Pulmonary Vasodilator Therapy in Persistent Pulmonary Hypertension of the Newborn
This article reviews the available evidence and future directions for research in PPHN. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - January 21, 2022 Category: Perinatology & Neonatology Authors: Megha Sharma, Emily Callan, G. Ganesh Konduri Source Type: research
Biomarkers of Necrotizing Enterocolitis: The Search Continues
Necrotizing enterocolitis (NEC) is the most common gastrointestinal (GI) emergency in the neonatal intensive care unit. Despite advances in medical care, mortality and morbidity from NEC have not changed. This is likely due to the lack of a clear understanding of this multifactorial disease, and reliable biomarkers for accurate diagnosis of NEC. Currently, the diagnosis of NEC is made by a combination of nonspecific clinical signs, symptoms, and radiological findings. Though biomarkers have been studied extensively, none offer an acceptable sensitivity or specificity to be used. This review will focus on the available lite...
Source: Clinics in Perinatology - January 21, 2022 Category: Perinatology & Neonatology Authors: Aarthi Gunasekaran, Christa Devette, Samuel Levin, Hala Chaaban Source Type: research
Prevention of Necrotizing Enterocolitis
Necrotizing enterocolitis (NEC) is considered to be one of the most devastating intestinal diseases seen in neonatal intensive care. Measures to treat NEC are often too late, and we need effective preventative measures to alleviate the burden of this disease. The purpose of this review is to summarize currently used measures, and those showing future promise for prevention. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - January 21, 2022 Category: Perinatology & Neonatology Authors: Josef Neu Source Type: research
Pharmacologic Analgesia and Sedation in Neonates
Chronic pain and agitation in neonatal life impact the developing brain. Oral sweet-tasting solutions should be used judiciously to mitigate behavioral responses to mild painful procedures, keeping in mind that the long-term impact is unknown. Rapidly acting opioids should be used as part of premedication cocktails for nonemergent endotracheal intubations. Continuous low-dose morphine or dexmedetomidine may be considered for preterm or term neonates exhibiting signs of stress during mechanical ventilation and therapeutic hypothermia, respectively. Further research is required regarding the pharmacokinetics, pharmacodynamic...
Source: Clinics in Perinatology - January 21, 2022 Category: Perinatology & Neonatology Authors: Christopher McPherson, Ruth E. Grunau Source Type: research
Controversies in Fetal Surgery
Fetal surgery is a constantly evolving field that showed noticeable progress with the treatment of myelomeningocele (MMC) using prenatal repair. Despite this success, there are ongoing questions regarding the optimal approach for fetal myelomeningocele repair, as well as which patients are eligible. Expansion of the inclusion and exclusion criteria is an important ongoing area of study for myelomeningocele including the recent Management of Myelomeningocele Plus trial. The significant personal and financial burden required of families seeking treatment has likely limited its accessibility to the general population. (Source...
Source: Clinics in Perinatology - January 21, 2022 Category: Perinatology & Neonatology Authors: John P. Marquart, Andrew B. Foy, Amy J. Wagner Source Type: research
New Horizons in Mild Hypoxic-ischemic Encephalopathy: A Standardized Algorithm to Move past Conundrum of Care
Hypoxic-ischemic encephalopathy (HIE) presents clinically with a neonatal encephalopathy (NE) whereby the mild spectrum is difficult to classify immediately after birth. For decades trials have focused exclusively on infants with moderate-severe HIE s, as these infants were easier to identify after birth and had the highest risk of adverse outcomes. Twenty years after those trials, the PRIME study finally solved the first part of the conundrum by providing a definition of mild HIE in the first 6 hours. There is strong biological plausibility and preclinical evidence supporting the efficacy of therapeutic hypothermia (TH) b...
Source: Clinics in Perinatology - January 21, 2022 Category: Perinatology & Neonatology Authors: Lina Chalak Source Type: research
Black Babies Matter
Despite dramatic advancements in neonatal intensive care since the 1960s, African –American infants still have more than a two-fold higher first-year mortality rate than non-Latinx White infants. Our essay examines the impact of upstream factors closely linked to the historical and contemporary context of structural racism in the United States on the African–American women’ s birth outcome disadvantage. In the process, we propose a paradigm to address the racial health inequity in adverse birth outcome by considering the interplay of racism and social class. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - January 21, 2022 Category: Perinatology & Neonatology Authors: James W. Collins, Richard J. David Source Type: research
Exome and Whole Genome Sequencing in the Neonatal Intensive Care Unit
The role of genomic sequencing (exome and whole genome) in the neonatal intensive care unit (NICU) has changed with advances in technology and bioinformatics in the last decade. Evidence from 18 retrospective and prospective studies of exome and whole genome sequencing in pediatric intensive care settings has demonstrated an average diagnostic yield of close to 40% and an immediate impact on clinical management in more than 20% of patients tested, and the highest clinical utility was in the perinatal setting. Genomic sequencing, when indicated, should be the standard of care for patients in the NICU. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - January 21, 2022 Category: Perinatology & Neonatology Authors: Michael Muriello Source Type: research
Novel Ventilation Strategies to Reduce Adverse Pulmonary Outcomes
Extremely preterm infants who must suddenly support their own gas exchange with lungs that are incompletely developed and lacking adequate amount of surfactant and antioxidant defenses are susceptible to lung injury. The decades-long quest to prevent bronchopulmonary dysplasia has had limited success, in part because of increasing survival of more immature infants. The process must begin in the delivery room with gentle assistance in establishing and maintaining adequate lung aeration, followed by noninvasive support and less invasive surfactant administration. Various modalities of invasive and noninvasive support have be...
Source: Clinics in Perinatology - January 21, 2022 Category: Perinatology & Neonatology Authors: Martin Keszler Source Type: research
Current Controversies in Perinatology
In the modern era of perinatology, controversy exists in the daily clinical management of the most vulnerable infants in the neonatal intensive care unit (NICU). Infants who may not have survived beyond the perinatal period in the past now survive, and their comorbidities create clinical conundrums in both the short term and the long term. Therefore, we are always in search of new and better ways to care for these infants. We have become increasingly aware though that innovation requires continued critical evaluation and review. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - January 21, 2022 Category: Perinatology & Neonatology Authors: Susan S. Cohen, Robert M. Kliegman Tags: Preface Source Type: research
Controversies Will Always Be There: They Need to Be Managed
More than twenty years after the publication of the landmark report To Err Is Human,1 much progress has been made in making health care safe. Institutions across the country have focused on improving quality and patient safety through standardization of practices. In a follow-up publication in 2005, Drs Leape and Berwick2 commented on the progress made after the original report and future expectations. They predicted that the pace of change would accelerate with implementation of electronic medical records, coupled with more widespread adoption of best practices to improve patient safety and outcomes. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - January 20, 2022 Category: Perinatology & Neonatology Authors: Lucky Jain Tags: Foreword Source Type: research
Physiologic Changes during Neonatal Transition and the Influence of Respiratory Support
Very preterm infants have difficulties establishing effective breathing at birth because their lungs are structurally immature, surfactant-deficient, and not supported by a stiff chest wall.1 Indeed, 10% of newborn infants require respiratory support at birth, which is increasing with decreasing gestational age.2 The International Liaison Committee on Resuscitation recommends to provide positive pressure ventilation (PPV) for newborns who are apneic, bradycardic, or demonstrate inadequate respiratory effort immediately after birth. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - November 11, 2021 Category: Perinatology & Neonatology Authors: Marlies Bruckner, Georg M. Schm ölzer Source Type: research
Synchronized Invasive Mechanical Ventilation
Respiratory care of premature neonates has witnessed substantial advances in the last two decades and has played a crucial role in decreasing early mortality in this population. This review outlines advances in techniques of synchronization and modes of synchronized invasive mechanical ventilation in neonates. The use of synchronized ventilation in the neonatal population was delayed a s compared to adults, mainly because of technical reasons. Coordinating the infant's respiratory effort and the onset of mechanical ventilation in the neonatal population has requested high sensitivity instruments. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - November 11, 2021 Category: Perinatology & Neonatology Authors: Ilia Bresesti, Massimo Agosti, Satyan Lakshminrusimha, Gianluca Lista Source Type: research
Volume-Targeted Ventilation
Volume-targeted ventilation (VTV) has been increasingly used in neonatology. In systematic reviews, VTV has been shown to reduce the risk of neonatal morbidities and improve long-term outcomes. It is adaptive ventilation using complex computer algorithms to deliver ventilator inflations with expired tidal volumes close to a target set by clinicians. Significant endotracheal tube leak and patient –ventilator interactions may complicate VTV and make ventilator parameters and waveforms difficult to interpret. In this article, we review the rationale for using VTV and the evidence supporting its use and provide practical adv...
Source: Clinics in Perinatology - November 11, 2021 Category: Perinatology & Neonatology Authors: Gusztav Belteki, Colin J. Morley Source Type: research
Weaning from the Ventilator in Bronchopulmonary Dysplasia
For the newborns needing respiratory support at 36 weeks postmenstrual age, regardless of the type of ventilation used, it is critical to take into account the mechanics properties of both airways and lungs affected by severe bronchopulmonary dysplasia (sBPD). Ventilator strategies, settings, and weaning must change dramatically after sBPD is esta blished, but to date there is almost no high-quality evidence base supporting a specific approach to guide the optimal ventilator management and weaning in patients with sBPD. Weaning from invasive mechanical ventilation, management of the immediately postextubation period, and...
Source: Clinics in Perinatology - November 11, 2021 Category: Perinatology & Neonatology Authors: Giovanni Vento, Chiara Tirone, Angela Paladini, Claudia Aurilia, Alessandra Lio, Milena Tana Source Type: research
