Noninvasive Ventilation in the Age of Surfactant Administration
Numerous advances in neonatal care have improved outcomes in preterm infants. Antenatal steroids, through their ability to promote lung maturation and function, have led to significant improvements in death, intraventricular hemorrhage, necrotizing enterocolitis, and respiratory distress syndrome. For years, exogenous surfactant administration has been used in conjunction with antenatal steroids to further improve outcomes for preterm infants. However, as continuous positive airway pressure has been shown to be effective in treating respiratory distress syndrome, it has become less clear how exogenous surfactant should be ...
Source: Clinics in Perinatology - July 2, 2019 Category: Perinatology & Neonatology Authors: Roger F. Soll, Whittney Barkhuff Source Type: research

Achieved Oxygenation Saturations and Outcome in Extremely Preterm Infants
Infants in the Neonatal Oxygenation Prospective Meta-analysis trials were randomized to SpO2 targets of 85% to 89% or 91% to 95%. Group allocation was masked. Different outcomes are likely partially attributable to differences in achieved SpO2. Infants randomized to the lower range had higher than intended readings. SpO2 distributions of infants in the low-range group of the Benefits of Oxygen Saturation Targeting II UK trial who died or developed necrotizing enterocolitis were centered around 90% to 92%. These achieved SpO2 distributions caution against using lower SpO2 target ranges early or throughout the clinical cours...
Source: Clinics in Perinatology - July 2, 2019 Category: Perinatology & Neonatology Authors: Benjamin J. Stenson Source Type: research

Oxygen Toxicity in the Neonate
Fetal development occurs in a relatively hypoxemic environment, and birth represents significant oxidative stress. Premature infants are disadvantaged by a lack of maternal antioxidant transfer and impaired endogenous antioxidant responses. O2 metabolism is essential for life and its biochemical reactions are dynamic, compartmentalized, and difficult to characterize in  vivo. There is a growing appreciation for the role of reactive oxygen species in nonpathologic processes, including regulation of cell signaling and mitochondrial function. There are several gaps in the knowledge about the role of reactive oxygen speci...
Source: Clinics in Perinatology - July 1, 2019 Category: Perinatology & Neonatology Authors: Trent E. Tipple, Namasivayam Ambalavanan Source Type: research

Nasal Intermittent Mandatory Ventilation Versus Nasal Continuous Positive Airway Pressure Before and After Invasive Ventilatory Support
Continuous positive airway pressure (CPAP), noninvasive intermittent positive pressure ventilation (NIPPV), and heated humidified high-flow nasal cannula (HHFNC) are modes of noninvasive respiratory support used in neonatal practice. These modes of noninvasive respiratory support may obviate mechanical ventilation, prevent extubation failure, and reduce the risk of developing bronchopulmonary dysplasia. Although the physiologic bases of CPAP and HHFNC are well delineated, and their modes and practical application consistent, those of NIPPV are unproven and varied. Available evidence suggests that NIPPV is superior to CPAP ...
Source: Clinics in Perinatology - July 1, 2019 Category: Perinatology & Neonatology Authors: Osayame Ekhaguere, Shama Patel, Haresh Kirpalani Source Type: research

Intermittent Hypoxemia in Preterm Infants
Intermittent hypoxemia (IH) events are common during early postnatal life, particularly in preterm infants. These events have been associated with multiple morbidities, including retinopathy of prematurity, sleep disordered breathing, neurodevelopmental impairment, and mortality. The relationship between IH and poor outcomes may depend on the patterns (frequency, duration, and timing) of the IH events. Current treatment modalities used in the clinical setting have been only partially successful in reducing the incidence of apnea and accompanying IH, but the risks and benefits of more aggressive interventions should include...
Source: Clinics in Perinatology - July 1, 2019 Category: Perinatology & Neonatology Authors: Juliann M. Di Fiore, Peter M. MacFarlane, Richard J. Martin Source Type: research

Oxygen Therapy and Pulmonary Hypertension in Preterm Infants
The goal of oxygen therapy and oxygen saturation targeting in extremely preterm infants is to improve outcomes and balance the risks associated with both hypoxemia and hyperoxemia. Although the NeOProM trials addressed whether low or high oxygen saturation targets affect the most important outcomes of extreme prematurity including death and other co-morbidities, the trials did not evaluate infants for pulmonary hypertension. There is limited evidence for the optimal oxygen saturation targets in extremely preterm infants that can be used to prevent the development of pulmonary hypertension and manage pulmonary hypertension ...
Source: Clinics in Perinatology - July 1, 2019 Category: Perinatology & Neonatology Authors: Samuel J. Gentle, Steven H. Abman, Namasivayam Ambalavanan Source Type: research

Noninvasive Monitoring and Assessment of Oxygenation in Infants
Formerly, assessing oxygenation relied on recognizing cyanosis; however, this is unreliable. Also, in neonates, a pink color, suggesting absence of severe hypoxemia, is difficult to assess. An objective and continuous assessment of oxygenation is necessary. Currently, this is best achieved noninvasively by transcutaneous partial pressure of oxygen (PTcO2) monitoring or pulse oximetry. Because both PTcO2 and oxygen saturation monitors (pulse oximeters) may display erroneous measurements, thorough understanding of their operating principles is required. Also, clinicians must recognize the range of values expected in healthy ...
Source: Clinics in Perinatology - July 1, 2019 Category: Perinatology & Neonatology Authors: Christian F. Poets Source Type: research

New Methods for Noninvasive Oxygen Administration
Oxygen therapy is an essential part of neonatal care. Targeting oxygen saturations and preventing hypoxemia and hyperoxemia is difficult, particularly in preterm infants. The mode of oxygen delivery directly affects the stability of oxygen saturations, hypoxemia, and hyperoxemia. This stability has important clinical implications. New methods of noninvasive oxygen administration, including closed-loop automated control and servo-controlled oxygen environments, have been developed to improve oxygen saturation targeting and decrease episodes of hyperoxemia and hypoxemia. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - July 1, 2019 Category: Perinatology & Neonatology Authors: Colm P. Travers, Waldemar A. Carlo Source Type: research

Targeting Oxygen in Term and Preterm Infants Starting at Birth
Transition into the extrauterine world is characterized by a substantial increase in oxygen availability to tissue. Exact oxygen provision may be needed to avoid negative consequences of hypoxia or hyperoxia. For term and near-term infants, it is recommended to start with air and titrate the oxygen supplement to the saturation nomogram. However, oxygen supplementation in infants less than 32 weeks ’ gestation is an unsolved conundrum. At present, the inspired fraction of oxygen is set according to gestational age and blended to achieve targeted saturations and heart rates. Studies are still needed to overcome uncerta...
Source: Clinics in Perinatology - July 1, 2019 Category: Perinatology & Neonatology Authors: Maximo Vento, Ola Didrik Saugstad Source Type: research

Newborn Resuscitation in Settings Without Access to Supplemental Oxygen
Low- and middle-income countries and resource-limited regions are major contributors to perinatal and infant mortality. Oxygen is widely used for resuscitation in high- and middle-income settings. However, oxygen supplementation is not available in resource-limited regions. Oxygen supplementation for resuscitation at birth has adverse effects in human/animal model studies. There has been a change with resultant recommendations for restrictive oxygen use in neonatal resuscitation. Neonatal resuscitation without supplemental oxygen decreases mortality and morbidities. Oxygen in resource-limited settings for neonatal resuscit...
Source: Clinics in Perinatology - July 1, 2019 Category: Perinatology & Neonatology Authors: Vivek Shukla, Waldemar A. Carlo, Maximo Vento Source Type: research

Current Recommendations and Practice of Oxygen Therapy in Preterm Infants
This narrative review identified 23 publications in 2011 to 2019 discussing randomized trials of oxygen saturation targets of 85% to 89% versus 91% to 95% in infants below 28 weeks ’ gestation. Of 18 commentaries or consensus statements, 17 recommended saturation targets above 89%. Five systematic reviews reported that the 85% to 89% target increased mortality but not the composite of death or disability. The evidence for increased mortality was assessed as of “high”, “ moderate,” or “low,” quality, reflecting substantial differences in interpreting the GRADE guidelines. Systematic...
Source: Clinics in Perinatology - July 1, 2019 Category: Perinatology & Neonatology Authors: William Tarnow-Mordi, Adrienne Kirby Source Type: research

Oxygen Therapy for Preterm Infants
Randomized controlled trials and meta-analyses of higher (91% –95%) oxygen saturation targets in extremely preterm infants and room air resuscitation show improved outcomes, including increased survival. The fetal-to-neonatal transition occurs during a period of marked susceptibility to oxidative stressors due to deficits in antioxidant defenses, particularl y in preterm infants. Each article in this issue is a review of the evidence that supports state-of-the-art oxygen and respiratory care practices in neonates. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - June 28, 2019 Category: Perinatology & Neonatology Authors: Waldemar A. Carlo, Maximo Vento Tags: Preface Source Type: research

Targeting Arterial Oxygen Saturation by Closed-Loop Control of Inspired Oxygen in Preterm Infants
This article reviews the evidence provided by clinical studies evaluating the efficacy of these systems in extreme premature infants. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - June 22, 2019 Category: Perinatology & Neonatology Authors: Nelson Claure, Eduardo Bancalari Source Type: research

Oxygen and Its Checkered History in Neonatal Care
If he were alive today, Dr Bill Silverman would have been anguished by how long it has taken us to bring clarity around the use of oxygen in newborns. After all, it is one of the most widely prescribed treatments in our discipline, and one that carries serious risks of harm with both overuse and underuse. Decades earlier, while referring to one of the earliest randomized clinical trials exploring the role of oxygen in causing retinopathy of prematurity,1 Dr Silverman (Fig.  1) had cautioned us that “in making war with nature, there is a risk of loss in winning” (John McPhee, The Control of Nature). (Source...
Source: Clinics in Perinatology - June 22, 2019 Category: Perinatology & Neonatology Authors: Lucky Jain Tags: Foreword Source Type: research

Is Nasal High Flow Inferior to Continuous Positive Airway Pressure for Neonates?
Nasal high-flow therapy (nHF) is increasingly used for neonates, with perceived benefits including reduced rates of nasal trauma and parent and nursing staff preference. Current evidence suggests that although nHF is a reasonable alternative for postextubation support of preterm infants, continuous positive airway pressure is a superior modality for primary support of respiratory distress syndrome. Minimal evidence exists for use of nHF in extremely preterm infants less than 28  weeks’ gestation. Depending on clinician preference, units may still choose nHF in some settings, although careful choice of appropriat...
Source: Clinics in Perinatology - June 18, 2019 Category: Perinatology & Neonatology Authors: Kate A. Hodgson, Brett J. Manley, Peter G. Davis Source Type: research

Meta-analysis of Oxygenation Saturation Targeting Trials
Participant data from approximately 5000 infants have been meta-analyzed to guide oxygen saturation policy for extremely preterm infants. The Neonatal Oxygenation Prospective Meta-analysis showed that targeting a higher oxygen saturation range compared with a lower range resulted in decreased death and necrotizing enterocolitis and no difference in major disability but increased treated retinopathy of prematurity (ROP) and supplemental oxygen use at 36  weeks’ postmenstrual age. The 91% to 95% range can be recommended for all extremely preterm infants from birth but should be accompanied by stringent surveillanc...
Source: Clinics in Perinatology - June 13, 2019 Category: Perinatology & Neonatology Authors: Lisa Maree Askie Source Type: research

Oxygen Saturation and Retinopathy of Prematurity
This article describes recent findings for oxygen saturation target studies and suggests area of future study for ROP. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - June 13, 2019 Category: Perinatology & Neonatology Authors: Rosemary D. Higgins Source Type: research

Clinics In Perinatology
Oxygen Therapy (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - June 1, 2019 Category: Perinatology & Neonatology Source Type: research

Drugs for the Treatment and Prevention of Preterm Labor
This article discusses the prevention and treatment of spontaneous preterm labor utilizing progesterone and tocolytic agents and provides management recommendations in patients with and without a history of prior spontaneous preterm birth. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - April 20, 2019 Category: Perinatology & Neonatology Authors: Soha S. Patel, Jack Ludmir Source Type: research

Perinatal Pharmacology
CLINICS IN PERINATOLOGY (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - April 20, 2019 Category: Perinatology & Neonatology Authors: Jonathan M. Davis, Errol R. Norwitz Source Type: research

Copyright
ELSEVIER (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - April 20, 2019 Category: Perinatology & Neonatology Source Type: research

Contributors
LUCKY JAIN, MD, MBA (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - April 20, 2019 Category: Perinatology & Neonatology Source Type: research

Contents
Lucky Jain (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - April 20, 2019 Category: Perinatology & Neonatology Source Type: research

Forthcoming Issues
Hospital Medicine and Clinical Education (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - April 20, 2019 Category: Perinatology & Neonatology Source Type: research

CME Accreditation Page
(Source: Clinics in Perinatology)
Source: Clinics in Perinatology - April 20, 2019 Category: Perinatology & Neonatology Source Type: research

Balancing the Use of Medications While Maintaining Breastfeeding
Breast milk is the most beneficial nutrition a mother can give her infant. Fortunately, the dose of most drugs transferred into milk is small and does not lead to clinically significant effects on the infant. In almost all instances, the mother should be advised to continue breastfeeding. Certain medications are absolutely contraindicated, including anticancer agents, radioactive drugs, and those that inhibit milk production. However, most medications can be used safely. An improved understanding of the relationship between maternal and infant exposure to medications would provide a more enlightened understanding of the ri...
Source: Clinics in Perinatology - April 1, 2019 Category: Perinatology & Neonatology Authors: Palika Datta, Teresa Baker, Thomas W. Hale Source Type: research

Current Understanding of Medication Use in Pregnancy/Lactation and Neonates: What Are the Key Knowledge Gaps?
Of the 6 million women who are pregnant in the United States each year, an estimated 90% are prescribed at least one medication while pregnant or lactating, and many receive multiple concomitant medications with significant potential for adverse drug-drug interactions. In addition to potential harmful effects on the developing fetus, the physiologic changes that accompany pregnancy may affect the way drugs are absorbed, distributed, and metabolized in the mother, resulting in standard doses being too high or too low. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - April 1, 2019 Category: Perinatology & Neonatology Authors: Jonathan M. Davis, Errol R. Norwitz Tags: Preface Source Type: research

Perinatal Pharmacology at Crossroads
Drug development for newborns and young children has never been a huge priority for the pharmaceutical industry. It should come as no surprise then that more than 90% of drugs used in newborns and infants are either off-label or unlicensed.1,2 Many reasons account for this gap: logistical and ethical challenges in conducting clinical trials in newborns, complexities in pathophysiology of the disease process, and market size of products when they finally get commercialized. Add to this the burden of unknown long-term effects of drugs in a growing child. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - April 1, 2019 Category: Perinatology & Neonatology Authors: Lucky Jain Tags: Foreword Source Type: research

Treatment and Prevention of Hypertensive Disorders During Pregnancy
This article reviews the pharmacology of the most commonly used antihypertensive medications during pregnancy; their mechanism of action; and the effects on the mother, the fetus, and lactation. Each class of antihypertensive pharmacologic agents have specific mechanisms of action by which they exert their antihypertensive effect. β-Adrenoreceptor antagonists block these receptors in the peripheral circulation. Calcium channel blockers result in arterial vasodilation. α-Agonists inhibit vasoconstriction. Methyldopa is a centrally acting adrenoreceptor antagonist. Vasodilators have a direct effect on vascular smo...
Source: Clinics in Perinatology - March 30, 2019 Category: Perinatology & Neonatology Authors: Karla Leavitt, Sarah Obi čan, Jerome Yankowitz Source Type: research

Magnesium Sulfate and Novel Therapies to Promote Neuroprotection
This article also dis cusses novel and emerging therapies for the prevention of cerebral palsy. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - March 30, 2019 Category: Perinatology & Neonatology Authors: Rebecca A. Jameson, Helene B. Bernstein Source Type: research

The Use of Cardiotonic Drugs in Neonates
There is a distinct lack of age-appropriate cardiotonic drugs, and adult derived formulations continue to be administered, without evidence-based knowledge on their dosing, safety, efficacy, and long-term effects. Dopamine remains the most commonly studied and prescribed cardiotonic drug in the neonatal intensive care unit (NICU), but evidence of its effect on endorgan perfusion still remains. Unlike adult and pediatric critical care, there are significant gaps in our knowledge on the use of various cardiotonic drugs in various forms of circulatory failure in the NICU. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - March 30, 2019 Category: Perinatology & Neonatology Authors: Eugene Dempsey, Heike Rabe Source Type: research

Drugs for the Prevention and Treatment of Bronchopulmonary Dysplasia
Rates of bronchopulmonary dysplasia (BPD) are increasing. After preterm birth, there are important developmental periods in which neonates are more vulnerable to stressful events. These periods are opportunities for pharmacologic interventions. Many drugs remain inadequately tested and no new drugs have been approved in more than 25 years for BPD prevention or therapy. More progress is needed in defining appropriate end points based on the pathophysiology of BPD and postdischarge chronic pulmonary insufficiency of prematurity and to develop effective new drugs. In addition, much work is needed to better define perinatal fa...
Source: Clinics in Perinatology - March 30, 2019 Category: Perinatology & Neonatology Authors: Erica W. Mandell, Panagiotis Kratimenos, Steven H. Abman, Robin H. Steinhorn Source Type: research

Drugs for the Prevention and Treatment of Sepsis in the Newborn
Antimicrobial medications are the most commonly used medications in the neonatal intensive care unit. Antibiotics are used for infection prophylaxis, empiric treatment, and definitive treatment of confirmed infection. The choice of medication should be informed by the epidemiology and microbiology of infection in specific clinical scenarios and by the clinical condition of the infant. Understanding evolving pathogen susceptibility to antimicrobials and key pharmacotherapy determinants in neonates can inform optimal antibiotic use. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - March 30, 2019 Category: Perinatology & Neonatology Authors: Sagori Mukhopadhyay, Kelly C. Wade, Karen M. Puopolo Source Type: research

Analgesia, Opioids, and Other Drug Use During Pregnancy and Neonatal Abstinence Syndrome
This article summarizes the use of Food and Drug Administration –approved products, including methadone, buprenorphine, and the combination formulation of buprenorphine and naloxone to treat adult opioid use disorder during the perinatal period. All labels include pregnancy, neonatal, and lactation information and note the accepted use of these medications dur ing the perinatal period if the benefits outweigh the risks. A summary of the neonatal abstinence syndrome definition, its assessment tools, treatment approaches, and future genetic directions are provided. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - March 30, 2019 Category: Perinatology & Neonatology Authors: Hendr ée E. Jones, Walter K. Kraft Source Type: research

Principles of Pharmacokinetics in the Pregnant Woman and Fetus
Pregnancy profoundly alters a woman's physiology. These changes alter drug absorption, distribution, metabolism, and elimination and emphasize the pharmacologic complexity of pregnancy. They also emphasize the dangers of extrapolating pharmacologic expectations from nonpregnant populations to pregnant women and their fetuses. Although concerns about fetal safety have historically limited pharmacokinetic studies during pregnancy, it is important to recognize that many medications are clinically indicated for various maternal or fetal conditions, and it is particularly important that these therapies be evidence-based with ap...
Source: Clinics in Perinatology - March 30, 2019 Category: Perinatology & Neonatology Authors: Robert M. Ward, Michael W. Varner Source Type: research

Challenges in Designing Clinical Trials to Test New Drugs in the Pregnant Woman and Fetus
The need for new drugs in pregnancy is widely recognized. This review identifies several unique challenges and describes some solutions. Specific studies and drug development programs need careful planning that accounts for the needs of regulatory agencies. The perinatal (obstetric/pediatric) community needs to establish collaborations to develop methodologies, to facilitate data sharing, and to lobby for research and access to medicines. There is a need to gather and present information that promotes proportionate judgments of the balance between potential benefits and risks. This will require researchers to look beyond t...
Source: Clinics in Perinatology - March 30, 2019 Category: Perinatology & Neonatology Authors: Mark A. Turner, Louise Kenny, Zarko Alfirevic Source Type: research

Medications that Cause Fetal Anomalies and Possible Prevention Strategies
Many conditions that require frequent medication use are common during pregnancy. The purpose of this article is to list some of the most common of these disorders and to discuss the risk to the developing fetus of the medications used most frequently to treat them. Included are drugs used for the treatment of asthma, nausea and vomiting, hyperthyroidism, pain and fever, and depression during pregnancy. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - March 28, 2019 Category: Perinatology & Neonatology Authors: Elizabeth Kiernan, Kenneth L. Jones Source Type: research

Safety of Psychotropic Medications During Pregnancy
Risks, benefits, alternatives, and appropriateness of psychotropic medications, including risks of no treatment, are discussed for antidepressants, mood-stabilizing medications, anxiolytic/sedative hypnotic medications, stimulants, and medication-assisted treatment of substance use disorders. Early screening, diagnosis, and intervention prior to and/or during pregnancy often reduce morbidity and mortality of mental health disorders for mothers and infants. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - March 28, 2019 Category: Perinatology & Neonatology Authors: Edwin R. Raffi, Ruta Nonacs, Lee S. Cohen Source Type: research

Treatment of Viral Infections During Pregnancy
This article reviews the treatment of herpes simplex virus, cytomegalovirus, hepatitis B and C viruses, and human immunodeficiency virus during pregnancy. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - March 28, 2019 Category: Perinatology & Neonatology Authors: Sarah C. Rogan, Richard H. Beigi Source Type: research

Drugs to Control Diabetes During Pregnancy
Diabetes is a common complication of pregnancy associated with both short- and long-term adverse maternal and offspring effects. All types of diabetes in pregnancy are increasing in prevalence. Treatment of diabetes in pregnancy, targeting glycemic control, improves both maternal and offspring outcomes, albeit imperfectly for many women. Pharmacologic treatment recommendations differ between pregestational and gestational diabetes. Improved treatment of diabetes in pregnancy will need to consider maternal disease heterogeneity and comorbidities as well as long-term offspring outcomes. In this review, the authors summarize ...
Source: Clinics in Perinatology - March 26, 2019 Category: Perinatology & Neonatology Authors: Maisa N. Feghali, Jason G. Umans, Patrick M. Catalano Source Type: research

Pharmacologic Prevention and Treatment of Neonatal Brain Injury
Neonatal brain injury (NBI) remains a major contributor to neonatal mortality and long-term neurodevelopmental morbidity. Although therapeutic hypothermia is the only proven treatment to minimize brain injury caused by neonatal encephalopathy in term neonates, it provides incomplete neuroprotection. There are no specific drugs yet proven to prevent NBI in preterm neonates. This review discusses the scientific and emerging clinical trial data for several neuroprotective drugs in development, examining potential efficacy and safety concerns. Drugs with the highest likelihood of success and closest to clinical application inc...
Source: Clinics in Perinatology - March 26, 2019 Category: Perinatology & Neonatology Authors: Melanie A. McNally, Janet S. Soul Source Type: research

Necrotizing Enterocolitis
CLINICS IN PERINATOLOGY (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - February 14, 2019 Category: Perinatology & Neonatology Authors: Michael S. Caplan Source Type: research

Copyright
ELSEVIER (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - February 14, 2019 Category: Perinatology & Neonatology Source Type: research

Contributors
LUCKY JAIN, MD, MBA (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - February 14, 2019 Category: Perinatology & Neonatology Source Type: research

Contents
Lucky Jain (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - February 14, 2019 Category: Perinatology & Neonatology Source Type: research

Clinics In Perinatology
Perinatal Pharmacology (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - February 14, 2019 Category: Perinatology & Neonatology Source Type: research

CME Accreditation Page
(Source: Clinics in Perinatology)
Source: Clinics in Perinatology - February 14, 2019 Category: Perinatology & Neonatology Source Type: research

Modifiable Risk Factors in Necrotizing Enterocolitis
Multicenter groups have reported reductions in the incidence of necrotizing enterocolitis (NEC) among preterm infants over the past 2 decades. These large-scale prevalence studies have coincided with reports from multicenter consortia and single centers of modifications in practice using quality-improvement techniques aimed at either reducing NEC risk specifically or reducing risk of mortality and multiple morbidities associated with extreme prematurity. The modifications in practice have been based on mechanistic studies, epidemiologic association data, and clinical trials. Recent reports from centers modifying practice t...
Source: Clinics in Perinatology - December 21, 2018 Category: Perinatology & Neonatology Authors: C. Michael Cotten Source Type: research

We Need to Stamp Out Necrotizing Enterocolitis
Few conditions in the neonatal intensive care unit (NICU) provoke the level of fear, helplessness, and despair as does necrotizing enterocolitis (NEC). While our understanding of several aspects of the disease has improved over time, strategies for early diagnosis and treatment have remained largely elusive. A recent study1 evaluating the incidence of NEC in high-income countries found a nearly fourfold difference (2% to 7%) in the rate of NEC among infants born less than 32  weeks’ gestation and a staggering fivefold difference (5% to 22%) among those with birth weight less than 1000 grams. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - December 21, 2018 Category: Perinatology & Neonatology Authors: Lucky Jain Tags: Foreword Source Type: research

Role of Abdominal US in Diagnosis of NEC
Current assessment for and diagnosis of necrotizing enterocolitis (NEC) remain inadequate. The introduction of interrogating bowel with ultrasound when NEC is suspected or when NEC has occurred presents greater opportunity to characterize the physical changes that have occurred in the bowel wall structures. The evaluation of bowel by ultrasound has been shown to have high specificity for bowel necrosis. There are current barriers in adoption of these techniques because they have not been integrated into routine diagnostic imaging and are not well incorporated in neonatal medicine. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - December 20, 2018 Category: Perinatology & Neonatology Authors: Jae H. Kim Source Type: research