Pediatrics

Expectant PDA management matches drug closure for BPD/death and improves survival

Extremely preterm infants (22-28 weeks; median 25 weeks, 760 g) with protocol-defined PDA were randomized to expectant management or pharmacologic closure. Death or bronchopulmonary dysplasia at 36 weeks’ postmenstrual age was similarly high in both groups (about 81% vs 80%). Mortality before 36 weeks was lower with expectant management, including fewer infection-related deaths. The trial stopped early for futility and safety due to higher survival in the expectant group. These results support conservative PDA management and caution against routine early pharmacologic closure in extremely preterm infants. 1

Initial FiO2 0.3 vs 0.6 in preterm resuscitation yields similar death/brain injury

Preterm infants at 23-28 weeks’ gestation were randomized to initial resuscitation with FiO2 0.6 vs 0.3 and titrated to standard saturation targets. Death or brain injury by 36 weeks’ corrected age occurred in about 47% of infants in both groups (relative risk 0.98). Escalation to FiO2 1.0 was common and similar across arms, reflecting comparable illness severity. These findings indicate that starting at FiO2 0.6 does not improve short-term survival or brain outcomes compared with FiO2 0.3. Delivery room protocols can safely emphasize careful titration over higher initial oxygen fractions in this population. 2

US nonreceipt of intramuscular vitamin K is increasing and unevenly distributed

This cohort study assessed recent US trends in newborns not receiving intramuscular vitamin K prophylaxis. The proportion of infants who did not receive IM vitamin K increased over time. Nonreceipt clustered within particular demographic groups and regions, suggesting strong local drivers and beliefs. These findings support targeted anticipatory counseling, standardized consent processes, and institutional policies to preserve vitamin K coverage. 3

Selected 21-week infants can survive to NICU discharge with intensive care

In a single level IV NICU, 22 infants were born alive at 21 weeks’ gestation, and 17 received resuscitation attempts. Six resuscitated infants survived to NICU discharge, one remained hospitalized, and ten died. Survivors were more likely to have received complete antenatal corticosteroids and less likely to be from multiple gestations. Most survivors had early hemodynamic and respiratory instability requiring vasoactive agents and/or inhaled nitric oxide but were discharged on low-flow oxygen without tracheostomy. Intraventricular hemorrhage ranged from none to severe, yet no survivor required neurosurgical intervention. These data show that survival at 21 weeks is possible with highly selective, resource-intensive care, informing periviability counseling. 4