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Newborn health

This section contains RHL summaries of published systematic reviews on care of the newborn infant, newborn nutrition and feeding and management of unwell newborns.

Management of the unwell newborn

Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants

RHL summary The administration of restricted supplemental oxygen compared with unrestricted oxygen in preterm and low-birth-weight infants significantly reduces the incidence and severity of retinopathy of prematurity, without affecting mortality rates. Further research is required to determine the...

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Surfactant for meconium aspiration syndrome in term and late preterm infants

Intratracheal surfactant administration to term and late preterm infants with meconium aspiration syndrome (MAS) can reduce the need for ECMO and their length of hospital stay, however there is no clear impact on infant mortality.

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Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants

RHL Summary Key findings There is no clear evidence that delaying the introduction of progressive enteral feeds affected the risk of NEC or death Delaying the introduction of feeds results in a delay of one to three days until full enteral feeding is achieved. The clinical significance of this...

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Volume-targeted versus pressure-limited ventilation in the neonate

RHL summary In some preterm babies, ventilator-assisted breathing can be lifesaving, but such an intervention can also damage the baby’s immature lungs. New ‘volume targeted’ modes of ventilation have aim to reduce lung injury by controlling the amount of air entering the lungs with each breath...

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Furosemide for transient tachypnoea of the newborn

An updated version of this systematic review has been published and can be found online at www.cochrane.org . We will soon update the below RHL summary to reflect the updated findings of the systematic review. RHL summary Findings of the review : This review includes two trials that had evaluated...

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Newborn nutrition and feeding

Formula milk versus donor breast milk for feeding preterm or low birth weight infants

RHL summary An updated version of this systematic review has been published and can be found online at www.cochrane.org . We will soon update the below RHL summary to reflect the updated findings of the systematic review. Feeding preterm and low birth weight infants with formula milk compared to...

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Enteral iron supplementation in preterm and low-birth-weight infants

Available evidence is insufficient to assess the effect of enteral iron supplementation on the neurodevelopmental and long-term growth outcomes for preterm and low-birth-weight infants. In both groups of infants, iron supplementation marginally improved haemoglobin levels and iron stores and reduced...

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Cup-feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed

This Cochrane review found that, compared with bottle-feeding, cup-feeding confers no significant benefit in maintaining breastfeeding beyond discharge from hospital. Moreover, cup-feeding was associated with a longer stay in hospital for infants. However, these findings may not be applicable to under-resourced settings since most of the studies included in the review had been conducted in hospitals in developed countries, and the number of infants studied was relatively small to yield reliable results from a meta-analysis.

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Protein supplementation of human milk for promoting growth in preterm infants

In preterm infants, human milk supplemented with protein leads to short-term increases in weight and linear and head growth. However, preterm infants fed only breast milk suffer not only from protein deficit but also deficits in energy, calcium, phosphate, trace minerals and vitamins. Hence, in...

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Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants

Infants in the ad libitum or demand/semi-demand feeding group had a shorter duration of hospital stay compared with those in the scheduled feeding group, but weight gain in both groups was similar. None of the studies in the review were from under-resourced settings, where staff resources are...

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Avoidance of bottles during the establishment of breast feeds in preterm infants

Preterm infants who received supplemental feeds with the aid of a cup were more likely to be breastfeeding on discharge from hospital compared with those who received their supplemental feeds through a bottle. However, cup-feeding was associated with longer hospital stay and breastfeeding continuation rates were not significantly higher in cup-fed infants beyond discharge from hospital.

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Nutrient-enriched formula versus standard term formula for preterm infants following hospital discharge

Meta-analyses of trials that had followed-up the babies for 12–18 months did not find any statistically significant differences in the growth parameters between babies fed with nutrient-enriched formula or standard term formula. Two trial in which follow-up was done for up to 6 months, in fact,...

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Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants

RHL Summary Key findings There is no clear evidence that delaying the introduction of progressive enteral feeds affected the risk of NEC or death Delaying the introduction of feeds results in a delay of one to three days until full enteral feeding is achieved. The clinical significance of this...

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Care of the newborn infant

Breastfeeding or breast milk for procedural pain in neonates

In term and preterm healthy neonates, compared with placebo, no treatment, swaddling or pacifier, breast-feeding or breast milk feeding in general reduces procedural pain of heel lance or venepuncture, regardless of setting.

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Naloxone for opiate-exposed newborn infants

Citation: East CE, Smyth RMD, Leader LR, Henshall NE, Colditz PB, Lau R,Tan KH. Vibroacoustic stimulation for fetal assessmentin labour in the presence of a nonreassuring fetal heart rate trace.Moe-Byrne T, Brown JVE, McGuire W. Naloxone for opiate-exposednewborn infants.Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD003483. DOI: 10.1002/14651858.CD003483.pub2.

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WHO recommendation on skin-to-skin contact during the first hour after birth

Newborns without complications should be kept in skin-to-skin contact (SSC) with their mothers during the first hour after birth to prevent hypothermia and promote breastfeeding.

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Sucrose for analgesia in newborn infants undergoing painful procedures

Administration of oral sucrose (in dosages of 0.5–2 ml of 12%–50% solution) approximately two minutes prior to single heel lance is effective in providing pain relief in both term and preterm infants. However, the longer-term effects of sucrose, especially for extremely premature babies, who are at the greatest risk of receiving repeat doses, is not known.

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Early volume expansion for prevention of morbidity and mortality in very preterm infants

An updated version of this systematic review has been published and can be found online at www.cochrane.org. We will soon update the below RHL summary to reflect the updated findings of the systematic review. Early volume expansion in preterm very-low-birth-weight does not appear to have any clinically significant benefit. The role of early volume expansion in such infants is therefore questionable because of the complex pathophysiological mechanisms leading to cardiovascular compromise in these infants.

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WHO recommendation on bathing and other immediate postnatal care of the newborn

Bathing should be delayed until 24 hours after birth. If this is not possible due to cultural reasons, bathing should be delayed for at least six hours. Appropriate clothing of the baby for ambient temperature is recommended. This means one to two layers of clothes more than adults, and use of hats...

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WHO recommendation on newborn routine nasal or oral suction

In neonates born through clear amniotic fluid who start breathing on their own after birth, suctioning of the mouth and nose should not be performed.

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WHO recommendation on breastfeeding as soon as possible after birth

All newborns, including low-birth-weight (LBW) babies who are able to breastfeed, should be put to the breast as soon as possible after birth when they are clinically stable, and the mother and baby are ready.

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Skin-to-skin care for procedural pain in neonates

Citation: Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin-to-skin care for procedural pain in neonates.Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD008435. DOI: 10.1002/14651858.CD008435.pub2.

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Standardised formal neonatal resuscitation training (SFNRT) programmes for reducing mortality and morbidity in newborn infants

The review assessed whether SNFRT programmes can reduce neonatal mortality and morbidity, improve knowledge and skills, or change teamwork and resuscitation behaviour (compared to no SNFRT).

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WHO recommendation on haemorrhagic disease prophylaxis using vitamin K

All newborns should be given 1 mg of vitamin K intramuscularly after birth (i.e. after the first hour by which the infant should be in skin-to-skin contact with the mother and breastfeeding should be initiated).

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