While hypoglycemia occurs commonly among neonates, treatment can be challenging if hypoglycemia persists beyond the first few days of life. This review discusses the available treatment options for both transient and persistent neonatal hypoglycemia. These treatment options include dextrose infusions, glucagon, glucocorticoids, diazoxide, octreotide, and nifedipine. A stepwise, practical approach to the management of these patients is offered.

Our data indicate that airborne RSV-laden particles can be detected in pediatric outpatient clinics during the epidemic peak. However, RSV airborne transmission is highly inefficient. Thus, the logistical and financial implications of mandating the use of masks and goggles to prevent RSV spread seem unwarranted in this setting. Pediatr Pulmonol. 2017;52:684-688. © 2016 Wiley Periodicals, Inc.

Objective Preterm birth is a significant cause of infant morbidity and mortality, which are primarily the result of respiratory and neurodevelopmental complications. However, no objective biomarker is currently available to predict at birth the risk and severity of such complications. Thus, we sought to determine whether serum neurotrophins concentrations measured at birth correlate with risk for later development of bronchopulmonary dysplasia (BPD) and long‐term neurodevelopmental outcomes. Methods This study prospectively included 223 newborns admitted to neonatal intensive care units (NICU) and divided into three groups: (i) preterm infants who developed BPD; (ii) preterm infants who did not develop BPD; (iii) term infants. An exploratory cohort was enrolled in West Virginia, followed by a validation cohort recruited in four NICUs in Ohio. Specimens for serum and tracheal neurotrophins concentrations were collected within 48 h of admission. Infants requiring a fraction of inspired oxygen >0.21 for at least 28 days were diagnosed with BPD. Neurodevelopmental outcomes were extrapolated from Bayley Scales of Infant Development—Third Edition (BSID‐III) administered at the 24‐month follow‐up visit. Results Serum brain‐derived neurotrophic factor (BDNF) concentration at birth had significant negative correlation with later diagnosis of BPD (P = 0.011) and with duration of invasive ventilation and oxygen supplementation (P = 0.009 and 0.015, respectively). Serum nerve growth factor (NGF) concentration at birth had significant positive correlation with BSID‐III cognitive and language composite scores at 24 months (P < 0.001 and 0.010, respectively). Conclusions These data suggest that serum neurotrophins concentrations measured at birth provide prognostic information on subsequent respiratory and neurodevelopmental outcomes.

Introduction: Audit tools optimize the delivery of healthcare to patients. A network of 11 neonatal intensive care units (NICUs) affiliated with a large urban pediatric care institution implemented an audit tool for use on daily patient rounds. The article reports findings collected from 2011 to 2016. Methods: Primary drivers for implementation were (1) engagement from local providers; (2) identification of local improvement needs and improvement progress; (3) ability to customize audit questions based on local needs; (4) encouragement of information sharing between NICUs; and (5) improving measurable outcomes in neonatal care delivery. The Level IV NICU managed and refined a centralized process for managing site-specific tools, data analysis, and reporting. Each NICU customized the number and wording of action questions based on their needs. Answer choices were limited to “yes” or “no,” which corresponded to favorable or unfavorable actions toward the patient. Users also answered, “Was action taken as a result of an unfavorable response?” Results: Plan-Do-Study-Action cycles were completed to refine the tool and its implementation process. Adherence was variable among and within each network site. Across the network, 11.4% of actions tracked by the audit indicated improvement over time. Conclusion: Generalized use of the Audit Tool resulted in limited optimization of care actions addressed in the NICUs. Success depended on multi-disciplinary, multi-professional teamwork, respect for local autonomy, and leadership support. Increasing the use of the Audit Tool likely depends on the team’s ability to evolve the tool’s intrinsic value from a reminder to a monitoring system.

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