BACKGROUND AND OBJECTIVES: Thrombocytopenia is associated with late closure of patent ductus arteriosus (PDA). There are few studies evaluating platelet transfusions to treat PDA. We compared liberal platelet-transfusion criteria (to maintain a platelet count >100 000 per µL) versus standard criteria achieve earlier PDA closure among thrombocytopenic preterm neonates (<35 weeks’ gestation) with hemodynamically significant PDA (hs-PDA) presenting within the first 2 weeks of life. METHODS: Thrombocytopenic (<100 000 per µL) preterm neonates with hs-PDA were enrolled and randomly allocated to the liberal and standard transfusion groups: 22 in each arm. They underwent echocardiography daily until closure of PDA, completion of 120 hours follow-up, or death. All subjects received standard cotreatment with nonsteroidal antiinflammatory drugs. Primary outcome of time to PDA closure was compared by survival analysis. Multivariate Cox proportional hazard regression was performed with randomization group, baseline platelet count, gestational age, and age at enrollment as predictor variables. RESULTS: Median time to PDA closure was 72 (95% confidence interval [CI] 55.9–88.1) versus 72 (95% CI 45.5–98.4) hours in the liberal versus restrictive transfusion groups, respectively (unadjusted hazard ratio 0.88 [95% CI 0.4–1.9]; P = .697). Despite adjusting for potential confounders, there was no significant difference in time to PDA closure. In the liberal transfusion group, 40.9% of infants had any grade of intraventricular hemorrhage compared with 9.1% in the restrictive group (P = .034). CONCLUSIONS: Attempting to maintain a platelet count >100 000 per µL by liberally transfusing platelets in preterm thrombocytopenic neonates with hs-PDA does not hasten PDA closure.

Meconium aspiration syndrome is associated with significant mortality. Myocardial dysfunction, birth weight, and initial oxygen requirement are independent predictors of mortality.

Objective To estimate the direct causes of mortality among preterm neonates <33 weeks' gestation by examining three large multicentric, hospital-based datasets in India. Method Three prospective hospital-based datasets: National Neonatal Perinatal Database (NNPD) of India, Delhi Neonatal Infection Study (DeNIS) cohort, and Goat Lung Surfactant Extract (GLSE)-Plus cohort were analyzed to study the causes of death among preterm neonates of less than 33 weeks' gestation admitted to the participating tertiary care hospitals in India. Results A total of 8024 preterm neonates were admitted in the three cohorts with 2691 deaths. Prematurity-related complications and sepsis contributed to 53.5% and 19.8% of deaths in the NNPD cohort, 51.0% and 25.0% in the DeNIS cohort, and 39.7% and 40.9% in GLSE-Plus cohort, respectively. Conclusions Nearly a quarter (20-40%) of preterm neonates less than 33 weeks' gestation admitted to Indian NICUs died of sepsis. The study results have implications for health policies targeted to reduce the neonatal mortality rate in India.

Objective To test the hypothesis that oral paracetamol is non-inferior to oral ibuprofen in closing hemodynamically significant patent ductus arteriosus (hsPDA) with an a priori noninferiority (NI) margin of 15%. Study design Multicenter, randomized, controlled, NI trial conducted in level III neonatal intensive care units. Consecutively inborn preterm neonates of <32 weeks of gestation with hsPDA were included. Those with structural heart disease, major malformations, and contraindications for enteral feeding or for administration of study drugs were excluded. Interventions included oral paracetamol in the experimental arm and oral ibuprofen in the active control arm. The primary outcome was closure of hsPDA by 24 hours from the last dose of the study drug. Secondary outcome measures included closure of hsPDA by 24 hours after the first course of the study drug, rate of reopening after the first course, and adverse events associated with the study drug. Results Out of 1250 neonates screened, 161 were randomized. Oral paracetamol was noninferior to oral ibuprofen in closure of hsPDA by both per protocol analysis (62 [95.4%] vs 63 [94%]; relative risk [RR], 1.01 [95% CI, 0.94-1.1]; risk difference [RD], 1.4 [95% CI, À6 to 9]; P = .37) and intention-to-treat analysis (63 [89%] vs 65 [89%]; RR, 0.99 [95% CI, 0.89-1.12]; RD, À0.3 [95% CI, À11 to 10]; P = .47). All adverse events were comparable in the 2 study arms. Conclusions Oral paracetamol is noninferior to oral ibuprofen for the closure of hsPDA in preterm neonates of <32 weeks of gestation. No difference was observed in the adverse events studied.

In preterm infants with respiratory distress starting within 6 h of life, CPAP failure rates were similar with Jet CPAP and Bubble CPAP.

WHAT'S KNOWN ON THIS SUBJECT: Pulse oximeter is better than skin color assessment in the initial minutes of life. After sensor application, a delay occurs in the display of reliable saturation and heart rate. An appropriate method of sensor placement can minimize the delay. WHAT THIS STUDY ADDS:Attaching sensor first to oximeter and then to neonate picked up signal faster than attaching it to the neonate first and then to the equipment. However, the time from birth to display of reliable signal was similar between the methods. abstract OBJECTIVE: This study was done to compare 2 techniques of pulse oximeter sensor application during neonatal resuscitation for faster signal detection. METHODS:Sensor to infant first (STIF) and then to oximeter was compared with sensor to oximeter first (STOF) and then to infant in $28 weeks gestations. The primary outcome was time from completion of sensor application to reliable signal, defined as stable display of heart rate and saturation. Time from birth to sensor application, time taken for sensor application, time from birth to reliable signal, and need to reapply sensor were secondary outcomes. An intentionto-treat analysis was done, and subgroup analysis was done for gestation and need for resuscitation. RESULTS:One hundred fifty neonates were randomized with 75 to each technique. The median (IQR) time from sensor application to detection of reliable signal was longer in STIF group compared with STOF group (16 [15-17] vs. 10 [6-18] seconds; P ,0.001). Time taken for application of sensor was longer with STIF technique than with STOF technique (12 [10-16] vs. 11 [9-15] CONCLUSIONS: In the delivery room setting, the STOF method recognized saturation and heart rate faster than the STIF method. The time from birth to reliable signal was similar with the 2 methods. Pediatrics

The risk factors, clinical trends, and maternal and fetal health of early-and late-onset preeclampsia have not been adequately studied. We examined the effects of early-and late-onset preeclampsia on maternal and perinatal outcomes as well as the known risk factors of preeclampsia. Methods One hundred and fifty women with preeclampsia were consecutively enrolled in each group. Those who developed preeclampsia before 34 weeks of gestation were identified as having early-onset preeclampsia, while those who developed at 34 weeks or later were identified as having late-onset preeclampsia. Maternal and perinatal outcomes were compared between groups. Results Compared with the late-onset group, the early-onset group had higher rates of abruptio placentae (16% vs. 7.3%; P=0.019), but there was no intergroup difference in the composite maternal outcomes. A significantly higher number of women with early-onset preeclampsia developed severe features during the disease course, and most required treatment with antihypertensive drugs. Late-onset preeclampsia was more prevalent among primigravid mothers. Babies born to mothers with early-onset preeclampsia had a significantly higher rate of adverse outcomes. Conclusion These study findings indicate that women with early-onset preeclampsia had more adverse outcome than those with late-onset preeclampsia, but the difference was not statistically significant. There were more babies with adverse perinatal outcomes in the early-than late-onset group.

Thrombocytopenia within 24 hours of birth independently predicts delayed PDA closure and PDA on day 7 in preterm neonates.