2 Minute Medicine ® - Neonatal/Perinatal Medicine

1. Among United States veterans of the Iraq and Afghanistan wars, the experience of a moderate, severe, or penetrating traumatic brain injury was associated with a greater risk of developing brain cancer.  Evidence Rating Level: 2 (Good) Primary brain cancer is uncommon, affecting 7.02 per 100,000 persons in the United States. Little is known about the risk factors for primary brain cancer. In this retrospective cohort study, researchers aimed to determine whether traumatic brain injury (TBI) is associated with the development of primary brain cancer...

1. In this post-hoc analysis of the CHANCE-2 trial, ticagrelor-acetylsalicylic acid was more beneficial compared to clopidogrel-acetylsalicylic acid for preventing recurrent stroke among those with elevated levels of homocysteine and CYP2C19 LOF mutations.  Evidence Rating Level: 2 (Good)  Elevated homocysteine levels are associated with increased hemostasis, progression of atherosclerosis, and greater risk of initial or recurrent stroke. Little is known about whether homocysteine levels impact the effectiveness of dual antiplatelet treatments for preventing stroke...

1. In this randomized controlled trial, N-acetyl-L-leucine (NALL) improved neurologic status in Niemann-Pick Disease type C more effectively than a placebo. 2. Patients showed a significant reduction in neurological symptoms after taking NALL. Evidence Rating Level: 1 (Excellent) Study Rundown: Niemann-Pick Disease Type C is an inherited lysosomal storage disorder following the autosomal recessive pattern leading to premature death. The current treatment method relies on miglustat, a drug used in lysosomal storage disorders, to delay the progression of neurological symptoms typically produced by this disease...

1. This randomized controlled trial showed no evidence that ibuprofen treatment for bronchopulmonary dysplasia reduced premature infant mortality. 2. This study is consistent with other studies examining the role of ibuprofen as a treatment method for patent ductus arteriosus (PDA), showing no effect on mortality rates. Evidence Rating Level: 1 (Excellent) Study Rundown: Neonatal medicine has advanced substantially in recent decades. Yet, the incidence of bronchopulmonary dysplasia has increased in preterm infants with associated mortality...

1. In this randomized controlled trial, apixaban lowered the risk of stroke or systemic embolism significantly more than aspirin in patients with subclinical atrial fibrillation.  2. Apixaban was associated with a higher risk of major bleeding than aspirin.  Evidence Rating Level: 1 (Excellent) Study Rundown: Symptomatic atrial fibrillation is a leading cause of stroke and stroke-related disability and mortality, for which oral anticoagulants are established prophylactic therapies. Conversely, subclinical atrial fibrillation can be asymptomatic or only produce short-lasting symptoms and is only diagnosed by continuous cardiac rhythm monitoring with a pacemaker or defibrillator...

1. Absence of moderate or severe headache 24 hours following administration of treatment drug was significantly greater among patients with migraine attacks that were treated with ubrogepant during the prodrome phase. 2. Adverse events were slightly more frequent in the ubrogepant group versus placebo. Evidence Rating Level: 1 (Excellent) Study Rundown : Ubrogepant, a calcitonin gene-related peptide (cGRP) receptor antagonist, is approved for acute migraine treatment. However, its use during the prodromal phase to reduce the frequency of subsequent migraine headaches is not well understood...

1. In this randomized controlled trial, replacing biomass stoves with those using liquefied petroleum gas (LPG) during pregnancy did not reduce stunting in infants at one year despite reductions in household air pollution.  2. There was no appreciable difference in stunting in infants at six months between the biomass cookstove and liquefied petroleum gas cookstove groups.  Evidence Rating Level: 1 (Excellent) Study Rundown: Household air pollution is a significant environmental risk factor in low- and middle-income countries and arises from incomplete combustion of biomass fuels...

1. This longitudinal prospective cohort study found that older adults with trajectories involving impairments to instrumental activities of daily living, higher comorbidity, and increasing depressive symptoms were particularly at risk for developing cognitive impairment. Evidence Rating Level: 2 (Good) The global population is rapidly aging, and with this comes an increased incidence of morbidity and disease burden. In particular, cognitive impairment – marked by difficulties with memory, learning, concentration, and decision-making – will continue to burden the aging population...

1. In this cohort study, children with low dose prenatal alcohol and tobacco exposure were found to have differences in electroencephalogram activity even at 11 years of age. 2. Males were particularly vulnerable to the effects of prenatal alcohol exposure compared to females.  Evidence Level Rating: 2 (Good) Tobacco and alcohol consumed during pregnancy have teratogenic effects on the fetus, even when consumed in low amounts. In this cohort study, researchers sought to further characterize the effects of PAE and PTE on neurodevelopment in childhood...

1. Many participants who sustained a traumatic brain injury experienced no cognitive dysfunction, though more severe initial injuries were associated with a greater risk of cognitive decline 6 months of follow-up.  Evidence Rating Level: 1 (Excellent) Traumatic Brain Injuries (TBIs) are often associated with cognitive dysfunction. The typical course of cognitive recovery during the first several months following the experience of a TBI has not previously been well established. In this prospective cohort study, researchers collected data from Transforming Research and Clinical Knowledge in TBI (TRACK-TBI)...

1. Patients in the thrombectomy group reported significantly greater improvement, with lower mortality at 90 days versus medical management alone. 2. Symptomatic intracranial hemorrhage was comparable between groups. Evidence Rating Level : 1 (Excellent) Study Rundown: Patients with acute ischemic stroke and large vessel infarct benefit from endovascular thrombectomy. However, previous studies have shown clinical benefits using multimodal imaging while non-contrast CT is predominantly used in practice. This randomized controlled trial aimed to assess the efficacy of endovascular thrombectomy in patients with acute ischemic stroke and large vessel occlusion, with patient selection done using non-contrast CT...

1. Docosahexaenoic acid supplementation at the in utero dose for infants born at less than 29 weeks gestation did not improve behavioral and emotional functioning at 5 years of age. 2. No differences in executive functioning or health were found between the children who had received high-dose docosahexaenoic acid and the children who had not. Evidence Rating Level:   2 (Good)        Study Rundown:   Following preterm birth, children are at increased risk of developing behavioral problems, neurobehavioral disability, impaired executive functioning, chronic disease, and poor quality of life...

1. In these two randomized parallel-group trials, the use of gantenerumab did not lead to slower cognitive decline over 116 weeks among persons with early symptomatic Alzheimer’s disease compared to placebo. 2. After 116 weeks, gantenerumab was associated with lower amyloid plaque burden than the placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: The accumulation of aggregated amyloid-beta (Aβ) has been posited to play a significant role in the pathologic processes of Alzheimer’s disease. Monoclonal antibodies which target Aβ proteins have been developed but their efficacy in clinical trials has been equivocal...

1. In this randomized controlled trial, botulinum toxin was more effective than placebo in treating isolated or essential head tremor at 18 weeks follow-up. 2. Adverse events occurred more frequently in the botulinum toxin group including head and neck pain, posterior cervical weakness, and dysphagia. Evidence Rating Level: 1 (Excellent) Study Rundown: Essential tremor is the most common etiology of tremor and one of the most common movement disorders in adults. Botulinum toxin type A, which hinders pre-synaptic release of acetylcholine rendering decreased aberrant muscle movement, has shown varying degrees of efficacy in the treatment of essential hand tremor...

1. In this cohort study, a 38% increased risk of stroke was reported amongst black women reporting interpersonal racism in employment, housing, and police interactions. Evidence Rating Level: 2 (Good) It is well documented in prior literature that black individuals in the United States face disproportionately higher stroke incidence and mortality rates compared to their White counterparts. This association is most marked in black women, who experience the highest rates and earliest onset of stroke compared to women from other racial groups...

1. In this randomized controlled trial, in patients with treatment-resistant depression esketamine nasal spray as augmentation therapy was associated with higher rates of remission as compared to extended-release quetiapine. 2. Once remission was achieved, esketamine nasal spray was associated with lower risks of relapse at 32 weeks compared to extended-release quetiapine. Evidence Rating Level: 1 (Excellent) Study Rundown: Treatment-resistant depression impacts approximately one-third of all patients with diagnosed major depressive disorder, and has implications for increased risk of hospitalization episodes and mortality...

1. In this randomized controlled trial, over a period of 240 weeks, solanezumab did not slow cognitive decline as compared to placebo in patients with preclinical Alzheimer’s disease. 2. Solanezumab did not change the levels of amyloid levels in the brain as compared to placebo in persons with preclinical Alzheimer’s disease. Evidence Rating Level: 1 (Excellent) Study Rundown: The pathophysiology of Alzheimer’s disease involves the accumulation of amyloid-beta (Aβ) into fibrillar plaques and hyperphosphorylated tau...

1. Global preterm births have remained stable from 2010 to 2020 (13.4 million vs. 13.8 million). 2. A large proportion of preterm births occur at less than 32 weeks of gestation. Evidence Rating Level: 1 (Excellent) Study Rundown : Preterm birth is a leading cause of neonatal mortality, accounting for one-tenth of all live births in 2014. Addressing the global burden of preterm births is key to improving neonatal outcomes and preventing early childhood mortality. This systematic analysis aimed to update global preterm birth rates and trends, including estimated gestational age subgroups, to inform global health goals...

1. In this randomized controlled trial, early compared to late blood pressure management following an acute ischemic stroke did not impact the risk of death or functional dependency at 90 days.  Evidence rating level: 1 (Excellent) Researchers aimed to determine whether early treatment of hypertension after an ischemic stroke impacts the risk of death or functional dependency (modified Rankin scale score ≥3). 4810 participants were included in the study, which was conducted in China between June 13, 2018, and July 10, 2022...

1. The 90-day modified Ranking Scale score was comparable for patients in intravenous thrombolysis plus endovascular treatment versus endovascular treatment alone. 2. Intracranial hemorrhage was less frequent in the endovascular treatment alone group. Evidence Rating Level: 1 (Excellent) Study Rundown : Intravenous thrombolysis before endovascular treatment is the preferred therapy among patients with acute ischemic stroke; however, its utility among patients directly admitted to endovascular treatment centers remains unknown...