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Medscape
28-05-2025
- General
- Medscape
NICU Admissions Higher in Pregestational Diabetes
Neonatal intensive care unit (NICU) admission rates were significantly higher among infants born to mothers with pregestational diabetes than among those born to mothers with gestational diabetes (GD). METHODOLOGY: This Irish study compared risks for NICU admission across maternal diabetes subtypes (type 1 diabetes [T1D], type 2 diabetes [T2D], and GD) to refine counselling and neonatal care. Researchers conducted a retrospective analysis of 25,238 births (January 2018 to December 2020) and identified 3905 neonates born ≥ 34 weeks to mothers with diabetes, including those with T1D (n = 67), T2D (n = 60), and GD (n = 3712). Data on gestational age, birth weight, mode of delivery, and maternal age were extracted from the registry. NICU admission details (indications, hypoglycaemia, and respiratory support) and maternal characteristics (body mass index [BMI] > 30 and preeclampsia) were obtained via electronic records. The analysis was performed using quasi-Poisson regression for assessing NICU admission risk ratios (RRs), analysis of variance for comparing gestational age/birth weight, and chi-square tests for comparing categorical variables. The primary outcome was the NICU admission rate; secondary outcomes included respiratory distress, severe hypoglycaemia, and maternal discharge timing. TAKEAWAY: Neonates born to mothers with T1D and T2D had a admission rate of 41.8% (RR, 3.32) and 31.1% (RR, 3.89), respectively, with both significantly higher than that in those born to mothers with GD (12.5%; RR, 0.133; P ≤ .001); the hospital baseline admission rate was 11.5%. ≤ .001); the hospital baseline admission rate was 11.5%. Neonates of mothers with T1D were born earlier (mean, 37 + 1 weeks) than those of mothers with T2D (mean, 38 + 1 weeks; P = .0019) and GD (mean, 39 weeks; P ≤ .001). = .0019) and GD (mean, 39 weeks; ≤ .001). Moreover, they showed significantly higher birth weight centiles than those of mothers with T2D and GD at 25th (T1D vs T2D, P = .0042; T1D vs GD, P ≤ .001), median ( P ≤ .0001 for both), and 75th centiles (T1D vs T2D, P ≤ .0001; T1D vs GD, P = .0009). = .0042; T1D vs GD, ≤ .001), median ( ≤ .0001 for both), and 75th centiles (T1D vs T2D, ≤ .0001; T1D vs GD, = .0009). Respiratory distress dominated T1D admissions (36.7%), while hypoglycaemia was primary in T2D (73.7%). Mothers with pregestational diabetes were more frequently discharged before their infants (T1D, 42.9%; T2D, 31.5%) than those with GD (21.2%). IN PRACTICE: "It is important to counsel mothers on risks and expectations for the newborn period," the authors of the study wrote. "The aim of our study is to describe how the type of maternal diabetes impacts admission to NICU and to provide up-to-date, local data to support healthcare professionals when counselling patients with diabetes in pregnancy," they added. SOURCE: This study was led by Dearbhla Hillick, Rotunda Hospital, Dublin, Ireland. It was published online on May 22, 2025, in the European Journal of Pediatrics . LIMITATIONS: This study was limited by the dataset being unbalanced, with most neonates born to mothers with GD. Neonates of mothers without diabetes requiring NICU admission were not included. Factors such as maternal smoking, raised BMI, or preeclampsia possibly confounded the NICU admission risk. DISCLOSURES: Open access funding was provided by the IReL Consortium. The authors reported having no relevant conflicts of interest.
Medscape
14-05-2025
- Health
- Medscape
Adult Sugammadex Dosing Safe, Effective in Kids Aged < 2
Sugammadex doses of 2 and 4 mg/kg, recommended for adults and children aged 2 years or older, were safe and effective for reversing neuromuscular blockade (NMB) in neonates and infants younger than 2 years. The 2-mg/kg dose of sugammadex reversed moderate NMB faster than neostigmine plus glycopyrrolate or atropine (neostigmine), whereas the 4-mg/kg dose led to a rapid reversal of deep NMB. METHODOLOGY: Researchers conducted a phase 4, multicenter clinical trial (July 2019-September 2023) to assess the tolerability and efficacy of sugammadex in reversing NMB in children younger than 2 years. Overall, 138 children (mean age, 164 days; 66.7% boys) received NMB induced by rocuronium or vecuronium for surgeries such as repair of a cleft lip or an inguinal hernia, and orchidopexy. The first part of the trial was open label and involved pharmacokinetic assessments of 2- and 4-mg/kg doses of sugammadex to determine if dose adjustment was necessary based on age. The second part was double blind, with patients randomly assigned to receive a 2-mg/kg dose of sugammadex for reversing moderate NMB (defined as return of second twitch), neostigmine for reversing moderate NMB, or a 4-mg/kg dose of sugammadex for reversing deep NMB (defined as a post-tetanic count of 1 or 2). The primary efficacy endpoint was time to neuromuscular recovery. TAKEAWAY: Doses of sugammadex of 2 and 4 mg/kg were found appropriate for reversing moderate and deep NMB in children younger than 2 years, according to pharmacokinetic assessments performed in the first part of the trial. In moderate NMB, time to neuromuscular recovery was significantly faster with the 2-mg/kg dose of sugammadex than with neostigmine (hazard ratio, 2.40; P = .0002). = .0002). A rapid neuromuscular recovery for deep NMB was achieved over a median of 1.1 minutes with the 4-mg/kg dose of sugammadex. Procedural pain and vomiting were the most frequently reported adverse events, with no significant differences observed between the sugammadex and neostigmine groups. No deaths or drug-related serious adverse events were reported with either doses of sugammadex. IN PRACTICE: 'These results support the use of sugammadex doses of 2 mg/kg and 4 mg/kg, the same doses as recommended for children > 2 years old and adults, for reversing rocuronium- or vecuronium-induced moderate and deep NMB in the youngest pediatric population from birth to < 2 years of age,' the researchers reported. SOURCE: This study was led by Edith Mensah-Osman, MD, PhD, and Yuki Mukai, MD, from Merck & Co., Inc., Rahway, New Jersey. It was published online on May 5, 2025, in Anesthesiology . LIMITATIONS: The pharmacokinetic analyses in the first part of the trial involved a relatively small number of participants, particularly for the cohort of infants aged 1 month or younger. The study was not designed as a dose-ranging trial but rather to confirm established doses from older age groups. The potential influence of the total dose of NMB agents was not evaluated. DISCLOSURES: This study received funding from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. Nine authors reported being employed by and owing stocks in the funding agency, and two authors reported receiving research grants from the same organization.
