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Latest & greatest articles for infants
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on infants or other clinical topics then use Trip today.
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External validation and clinical usefulness of first-trimester prediction models for small- and large-for-gestational-age infants: a prospective cohort study To assess the external validity of all published first-trimester prediction models based on routinely collected maternal predictors for the risk of small- and large-for-gestational-age (SGA and LGA) infants. Furthermore, the clinical potential of the best-performing models was evaluated.Multicentre prospective cohort.Thirty-six midwifery (...) after recalibration.The clinical relevance of the models is limited because of their moderate predictive performance, and because the definitions of SGA and LGA do not exclude constitutionally small or large infants. As most clinically relevant fetal growth deviations are related to 'vascular' or 'metabolic' factors, models predicting hypertensive disorders and gestational diabetes are likely to be more specific.The clinical relevance of prediction models for the risk of small- and large
The Association of Hydrocortisone Dosage on Mortality in Infants Born Extremely Premature To characterize common dosing strategies and to investigate the association between hydrocortisone dosage and in-hospital mortality in infants born extremely premature.We performed a retrospective review of a cohort of infants born ≤30 weeks' gestational age from 2010 to 2016 from the Pediatrix Clinical Data Warehouse who received hydrocortisone in the first 14 postnatal days. Infants were divided (...) by initial hydrocortisone dosage (high: >2 mg/kg/d vs low: ≤2 mg/kg/d). Baseline characteristics and medication coexposures were compared and mortality was evaluated in a multivariable analysis.A total of 1427 infants were included, 733 with high dosage (51%) and 694 with low dosage (49%). The groups were similar with regard to baseline characteristics. Infants in the high-dosage group had significantly more exposure to any vasopressors (89% vs 84%, P < .001) and greater mortality (50% vs 23%, P < .001
Timing of introduction of allergenic solids for infants at high risk Food allergy affects an estimated 2% to 10% of the population, with evidence of increasing prevalence over time. Preventing food allergy has become an important public health goal. Health Canada currently recommends breastfeeding infants exclusively until they are 6 months old, while acknowledging that in individual practice, signs of infant readiness may guide the introduction of complementary foods a few weeks earlier (...) . There is emerging evidence that early food introduction, between 4 to 6 months of age, may have a role in preventing food allergy, particularly for egg and peanut, in high-risk infants. For infants at high risk for allergic disease, it is now recommended that commonly allergenic solids be introduced at around 6 months of age, but not before 4 months of age, and guided by the infant’s developmental readiness for food. Continued breastfeeding should be encouraged and supported because of its
Mupirocin for Staphylococcus aureus Decolonization of Infants in Neonatal Intensive Care Units : media-1vid110.1542/5849573989001PEDS-VA_2018-1565Video Abstract BACKGROUND AND OBJECTIVES: Staphylococcus aureus (SA) is the second leading cause of late-onset sepsis among infants in the NICU. Because colonization of nasal mucosa and/or skin frequently precedes invasive infection, decolonization strategies, such as mupirocin application, have been attempted to prevent clinical infection, but data (...) supporting this approach in infants are limited. We conducted a phase 2 multicenter, open-label, randomized trial to assess the safety and efficacy of intranasal plus topical mupirocin in eradicating SA colonization in critically ill infants.Between April 2014 and May 2016, infants <24 months old in the NICU at 8 study centers underwent serial screening for nasal SA. Colonized infants who met eligibility criteria were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal
Smaller facemasks for positive pressure ventilation in preterm infants: A randomised trial Facial measurements of preterm infants indicate that standard diameter facemasks used during positive pressure ventilation are too large, which may lead to mask leak and compromise resuscitation. We aimed to determine whether the use of a facemask that better complies with the dimensions of preterm faces, compared with a standard facemask, reduces facemask leak.Parallel group, randomised controlled trial (...) . Preterm infants ≤32 weeks' gestation receiving facemask ventilation prior to intubation in the neonatal intensive care unit, and those 28-32+6 weeks' receiving facemask ventilation in the delivery room were eligible. Infants were randomised to receive ventilation via a standard (50mm) (control), or a smaller (35mm or 42mm) diameter facemask (intervention), stratified by gestation (≤26 weeks'; 35mm, 27-32+6; 42mm). The primary outcome was leak between the mask and the infants face.Of 298 eligible
Effect of Hydrocortisone Therapy Initiated 7 to 14 Days After Birth on Mortality or Bronchopulmonary Dysplasia Among Very Preterm Infants Receiving Mechanical Ventilation: A Randomized Clinical Trial. Dexamethasone initiated after the first week of life reduces the rate of death or bronchopulmonary dysplasia (BPD) but may cause long-term adverse effects in very preterm infants. Hydrocortisone is increasingly used as an alternative, but evidence supporting its efficacy and safety is lacking.To (...) assess the effect of hydrocortisone initiated between 7 and 14 days after birth on death or BPD in very preterm infants.Double-blind, placebo-controlled randomized trial conducted in 19 neonatal intensive care units in the Netherlands and Belgium from November 15, 2011, to December 23, 2016, among preterm infants with a gestational age of less than 30 weeks and/or birth weight of less than 1250 g who were ventilator dependent between 7 and 14 days of life, with follow-up to hospital discharge ending
Delayed umbilical cord clamping reduces hospital mortality for preterm infants Delayed umbilical cord clamping reduces hospital mortality for preterm infants Discover Portal Discover Portal Delayed umbilical cord clamping reduces hospital mortality for preterm infants Published on 6 February 2018 doi: Delays to clamping the umbilical cord of about a minute can reduce hospital mortality for preterm infants by around 32%. Delayed clamping also reduced the proportion of infants needing a blood (...) transfusion by 10%. This review adds more precise data on survival from new trials including a large Australian trial (over 1,600 babies) to a previous Cochrane 2012 review of trails including 738 infants and provides new more precise data on the survival benefit. These findings are consistent with current guidelines which recommend delayed clamping in preterm infants. Share your views on the research. Why was this study needed? The optimal timing of umbilical cord clamping has been debated. Globally
Infants anaesthetised without placing a tube in the trachea have fewer adverse breathing events Infants anaesthetised without placing a tube in the trachea have fewer adverse breathing events Discover Portal Discover Portal Infants anaesthetised without placing a tube in the trachea have fewer adverse breathing events Published on 11 July 2017 doi: Adverse breathing events are about three times more common when using endotracheal tubes than laryngeal mask airways for infants under 12 months (...) receiving non-urgent surgery. Airway problems are common during anaesthesia in children, accounting for three quarters of critical incidents and a third of cardiac arrests. They are more frequent in younger children, especially infants under 12 months, who have smaller airways and rapidly use up their oxygen reserves. Laryngeal mask airways have been used in adults and older children for over 35 years for minor and intermediate surgery. Many studies have shown them to have fewer airway-related
Infant diets that include egg or peanut products appear to reduce food allergies Infant diets that include egg or peanut products appear to reduce food allergies Discover Portal Discover Portal Infant diets that include egg or peanut products appear to reduce food allergies Published on 29 November 2016 doi: Certain allergenic foods introduced to an infant’s diet while weaning appear to reduce the chance of developing food allergies. This high quality review, including studies published (...) this year, suggests that historical recommendations to delay the introduction of peanut and other allergenic foods to infant child’s diet in the first year of life may have been mistaken. The methodological limitations in some studies included in this review, reduce our certainty in the degree of benefit, but as more high quality studies are undertaken the benefits and practicalities of how to introduce these foods are likely to become clearer. The causes of food allergies are not fully understood
High-flow oxygen therapy may have a role in treating infants with more severe bronchiolitis High-flow oxygen therapy may have a role in treating infants with more severe bronchiolitis Discover Portal Discover Portal High-flow oxygen therapy may have a role in treating infants with more severe bronchiolitis Published on 18 September 2018 doi: A randomised controlled trial of 1,472 infants with bronchiolitis found that more children improved when started on high-flow oxygen therapy than (...) with standard oxygen therapy. Those who failed to improve on standard therapy were switched to high flow oxygen. Most then improved - overall, similar numbers were transferred to intensive care. There was also no difference between the groups in the proportion of infants needing intubation, length of time on oxygen therapy or days spent in hospital. The place in the pathway for high-flow oxygen remains to be clarified. For example, it isn’t clear from this study whether high flow oxygen is best used
Inducing labour at or after 41 weeks reduces risks to infants Inducing labour at or after 41 weeks reduces risks to infants Discover Portal Discover Portal Inducing labour at or after 41 weeks reduces risks to infants Published on 11 September 2018 doi: Inducing labour after the due date slightly lowers the risk of stillbirth or infant death soon after birth compared with watchful waiting. But the overall risk is very low. Induced deliveries may reduce admissions to the neonatal intensive care (...) unit. Pregnant women having induced labour are less likely to have a caesarean section than those who wait for labour to begin naturally. They may have a slightly higher chance of needing an assisted vaginal birth (for example, using forceps or vacuum extraction). Many pregnancies continue for longer than the average 40 weeks. Because of the risks to infants, women are often offered the option of induced labour at between 41 and 42 weeks. However, induction also carries risks to mother and baby
Plastic wraps or bags keep pre-term infants warm immediately after birth Plastic wraps or bags keep pre-term infants warm immediately after birth Discover Portal Discover Portal Plastic wraps or bags keep pre-term infants warm immediately after birth Published on 22 May 2018 doi: Cheap and simple plastic wrapping used in the first 10 minutes after birth helps pre-term and low birth weight infants avoid hypothermia. Infants treated in this way are likely to be warmer when admitted to neonatal (...) intensive care than those treated according to standard care. Pre-term infants are most likely to benefit. Routine infant care usually involves ensuring the delivery room is warm, drying the infant immediately after birth, wrapping the infant in pre-warmed dry blankets and pre-warming surfaces. Despite this, about a quarter of babies born eight weeks early have temperatures that are too low and additional measures to warm pre-term and low birth weight infants are needed. Although babies were warmer
C-reactive protein for diagnosing late-onset infection in newborn infants. Late-onset infection is the most common serious complication associated with hospital care for newborn infants. Because confirming the diagnosis by microbiological culture typically takes 24 to 48 hours, the serum level of the inflammatory marker C-reactive protein (CRP) measured as part of the initial investigation is used as an adjunctive rapid test to guide management in infants with suspected late-onset infection.To (...) review authors independently assessed eligibility for inclusion, evaluated the methodological quality of included studies, and extracted data to estimate diagnostic accuracy using hierarchical summary receiver operating characteristic (SROC) models. We assessed heterogeneity by examining variability of study estimates and overlap of the 95% confidence interval (CI) in forest plots of sensitivity and specificity.The search identified 20 studies (1615 infants). Most were small, single-centre
Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial. Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's milk, prevents infections and associated complications. The aim of this large randomised controlled trial was to collect data (...) to enhance the validity and applicability of the evidence from previous trials to inform practice.In this randomised placebo-controlled trial, we recruited very preterm infants born before 32 weeks' gestation in 37 UK hospitals and younger than 72 h at randomisation. Exclusion criteria were presence of a severe congenital anomaly, anticipated enteral fasting for longer than 14 days, or no realistic prospect of survival. Eligible infants were randomly assigned (1:1) to receive either enteral bovine
Safety and Immunogenicity of Early Bacillus Calmette-Guerin Vaccination in Infants Who Are Preterm and/or Have Low Birth Weights: A Systematic Review and Meta-analysis Bacillus Calmette-Guérin (BCG) vaccination is commonly delayed in infants who are preterm and have low birth weights (LBW) despite the association of early vaccination with better vaccination coverage and potentially nonspecific benefits for survival.To determine the safety, immunogenicity, and protective efficacy against (...) tuberculosis (TB) of BCG vaccination given at or before 7 days after birth vs vaccination more than 7 days after birth among infants who are preterm and/or had LBW.Searches of Medline, Embase, and Global Health databases were conducted from inception until August 8, 2017.Clinical trials, cohort studies, and case-control studies that included infants who were preterm and/or had LBW and reported safety, mortality, immunogenicity, proxies of vaccine take, and/or efficacy against TB.Two authors independently
Effect of Prophylaxis for Early Adrenal Insufficiency Using Low-Dose Hydrocortisone in Very Preterm Infants: An Individual Patient Data Meta-Analysis To assess the effect of prophylaxis for early adrenal insufficiency using low-dose hydrocortisone on survival without bronchopulmonary dysplasia (BPD) in very preterm infants using an individual patient data meta-analysis.All existing randomized controlled trials testing the efficacy of the prophylaxis of early adrenal insufficiency using low-dose (...) as with decreases in medical treatment for patent ductus arteriosus (OR, 0.72; 95% CI, 0.56-0.93; P = .01; I2 = 0%) and death before discharge (OR, 0.70; 95% CI, 0.51-0.97; P = .03; I2 = 0%). The therapy was associated with an increased risk of spontaneous gastrointestinal perforation (OR, 2.50; 95% CI, 1.33-4.69; P = .004; I2 = 31.9%) when hydrocortisone was given in association with indomethacin exposure. The incidence of late-onset sepsis was increased in infants exposed to hydrocortisone (OR, 1.34; 95% CI
Randomised study comparing heart rate measurement in newly born infants using a monitor incorporating electrocardiogram and pulse oximeter versus pulse oximeter alone To determine whether IntelliVue (ECG plus Masimo pulse oximeter (PO)) measures heart rate (HR) in low-risk newborns more quickly than Nellcor PO (PO alone).Unmasked parallel group randomised (1:1) study.We studied 100 infants, 47 randomised to IntelliVue, 53 to Nellcor. Time to first HR was shorter with IntelliVue ECG than Nellcor (...) (median (IQR) 24 (19, 39) vs 48 (36, 69) s, p<0.001). There was no difference in time to display both HR and SpO2 (52 (47, 76) vs 48 (36, 69) s, p=0.507). IntelliVue PO displayed initial bradycardia more often than the Nellcor (55% vs 6%). Infants monitored with IntelliVue were handled more frequently and for longer.IntelliVue ECG displayed HR more quickly than Nellcor PO. IntelliVue PO often displayed initial bradycardia. Infants monitored with IntelliVue were handled more often. Study of ECG in high
rhIGF-1/rhIGFBP-3 in Preterm Infants: A Phase 2 Randomized Controlled Trial To investigate recombinant human insulin-like growth factor 1 complexed with its binding protein (rhIGF-1/rhIGFBP-3) for the prevention of retinopathy of prematurity (ROP) and other complications of prematurity among extremely preterm infants.This phase 2 trial was conducted from September 2014 to March 2016. Infants born at a gestational age of 230/7 weeks to 276/7 weeks were randomly allocated to rhIGF-1/rhIGFBP-3 (...) infants were allocated to rhIGF-1/rhIGFBP-3, 60 to standard care (full analysis set); 24 of 61 treated infants achieved target exposure (evaluable set). rhIGF-1/rhIGFBP-3 did not decrease ROP severity or ROP occurrence. There was, however, a 53% decrease in severe bronchopulmonary dysplasia in the full analysis set (21.3% treated vs 44.9% standard care), and an 89% decrease in the evaluable set (4.8% vs 44.9%; P = .04 and P = .02, respectively) for severity distribution between groups. There was also
Influence of infant feeding on the excretion of gluten immunopeptides in feces. the secretion of antigens from the diet into breast milk has been extensively documented. The transfer of gliadin could be critical for the development of an immune response.to investigate the presence of immunogenic gluten peptides in the feces of infants fed with different diets.a blind, prospective, controlled, collaborative study was performed in three hospitals, between September 2016 and January 2017 (...) . The study protocol was approved by the Ethics Committee of the hospitals in Seville prior to starting the study.the cohort was divided into three groups of 30 infants: an experimental group (average age 9.2 ± 2.8 weeks) with exclusive breastfeeding, a control group 1 (average age 10.3 ± 3.3 weeks) exclusively fed with onset formula and a control group 2 (average age 56 ± 3.7 weeks) with infants that consumed gluten on a regular basis. The peptide 33-mer of gliadin was negative in all feces samples from