Neuroimaging of the preterm infant is a common assessment performed in the NICU. Timely and focused studies can be used for diagnostic, therapeutic, and prognostic information. However, significant variability exists among neonatal units as to which modalities are used and when imaging studies are obtained. Appropriate timing and selection of neuroimaging studies can help identify neonates with brain injury who may require therapeutic intervention or who may be at risk for neurodevelopmental impairment. This clinical report reviews the different modalities of imaging broadly available to the clinician. Evidence-based indications for each modality, optimal timing of examinations, and prognostic value are discussed.

Intramuscular administration of vitamin K for prevention of vitamin K deficiency bleeding (VKDB) has been a standard of care since the American Academy of Pediatrics recommended it in 1961. Despite the success of prevention of VKDB with vitamin K administration, the incidence of VKDB appears to be on the rise. This increase in incidence of VKDB is attributable to parental refusal as well as lowered efficacy of alternate methods of administration. The aim of this statement is to discuss the current knowledge of prevention of VKDB with respect to the term and preterm infant and address parental concerns regarding vitamin K administration.

Maturational changes in the gut start in utero and rapidly progress after birth, with some functions becoming fully developed several months or years post birth including the acquisition of a full gut microbiome, which is made up of trillions of bacteria of thousands of species. Many factors influence the normal development of the neonatal and infantile microbiome, resulting in dysbiosis, which is associated with various interventions used for neonatal morbidities and survival. Extremely low gestational age neonates (<28 weeks’ gestation) frequently experience recurring arterial oxygen desaturations, or apneas, during the first few weeks of life. Apnea, or the cessation of breathing lasting 15–20 s or more, occurs due to immature respiratory control and is commonly associated with intermittent hypoxia (IH). Chronic IH induces oxygen radical diseases of the neonate, including necrotizing enterocolitis (NEC), the most common and devastating gastrointestinal disease in preterm infants. NEC is associated with an immature intestinal structure and function and involves dysbiosis of the gut microbiome, inflammation, and necrosis of the intestinal mucosal layer. This review describes the factors that influence the neonatal gut microbiome and dysbiosis, which predispose preterm infants to NEC. Current and future management and therapies, including the avoidance of dysbiosis, the use of a human milk diet, probiotics, prebiotics, synbiotics, restricted antibiotics, and fecal transplantation, for the prevention of NEC and the promotion of a healthy gut microbiome are also reviewed. Interventions directed at boosting endogenous and/or exogenous antioxidant supplementation may not only help with prevention, but may also lessen the severity or shorten the course of the disease.

Objective In 2010, an American Academy of Pediatrics (AAP) clinical report recommended that except for emergent situations, premedication should be used for all endotracheal intubations in newborns. The purpose of this study is to ascertain the current practice of premedication before elective intubation. Study Design An online, survey-based questionnaire on the practice of premedication before nonemergent intubations was distributed via e-mail to neonatologists who are members of the Perinatal Section of the AAP. Results Although 72% of respondents believed premedication should be used in nonemergent intubations, only 34% of the respondents report frequently premedicating before intubation with significant variation among the neonatal units (46% among level 4 units and 27% in level 3 and 2 units) p = 0.000. About 44% of respondents report having a written protocol or guideline on premedication which significantly correlated with the use of premedication (62% in level 4, 33% in level 3, and 16% in level 2 units), p = 0.000. Conclusion Despite a recent AAP clinical report recommending the use of premedication before nonemergent endotracheal intubation, only one-third of neonatologists report frequent use of premedication and less than half of the institutions have a written protocol on premedication.

Paco2 transcutaneous Pco2 (Ptcco2). and end-tidal PcO2 (PetcO2) measurements were studied in 12 critically ill neonates. Ptcco2 was measured using a combination CO2/O2 sensor during the routine care of these patients. End-tidal sidestream sampling was performed during blood gas measurement as dictated by the patient's clinical condition. There was a linear correlation between Ptcco2 and Paco2 (n = 51. r = .71, slope = 0.90). Petco2 and Paco2 did not correlate as well (n = 51, r = .52, slope = 0.42). Acidosis negatively affected the correlation between Ptcco2 and Paco2 When pH was >7.30, r = .75 and slope = 1.28 (n = 38), whereas when pH was < 7.30, r = .62 and slope = 0.73 (n = 13). The presence or absence of a metabolic acidosis did not have a significant effect on the slopes obtained. Ptcco2 monitoring using combined sensors is a useful and practical means of monitoring in the neonatal ICU although acidosis affects the ability to correlate transcutaneous and arterial values. End-tidal sidestream measurements are not as clinically useful because they vary due to different ventilation/perfusion relationships in the sick neonate.

The objective of our study was to identify factors associated with the initiation of breast-feeding in a poor urban area. One hundred postpartum, nonadolescent, non-drug using mothers, 50 breast-feeding and 50 formula feeding, were consecutively interviewed. Breast-feeding women were more likely to be born outside of the United States (42 versus 14%, p = 0.002), have more years of education (12.1 ± 1.9 versus 10.9 ± 1.7, p = 0.002), be employed either prior to or during pregnancy (38 versus 16%, p = 0.000), be married (46 versus 26%, p = 0.037), be a nonsmoker (86 versus 64%, p = 0.011), have more prenatal visits (8.4 ± 7.3 versus 5.0 ± 5.9, p = 0.010), or have a breast-feeding mother (48 versus 26%, p = 0.023). There were no differences in age or ethnicity. The father of the breast-feeding baby was more likely to be better educated (12.0 ± 2.8 versus 10.5 ± 3.6 years, p = 0.022) and to work full-time (68 versus 40%, p = 0.005). Eighty-four percent of formula feeders knew that breast milk was better for their babies but decided not to breast-feed due to concerns of pain, smoking, and work. Sixty-three percent of women made the choice to breast-feed prior to the pregnancy, 26% during the pregnancy, and 11% after delivery. Significantly more multiparas decided prior to the pregnancy compared with primaparas. We recommend that breast-feeding education should be started prior to the first pregnancy and tailored to the concerns of the women.