A considerable number of intraventricular hemorrhages (IVH) occur within the first hours of life (HOL). Temporality between IVH and its antecedents as well as a consistent definition of “early IVH” is lacking in a large and growing body of literature. We performed a systematic review of prospective studies that reported onset of IVH in preterm neonates within the first HOL and afterwards. The English literature was searched using three databases up to March 2013. Four timing periods of IVH can be compared in 16 identified studies: 0-6; 7-12; 13-24; after 24 HOL. The 0-6 and after 24 HOL were the major modes of IVH timing. Pooled IVH proportions were estimated through a meta-analysis of studies that were conducted after antenatal steroid and surfactant era. In neonates weighing ≤1500 g at birth: 48% of IVH (95% CI: 42-58%, 5 studies, 279 IVH cases) occurred during 0-6 HOL and 38% (95% CI: 19-57%, 4 studies, 241 IVH cases) after 24 HOL. The 0-6 HOL is the shortest, most vulnerable period for IVH, thus, an early IVH is an IVH occurs in it. Such early IVH had prognostic, etiological/preventive and medicolegal implications. Accordingly, preterm neonates at risk of IVH should have their first routine screening head ultrasound at about 6 HOL. Future research exploring the antecedents of IVH should guaranty the temporality between these antecedents and IVH. Additional research will be required to determine whether the long term neurological outcomes of early and late IVH are the same.
Objective: To study a hypothesis that keeping preterm infants' heads in midline positions reduces their risk of intraventricular hemorrhage (IVH). Methods:We conducted a pilot randomized trial to study this hypothesis by comparing the IVH risk associated with flat midline (FM) and flat lateral (FL) head positions throughout the first seven days of life. Randomization was stratified based on gender and gestational age (< 27 or 27-29.9 weeks).Results: Twenty-three infants younger than 30 weeks gestation were randomly assigned to the FM group, and 21 infants of similar age were assigned to the FL group (right-tilted: n = 9; left-tilted: n = 12). Important baseline characteristics were similar in both groups, except for multiple births which were significantly higher in the FM group. The risk of IVH was higher in the FM group than in the FL group (6 vs. 4; risk ratio (RR) 1.4; 95% confidence interval (CI): 0.4-4.2; p = 0.8). A secondary analysis showed that the risk of IVH was two times higher in the FM group than in the right-tilted FL group (6 vs. 1; RR 2.3; 95% CI: 0.3-16.9; p = 0.6) and was the same in the FM and left-tilted FL groups (6 vs. 3; RR 1.0; 95% CI: 0.3-3.5; p >0.99). Conclusions:Keeping a preterm infant´s head in the FM position throughout the first seven days of life does not decrease the risk of IVH; however, a right-tilted FL position may reduce this risk. A larger study is needed for a definitive conclusion. 1176RADIOGRAPHIC Conclusions: Preterm infants are exposed to a number of radiographs in the early weeks of life due to associated morbidities and also have diagnostic procedures that may involve X ray radiation. Repeated handling for radiographs can cause clinical instability and accumulation of a radiation dose that can have serious health consequences. Careful consideration should be given before requesting a radiograph in this vulnerable group. THE EFFECTS OF
BackgroundBreaking bad news (BBN) to parents whose newborn has a major disease is an ethical dilemma. In Saudi Arabia, BBN about newborns is performed according to the parental preferences that have been reported from non-Arabic/non-Islamic countries. Saudi mothers' preferences about BBN have not yet been studied. Therefore, we aimed to elicit the preferences of Saudi mothers about BBN concerning newborns.MethodsWe selected a convenience sample of 402 Saudi mothers, aged 18-50 years, who had no previous experience with BBN. We selected them via a simple number-randomization scheme from the premises of a level III Saudi hospital between October of 2009 and January of 2011. We used a hypothetical situation (BBN about trisomy 21) to elicit their preferences about BBN concerning newborns via a structured verbal questionnaire composed of 12 multiple-choice questions. We expressed their preferences as percentages (95% confidence interval), and we used the Kendall's W test (W) to assess the degree of agreement in preferences.ResultsThe Saudi mothers preferred that BBN be conducted with both parents together (64% [60-69]), albeit with weak levels of agreement (W = 0.29). They showed moderate agreement in their preferences that BBN should be conducted early (79% [75-83], W = 0.48), in detail (81% [77-85], W = 0.52), in person (88% [85-91], W = 0.58), and in a quiet setting (86% [83-90], W = 0.53). With extremely weak agreement, they preferred to have a known person present for support during BBN (56% [51-61], W = 0.01), to have close bodily contact with their babies (66% [61-70], W = 0.10), and to have no another patients present (64% [59-68], W = 0.08). They showed moderate levels of agreement in their desires to detail, in advance, their preferences about process of BBN by giving a reversible, written informed consent that could be utilized for guidance, if needed (80% [76-84], W = 0.36).ConclusionsIn our experience, Saudi mothers' preferences about BBN concerning newborns are varied, suggesting that a "one-size-fits-all" approach is inappropriate. A reversible, written informed consent detailing their preferences about BBN that would be kept in their medical records and utilized for guidance, if needed, may be the best solution, given this level of diversity. These findings merit further study.
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