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Background: Some oral probiotics have been shown to prevent necrotizing enterocolitis (NEC) and decrease mortality effectively in preterm very low birth weight (PVLBW) infants. However, it is unclear whether a single probiotic or a mixture of probiotics is most effective for the prevention of NEC. Objective: A meta-analysis was conducted by reviewing the most up to date literature to investigate whether multiple strains probiotics are more effective than a single strain in reducing NEC and death in PVLBW infants. Data sources: Relevant studies were identified by searches of the MEDLINE, EMBASE, and Cochrane CENTRAL databases, from 2001 to 2016. Data extraction and synthesis: The inclusion criteria were randomized controlled trials of any enteral probiotic supplementation that was initiated within the first 7 days and continued for at least 14 days in preterm infants (≤ 34 weeks’ gestation) and/or those of a birth weight ≤1500 g. Results: A total of 25 trials (n = 7345 infants) were eligible for inclusion in the meta-analysis using a fixed-effects model. Multiple strains probiotics were associated with a marked reduction in the incidence of NEC, with a pooled OR of 0.36 (95% CI, 0.24–0.53; P < .00001). Single strain probiotic using Lactobacillus species had a borderline effect in reducing NEC (OR of 0.60; 95% CI 0.36–1.0; P = .05), but not mortality. Multiple strains probiotics had a greater effectiveness in reducing mortality and were associated with a pooled OR of 0.58 (95% CI, 0.43–0.79; P = .0006). Trials using single strain of Bifidobacterium species and Saccharomyces boulardii did not reveal any beneficial effects in terms of reducing NEC or mortality. Conclusion: This updated report found that multiple strains probiotics appear to be the most feasible and effective strategy for the prevention of NEC and reduction of mortality in PVLBW neonates. Further clinical trials should focus on which probiotic combinations are most effective. [ABSTRACT FROM AUTHOR]

Background: Neonatal hypothermia remains a common problem and is related to elevated morbidities and mortality. However, the long-term neurodevelopmental effects of admission hypothermia are still unknown. This study attempted to determine the short-term and long-term consequences of admission hypothermia in VLBW preterm infants. Study Design: This retrospective study measured the incidence and compared the outcomes of admission hypothermia in very low birth weight (VLBW) preterm infants in a tertiary-level neonatal intensive care unit. Infants were divided into the following groups: normothermia (36.5–37.5°C), mild hypothermia (36.0–36.4°C), moderate hypothermia (32.0–35.9°C), and severe hypothermia (< 32°C). We compared the distribution, demographic variables, short-term outcomes, and neurodevelopmental outcomes at 24 months of corrected age among groups. Results: We studied 341 infants: 79 with normothermia, 100 with mild hypothermia, 162 with moderate hypothermia, and 0 with severe hypothermia. Patients in the moderate hypothermia group had significantly lower gestational ages (28.1 wk vs. 29.7 wk, P < .02) and smaller birth weight (1004 g vs. 1187 g, P < .001) compared to patients in the normothermia group. Compared to normothermic infants, moderately hypothermic infants had significantly higher incidences of 1-min Apgar score < 7 (63.6% vs. 31.6%, P < .001), respiratory distress syndrome (RDS) (58.0% vs. 39.2%, P = .006), and mortality (18.5% vs. 5.1%, P = .005). Moderate hypothermia did not affect neurodevelopmental outcomes at 2 years’ corrected age. Mild hypothermia had no effect on short-term or long-term outcomes. Conclusions: Admission hypothermia was common in VLBW infants and correlated inversely with birth weight and gestational age. Although moderate hypothermia was associated with higher RDS and mortality rates, it may play a limited role among multifactorial causes of neurodevelopmental impairment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association of mode of delivery (MOD) with short‐term and neurodevelopmental outcomes at 2 years of corrected age (CA) in periviable singleton infants. Methods: This retrospective cohort study of the Taiwan Premature Infant Follow‐up Network database between 2010 and 2016 compared non‐anomalous singleton deliveries (cesarean delivery [CD] vs vaginal delivery [VD]) between 22 0/7 and 25 6/7 gestational weeks. Major morbidities, mortality, and neurodevelopmental outcomes were evaluated at 2‐year CA. Results: The CD and VD groups included 354 and 472 infants, respectively. The intraventricular hemorrhage (IVH) rate was lower in the CD group (54% vs 66%, P = 0.001), but severe IVH differed non‐significantly between groups (20% vs 26%, P = 0.057). In the small‐for‐gestational age subgroup, CD was associated with lower IVH (56% vs 84%, adjusted odds ratio [aOR] 0.17, 95% confidence interval [CI] 0.04–0.69) and better survival without neurodevelopmental impairment (29% vs 8%, aOR, 6.64, 95% CI 1.02–43.29) after controlling for potential confounders. Conclusion: The optimal MOD for periviable singleton birth and its impact are unclear. CD in periviable singleton births is associated with a decreased IVH risk, without improvement in severe IVH, mortality, or neurodevelopment at 2‐year CA. The small‐for‐gestational age subgroup may benefit from CD for better survival without neurodevelopmental impairment. Synopsis: Cesarean delivery in periviable singleton small‐for‐gestational‐age births is associated with better survival without neurodevelopmental impairment. [ABSTRACT FROM AUTHOR]

This paper presents a retrospective view of the Charlotte distributed operating system, a testbed for developing techniques and tools to solve computation-intensive problems with large-grain parallelism. The final version of Charlotte runs on the Crystal multicomputer, a collection of VAX-11/750 computers connected by a local-area network. The kernel/process interface is unique in its support for symmetric, bidirectional communication paths (called links), and synchronous nonblocking communication. Our experience indicates that the goals of simplicity and function are not easily achieved. Simplicity in particular has dimensions that conflict with one another. Although our design decisions produced a high-quality environment for research in distributed applications, they also led to unexpected implementation costs and required high-level language support. We learned several lessons from implementing Charlotte. Links have proven to be a useful abstraction, but our primitives do not seem to be at quite the right level of abstraction. Our implementation employed finite-state machines and a multitask kernel, both of which worked well. It also maintains absolute distributed information, which is more expensive than using hints. The development of high-level tools, particularly the Lynx distributed programming language, has simplified the use of kernel primitives and helps to manage concurrency at the process level. [ABSTRACT FROM AUTHOR]