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Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation.

Assessing and monitoring the physical growth of preterm infants is fundamental to NICU care. The goals of nutritional care are to approximate the growth and body composition of the healthy fetus and to support optimal brain development while minimizing future cardiometabolic risk. Both poor and excessive growth predict adverse long-term health outcomes. Growth curves are clinical tools used to assess the preterm infant’s growth status. Several growth curves for preterm infants were developed in the past decade. To use them effectively, clinicians need to understand how each growth curve was developed; the underlying reference population; intended use; and strengths and limitations. Intrauterine growth curves are references that use size at birth to represent healthy fetal growth. These curves serve 2 purposes—to assign size classifications at birth and to monitor postnatal growth. The INTERGROWTH-21st preterm postnatal growth standards were developed to compare the postnatal growth of preterm infants to that of healthy preterm infants rather than the fetus. Individualized weight growth curves account for the water weight loss that frequently occurs after birth. In addition, body mass index (BMI) curves are now available. In this review, we discuss the main characteristics of growth curves used for preterm infants as well as the use of percentiles, z scores, and their change over time to evaluate size and growth status. We also review the differences in body composition between preterm infants at term-equivalent age and term-born infants and the potential role of monitoring proportionality of growth using BMI curves.

Helping Babies Breathe knowledge and skills can be retained and even improved with simple, inexpensive interventions, including supervised on-the-job and peer-to-peer training.

Background Liquid human milk fortifiers are used commonly in neonatal intensive care. Use of an acidified HMF (A‐HMF) is associated with transient metabolic acidosis, but whether growth outcomes differ between infants fed A‐HMF vs nonacidified HMF (NA‐HMF) remains unknown. Methods Retrospective cohort study of 255 infants born at <33 weeks' gestation and ≤1500 g who were receiving ≥75% fortified human milk on day of life 14, in a level III neonatal intensive care unit (NICU) from May 2015 to December 2018. Infants born before October 2017 (n = 165) received A‐HMF, whereas infants born after October 2017 (n = 90) received NA‐HMF. We used logistic regression to estimate odds of metabolic acidosis (serum bicarbonate <16 mEq/L in the first 21 days of life) in infants receiving A‐HMF vs NA‐HMF and linear mixed models to compare the mean size at discharge (weight, length, head z‐scores) by HMF type. We adjusted models for confounders and accounted for the nonindependence of multiple births. Results Median gestational age was 28.7 weeks (range, 22.6–32.9) and birth weight 1.1 kg (range, 0.4–1.5). Infants receiving A‐HMF had higher adjusted odds of metabolic acidosis than infants receiving NA–HMF (adjusted odds ratio, 2.7; 95% CI, 1.2–6.2). There were no differences between groups in size z‐scores at discharge. Conclusions In human‐milkfed, very‐low‐birthweight infants, fortification with liquid A‐HMF may contribute to metabolic acidosis in the first month of life, but this practice does not appear to impair growth through NICU discharge, compared with fortification with NA‐HMF.