on possibility of harm (RR mortality with sustained inflation 1.38; 1.00-1.91 in subgroup of infants <28 weeks' gestation #neoEBM
Here is the @Ilcor_org recommendations for sustained inflation, with no recommendation for term or late preterm infant
Regarding initial oxygen targets in preterm infants, the Torpedo trial (Oei et al., stopped for futility, with potential for high risk of bias) pubmed.ncbi.nlm.nih.gov/28034908/ showed different treatment effects from prior studies
The @Ilcor_org guidelines provide a weak recommendation to start with a lower oxygen target (21-30%) compared to higher (60-100%) for preterm infants <35 weeks' gestation, based on the very low certainty of evidence
Dr. Wyllie does highlight some of the gaps in knowledge and uncertainty in evidence of oxygen saturation targets
Regarding duration of resuscitation, @Ilcor_org provided a narrative recommendation, informed by a recent systematic-review and meta-analysis by Dr. Foglia pubmed.ncbi.nlm.nih.gov/32788267/
Thank you to @Ilcor_org and the community of over 50 members from around the world that help to synthesize the evidence for neonatal resuscitation and provide essential guidance to the global neonatal community

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More from @EBNEO

7 Dec
To conclude "New Approaches to Cooling", Sudhin Thayyil (@SudhinThayyil) of @imperialcollege discusses the “Hypothermia for Encephalopathy in Low and Middle-Income Countries (HELIX) Trial”

Trial protocol: pubmed.ncbi.nlm.nih.gov/28923118/

#HotTopicsNeo2020 @HotTopicsNeo #neoebm Image
Thayyil: current guidelines recommend therapeutic cooling in LMIC settings. Supported by MA findings, but based on small, low quality studies.

#HotTopicsNeo2020 @HotTopicsNeo #neoebm ImageImage
Thayyil: Aim, setting, eligibility, sample size and target outcomes for the HELIX trial.

#HotTopicsNeo2020 @HotTopicsNeo #neoebm ImageImageImageImage
Read 8 tweets
7 Dec
Next up in "New Approaches to Cooling" Deirdre Murray of @CUH_Cork discussing “Neurodevelopmental Outcomes after Mild HIE.” Read more about Prof. Murray and her work: infantcentre.ie/who-we-are-2/o…

#HotTopicsNeo2020 @HotTopicsNeo Image
Murray begins by defining the population discussed in her lecture: those with encephalopathy 2/2 perinatal asphyxia.

#HotTopicsNeo2020 @HotTopicsNeo Image
How do infants with different HIE severity grades perform on IQ testing at 5 years of age? Summary from:
pubmed.ncbi.nlm.nih.gov/27650049/, which includes additional outcomes measures.

Take home point: mild and moderate HIE infants similar.

#HotTopicsNeo2020 @HotTopicsNeo Image
Read 6 tweets
7 Dec
Last in the Rx for BPD trio at #HotTopicsNeo2020: Dr. Reese Clark of @MEDNAX with: "What Drugs are we Using? Practice Variability and Potential Harm." Read more about Dr. Clark's distinguished care:
blog.mednax.com/mednax-neonato…
@HotTopicsNeo Image
Reese: Talk to focus on steroid use. To begin, what postnatal steroids are we using? Dexamethasone and hydrocortisone most common systematic exposures, budenoside most common inhaled exposure.

#HotTopicsNeo2020 @HotTopicsNeo Image
The unstoppable pendulum of postnatal steroid use; data from @MEDNAX clinical data warehouse suggests use again on the rise.

#HotTopicsNeo2020 @HotTopicsNeo Image
Read 4 tweets
7 Dec
Next up in #HotTopicsNeo2020: Erik Jensen of @ChildrensPhila discussing how the baseline risk of BPD impacts the number needed to treat when considering effective therapies.

chop.edu/doctors/jensen…

@HotTopicsNeo Image
Presentation builds on recently published report in @JPediatr: drugs to Prevent Bronchopulmonary Dysplasia: Effect of Baseline Risk on the Number Needed to Treat
jpeds.com/article/S0022-…

#HotTopicsNeo2020
Jensen: objectives of talk:

#HotTopicsNeo2020 @HotTopicsNeo Image
Read 8 tweets
7 Dec
From the last session on periviability at @HotTopicsNeo, let’s get the pulse of the #neoEBM community with a few surveys (thread) #HotTopicsNeo2020
What is the earliest gestational age, assuming dating is correct, where you (or your hospital) routinely offer active postnatal resuscitation if desired by the family
If an infant at 22-24 weeks GA has evidence of inadequate organ perfusion (low urine output, decreasing BP), what is your first line treatment:
Read 6 tweets
7 Dec
First up in: "Pharmacotherapy for BPD: We Know Less than We Think We Do" at #HotTopicsNeo2020 is Dr. Gerri Baer (@thegerribaer), Team Leader for Neonatology @US_FDA, discussing "Challenges in Studying Drugs for BPD"
@HotTopicsNeo #neoEBM Image
Baer: no (zero, zilch, none!) drugs approved in the USA to prevent or treat BPD.

Highlights various cohorts demonstrating the ongoing high burden of BPD:

#HotTopicsNeo2020 @HotTopicsNeo Image
Baer: broad view of challenges to BPD Rx, illustrated by 3 buckets: understanding phenotypes/endotypes, definitions and classification and choosing adequate endpoints.
#HotTopicsNeo2020 @HotTopicsNeo Image
Read 5 tweets

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