Diuretics are used in preterm infants to treat the symptoms of bronchopulmonary dysplasia (BPD), although there is little evidence of their effectiveness in improving long-term outcomes. Prescribing patterns and frequency of diuretic use in patients with BPD are unknown.

The use of diuretics in infants with BPD, including the specific medications used and length of treatment, varies widely by institution. Long-term diuretic administration to patients with BPD is commonly practiced despite minimal evidence regarding effectiveness and safety. (Read the full article)

Adherence to infant feeding recommendations in the United States is low. The prevalence of early introduction of solid foods (<4 months of age) in the United States has been estimated to range from 19% to 29%.

Mothers’ most commonly cited reasons for early solid food introduction include perception of readiness, hunger, wanting to feed something in addition to breast milk or formula, perception of interest in solids, advice from a clinician, and to improve infant’s sleep. (Read the full article)

The American Academy of Pediatrics recommends neonates born at <37 weeks’ gestation receive a predischarge Infant Car Seat Challenge, meaning up to 500 000 infants qualify annually. However, little is known about incidence and risk factors for failure in this group.

This is the largest study to date to examine incidence and risk factors for failure of the Infant Car Seat Challenge. We sought to identify infants most at risk for failure to narrow the scope of testing. (Read the full article)

Medications used to treat gastroesophageal reflux disease (GERD) are some of the most widely used medications in children younger than 1 year. There are strong indications that GERD is overdiagnosed and overtreated.

The factors that drive overtreatment of GERD are not well understood, but it has been proposed that the use of the GERD disease label could perpetuate use of medication. In this study we find evidence for this possibility. (Read the full article)

Infant and neonatal mortality rates in the United States decreased markedly during the twentieth century but have not decreased notably during recent years. There has been an increase in preterm and low birth weight births in recent years.

The lack of decrease in infant and neonatal mortality rates in recent years is due in large part to the increasing proportion of preterm and low birth weight infants, particularly infants <500 g. (Read the full article)

Advances in the treatment of critically ill infants have increased survival of extremely low/very low birth weight and medically complex infants. Improved survival can result in prolonged mechanical ventilation and sometimes tracheostomy. Current tracheostomy rates for these infants are unknown.

This long-term review of infants discharged from a NICU with tracheostomies is the first to describe tracheostomy rates specifically in extremely low/very low birth weight infants. It focuses on long-term clinical outcomes and comorbidities rather than surgical complications. (Read the full article)

Recorded music, parent voices, and sung lullabies have been shown to increase oxygen saturation, nonnutritive sucking, and weight gain in premature infants.

Parent-preferred melodies and entrained live rhythm and breath sounds can enhance quiet alert and sleep states, suck response, and oxygen saturation in premature infants and significantly reduce fear and anxiety perception in parents. (Read the full article)

Pulse oximetry testing in newborns can detect asymptomatic cases of critical congenital heart defects and has been added to the US Recommended Uniform Screening Panel. However, the impact that earlier diagnosis may have on survival in this population is unclear.

One-year survival for infants with critical congenital heart defects has been improving over time, yet mortality remains high. Survival has been greatest for those diagnosed after 1 day of age and may increase more with screening using pulse oximetry. (Read the full article)

Juice consumption among 2- to 5-year-old children exceeds dietary recommendations. In 2007, the US Department of Agriculture revised the composition and quantities of prescribed foods in WIC food packages to align them with dietary guidelines. Juice allowances were reduced by approximately half.

WIC participants purchased about a quarter less juice volume after implementation of the revised WIC packages. Large reductions in WIC-provided juice were only partly compensated for by extra juice purchases with non-WIC funds. Little compensation occurred for other beverages. (Read the full article)

The Ages and Stages Questionnaires (ASQ) has been validated in many countries and translated into numerous languages. In most publications, it has been reported that the ASQ is accurate in detecting true problems in apparently healthy children and even in children with biological risk factors.

This report compares the third version of the ASQ and the Bayley Scales of Infant and Toddler Development, Third Edition, assessments. Psychometric properties showed a tendency to improve with testing age and when comparing term versus extremely preterm children. (Read the full article)

The systemic nonselective β-blocker propranolol hydrochloride is increasingly used as first-line management for infantile hemangiomas. Superficial nonulcerating lesions do not require systemic medications. Case series have suggested the efficacy of timolol; however, its safety has been questioned.

This randomized controlled trial indicates that timolol maleate 0.5% gel is a well-tolerated, safe, and effective treatment of superficial infantile hemangiomas. (Read the full article)

Extremely preterm infants who receive antihypotensive therapy have worse outcomes than untreated infants. The reasons for this are not clear. High-quality randomized trials have not been performed to date because of logistical challenges, thereby necessitating alternative methods of investigation.

Antihypotensive therapy administration was not associated with improved in-hospital outcomes for any of the 15 definitions of low blood pressure investigated. Alternative methods of deciding who to treat are needed to maximize patient benefit and minimize harm. (Read the full article)

Studies reveal that mothers of infants with colic (defined by Wessel’s criteria of >3 hours per day of distress) are more likely to develop depression. No studies have examined whether the consolability of infant crying predicts maternal depression risk.

Prolonged inconsolable infant crying has a stronger association with maternal depressive symptoms than overall daily duration of fussing and crying, suggesting that a mother’s report of inability to soothe her infant may be a powerful indicator of her depression risk. (Read the full article)

Public health policy focuses on reducing formula use for breastfed infants during the birth hospitalization. Observational evidence supports this approach, but no previous studies have examined the effect of early use of small volumes of formula on eventual breastfeeding duration.

Use of limited volumes of formula during the birth hospitalization may improve breastfeeding duration for newborns with high early weight loss. Reducing the use of formula during the birth hospitalization could be detrimental for some subpopulations of healthy term newborns. (Read the full article)

Infants aged <2 months are at highest risk for pertussis morbidity and mortality but are too young to receive pertussis vaccines. To protect young infants, the Advisory Committee on Immunization Practices recommends mothers receive 1 dose of Tdap during pregnancy.

This article evaluates the effect of Tdap during pregnancy compared with postpartum Tdap and cocooning in preventing infant pertussis cases, hospitalizations, and deaths, as well as their relative cost-effectiveness. (Read the full article)

Introduction of the pneumococcal conjugate vaccine was associated with decreased invasive pneumococcal disease (IPD) in children. Few data exist on the impact in infants aged 1 to 90 days, who are too young to be fully immunized.

The incidence and proportion of IPD in Utah infants aged 1–90 days remained stable after vaccine introduction. IPD caused by PCV7 serotypes decreased significantly in the post-vaccine period. Serotype 7F emerged as the predominant serotype and commonly resulted in meningitis. (Read the full article)

Infants with birth defects are more likely to be born preterm or with low birth weight and are at higher risk of death.

This study describes the prevalence of birth defects in a cohort of very low birth weight infants and evaluates in-hospital surgical procedures, morbidity, and mortality. (Read the full article)

Preterm neonates in resource-poor settings frequently develop hypothermia. Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in infants in developed countries.

For preterm infants born in a resource-poor health facility, placement in a plastic bag at birth can reduce the incidence of hypothermia at 1 hour after birth. (Read the full article)

Infants born late-preterm and early-term are at higher risk of morbidity and mortality compared with term infants. Home care practices recommended for all infants include supine sleep position, no smoke exposure, and breastfeeding to optimize health outcomes.

Our study provides new findings on the timing of hospital discharge, outpatient follow-up, and home care of late-preterm and early-term infants compared with term infants in the United States. (Read the full article)

The remarkable improvement in the survival of extremely premature infants has been well documented. However, there have been few cohort studies large enough to determine the neurodevelopmental outcomes of survivors born at 22 or 23 weeks.

The proportions of unimpaired or minimally impaired were 12.0% at 22 weeks (n = 75) and 20.0% at 23 weeks (n = 245). The outcomes were inferior compared with those for infants born at 24 and 25 weeks, but were improved compared with those in previous studies. (Read the full article)

Randomized controlled trials have shown that zinc supplementation during diarrhea substantially reduces the incidence and severity. However, the effect of short-course prophylactic zinc supplementation has been observed only in children >12 months of age.

The current study was able to show that short-course prophylactic zinc supplementation significantly reduced diarrhea morbidity in apparently healthy infants of 6 to 11 months even after 5 months of follow-up. (Read the full article)

Significant variation in the mortality of preterm infants has been observed among NICUs. Factors explaining this variation have been difficult to identify.

Sizable center differences in mortality exist, even among similarly sized NICUs in academic centers. Patient characteristics and center treatment rates explain some of the center effect, especially for the youngest infants, but a significant portion of these differences remains unexplained. (Read the full article)

Preterm infants in the NICU receive the greatest number of transfusions of any patient population. The administration of the long-acting erythropoiesis stimulating agent (ESA) darbepoetin to reduce or eliminate transfusions in preterm infants has not been evaluated.

Infants receiving ESAs received half the number of transfusions and were exposed to approximately half the donors compared with the placebo group. More than half of the ESA recipients (59% darbepoetin recipients, 52% erythropoietin recipients) remained untransfused during their hospitalization. (Read the full article)

Infants born late preterm and early term are at increased risk for short-term morbidities compared with term infants. Longer-term morbidity and disability in this group of infants is not well established.

Massachusetts infants born late preterm and early term are at increased risk of early intervention program enrollment than term infants. Boys and children whose mothers were less educated, older, and with public insurance were most affected. (Read the full article)

Among infants with birth weights of 501 to 1500 g born between 2000 and 2009, mortality and major morbidities among survivors declined.

Obstetrical and neonatal care practices for infants 501 to 1500 g changed significantly from 2000 and 2009, particularly decreased conventional ventilation and use of steroids for chronic lung disease and increased nasal continuous positive airway pressure and surfactant treatment after delivery. (Read the full article)

Brief periods of low oxygen saturation are common in infants while restrained in car safety seats. There is some evidence that an insert that allows the infant head to rest in a neutral position in sleep may reduce hypoxic episodes.

This randomized controlled study shows that the insert reduced numbers of obstructive apneas and the severity of desaturation events but did not significantly reduce the overall rate of moderate desaturations. (Read the full article)

Neonatal infections are frequent complications in very preterm infants, already at high risk of neurologic and cognitive disabilities. Few studies have linked neonatal infections and neurodevelopmental outcomes. Those that did evaluated children only to the age of 22 months.

This study assessed the respective effects of early- and late-onset sepsis and their association with 5-year neurodevelopmental outcomes. We identified a significant and cumulative risk of cerebral palsy when episodes of early- and late-onset sepsis were associated. (Read the full article)

Effective ventilation is fundamental to successful resuscitation of newborns, but face mask leak and airway obstruction are common during manual positive-pressure ventilation in the delivery room, which may compromise resuscitation.

Compared with a soft, round silicone face mask, using a nasal tube to provide respiratory support in the delivery room does not reduce the rate of intubation but may be a suitable alternative with equivocal efficacy. (Read the full article)

Bronchopulmonary dysplasia is associated with increased long-term neurodevelopmental and respiratory morbidity. Inhaled nitric oxide given to reduce morbidity in very preterm infants does not reduce the prevalence of bronchopulmonary dysplasia and has uncertain effects on long-term outcome.

Inhaled nitric oxide (5 ppm) given early in the course of respiratory illness in infants born before 29 weeks of gestation is not associated with changes in developmental or respiratory outcomes at 2 years of age corrected for prematurity. (Read the full article)

Preterm and low birth weight infants are at increased risk of hospitalization due to rotavirus gastroenteritis, and rotavirus vaccine is immunogenic and well tolerated among these infants when provided at or after discharge from the NICU.

Many preterm infants with a birth weight of ≤1500 g are not eligible to receive rotavirus vaccination because they remain in the NICU beyond the upper age limit recommended for immunization. New strategies are needed. (Read the full article)

Previous studies have reported that former late preterm infants are at increased risk for future learning and behavioral problems; thus it has been suggested that their development be closely monitored.

This population-based study indicates that the risk for attention deficit/hyperactivity disorder and learning disabilities may not be higher in former late preterm infants, and therefore intensive neurodevelopmental follow-up may not be required for all late preterm infants. (Read the full article)

Parents of premature infants are susceptible to developing trauma symptoms related to their NICU experience. There are no current well-established interventions that simultaneously address both parental trauma as well as redefinition of the parenting experience.

A brief, cost-effective, and feasible manualized intervention for NICU parents was effective in reducing both parental trauma and depression. Implementation of this intervention in the NICU setting has the potential to improve maternal well-being and infant outcomes. (Read the full article)

Abusive head trauma (AHT) is a type of physical child abuse, with infants at the highest risk. Parental characteristics associated with AHT include stress, young age, and current military service. However, a comprehensive evaluation of AHT among military families is lacking.

Risk factors and rates of AHT among military families are similar to civilian populations when applying a similar definition. Infants born preterm or with birth defects may have a higher abuse risk. (Read the full article)

Several studies have suggested that probiotics may prevent necrotizing enterocolitis and death in preterm infants. However, there are no data on the preventive effect of probiotics in infants with cyanotic congenital heart disease.

Although duration of hospitalization was not significantly decreased, Bifidobacterium lactis plus inulin appears to decrease the rate of nosocomial infection, necrotizing enterocolitis, and death in infants with cyanotic congenital heart disease. (Read the full article)

Research has focused on primarily white parents, months to years after their infant/child or adult child died of cancer, accidental injury, sudden infant death syndrome, or suicide. Many parents experience depression and/or posttraumatic stress disorder and greater risk for some physical health problems.

Data on hospitalizations, changes in and management of chronic conditions, complexity of medication regimens, depression, and posttraumatic stress disorder were collected over 13 months from 249 Hispanic, black, and white parents in 188 families who experienced an infant/child NICU/PICU death. (Read the full article)

Palivizumab prophylaxis prevents respiratory syncytial virus lower respiratory tract infection. An association between respiratory syncytial virus infection and subsequent recurrent wheezing has been suggested by many studies. Only a few studies conducted from Europe and North America have addressed this causal association.

In a prospective, multicenter, case-control study of 440 children with high follow-up rate of 98.4%, palivizumab prophylaxis administered to preterm Japanese infants (33–35 weeks’ gestational age) in their first respiratory season reduced the incidence of subsequent recurrent wheezing up to 3 years. (Read the full article)

Pertussis rates are on the rise in the United States. Infants often require hospitalization for pertussis. Vaccination can change hospitalization patterns for vaccine-preventable diseases. It is unknown if vaccinating adolescents for pertussis (recommended in 2006) might change infant hospitalization utilization.

Universal vaccination policy among adolescents against pertussis appears to have been effective in 3 of the 4 years we examined postvaccination. Further vaccination efforts among adolescents and adults are needed to prevent infantile hospitalization on a more consistent basis. (Read the full article)

Preterm infants are born with low serum levels and low body stores of tocopherol. Serum levels ≥0.5 mg/dL are required for protection against lipid peroxidation. Previous studies have shown good intestinal absorption of vitamin E given intragastrically to preterm infants.

Serum α-tocopherol increases after a single 50-IU/kg dose of vitamin E as dl-α-tocopheryl acetate given intragastrically to very preterm infants soon after birth; however, 30% of infants still have serum α-tocopherol level <0.5 mg/dL 24 hours after dosing. (Read the full article)

Certain characteristics of the sleep environment increase the risk for sleep-related, sudden, and unexplained infant death. These characteristics have the potential to generate asphyxia. The relationship between the deaths occurring in these environments and neurochemical abnormalities in the brainstem that may impair protective responses to asphyxia is unknown.

We report neurochemical brainstem abnormalities underlying cases of sudden infant death that are associated with and without potential asphyxial situations in the sleep environment at death. The means to detect and treat these abnormalities in infants at risk are needed. (Read the full article)

Bacteremia occurs in 2.2% of febrile infants who have a blood culture drawn. Regional data suggest that Escherichia coli, group B Streptococcus, and Staphylococcus aureus are leading causes; however, the geographic boundaries of these data limit universal applicability.

This is the first national study examining epidemiology of bacteremia in febrile infants admitted to a general inpatient unit. The most common pathogens were Escherichia coli (42%), group B Streptococcus (23%), and Streptococcus pneumoniae (6%). No Listeria monocytogenes was identified. (Read the full article)

Late-onset sepsis is a frequent complication of prematurity, contributing to morbidity and mortality. Although evidence is accumulating that administration of probiotics to very preterm infants reduces necrotizing enterocolitis (NEC) and all-cause mortality, the effect on late-onset sepsis is less clear.

The probiotic combination Bifidobacterium infantis, Streptococcus thermophilus, and Bifidobacterium lactis reduced NEC in very preterm infants, but not mortality or late-onset sepsis. Probiotics may be of greatest global value in neonatal settings with high rates of NEC. (Read the full article)

Better postnatal growth, especially head growth, associates with better cognitive development in preterm infants. Suboptimal postnatal growth is more common in infants with poor antenatal growth than in infants with normal growth.

Good weight gain and head circumference growth until 2 years was associated with better 5-year cognitive outcome in non–small for gestational age infants. Good head circumference growth around term age benefits the cognitive outcome of small for gestational age infants. (Read the full article)

A serum 25-hydroxyvitamin D (25(OH)D) concentration of 20 ng/mL meets the requirements of at least 97.5% of the population older than 1 year. A recommended dietary intake to achieve this serum 25(OH)D concentration has not been established during infancy.

Daily maternal (during pregnancy) and then infant vitamin supplementation with 1000/400 IU or 2000/800 IU increases the proportion of infants with 25(OH)D ≥20 ng/mL during infancy with the higher dose sustaining this increase for longer. (Read the full article)

Preterm infants dependent on parenteral nutrition are vulnerable to deficits in early postnatal nutritional intake. This coincides with a period of suboptimal head growth. Observational studies indicate that poor nutritional intake is associated with suboptimal head growth and neurodevelopmental outcome.

This study provides randomized controlled trial evidence that head growth failure in the first 4 weeks of life can be ameliorated with early nutritional intervention. Early macronutrient intake can be enhanced by optimizing a standardized, concentrated neonatal parenteral nutrition regimen. (Read the full article)

Cranial ultrasound is routinely used in identifying cerebral abnormalities in premature infants. Grade III and IV intraventricular hemorrhages, cystic periventricular leukomalacia, and late ventriculomegaly are all known predictors of adverse neurodevelopmental sequelae in these infants.

We reviewed neurodevelopmental outcomes among 2414 extreme preterm infants. Infants with grades I and II intraventricular hemorrhage had increased rates of neurosensory impairment, developmental delay, cerebral palsy, and deafness at 2 to 3 years’ corrected age. (Read the full article)

Preterm infants are at an increased risk of regulatory difficulties during infancy and of behavioral problems in childhood. In the full-term population, persistent crying problems that last beyond 3 months of age have been related to later behavioral problems.

Excessive crying by a preterm infant may reflect an increased risk for later behavioral problems and higher parenting stress even years later. Therefore, it is clinically relevant to assess systematically the crying behavior of preterm infants. (Read the full article)

Infant sleep and crying problems are common and associated with postnatal depression. No programs aiming to prevent all 3 issues have been rigorously evaluated.

A prevention program targeting these issues improves caregiver mental health, behaviors, and cognitions around infant sleep. Implementation at a population level may be best restricted to infants who are frequent feeders because they experience fewer crying and daytime sleep problems. (Read the full article)

Infants with trisomy 13 (T13) or trisomy 18 (T18) are known to have poor survival. Little is known about how very low birth weight (VLBW) impacts survival and morbidities among infants with T13 or T18.

We examined the risks of mortality and neonatal morbidities for VLBW infants with T13 or T18 compared with VLBW infants with trisomy 21 and VLBW infants without birth defects in a 16-year cohort from the Neonatal Research Network. (Read the full article)

In preterm infants receiving supplemental oxygen, manual control of the inspired oxygen fraction is often difficult and time consuming, which may increase the risk of complications. We developed a system for automatic oxygen control and proved its efficacy in the past.

A multicenter study adds evidence for the proposed automatic oxygen control system to significantly improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload compared with routine manual oxygen control. (Read the full article)

Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss and neurodevelopmental impairment in full-term infants. The incidence of congenital CMV infection in preterm infants and the possible associations with developmental outcomes are unknown.

This study defines the incidence of congenital CMV infection in very low birth weight infants and identifies strong associations of congenital CMV infection with hearing loss and adverse neurodevelopmental outcomes in this population. (Read the full article)