High-frequency Ventilation
High-frequency ventilation (HFV) is an alternative to conventional mechanical ventilation, with theoretic benefits of less risk of ventilator lung injury and more effectivity in washout CO2. Previous clinical studies have not demonstrated advantages of HFV in preterm infants compared with conventional ventilation, so rescue HFV has been used when severe respiratory insufficiency needs aggressive ventilator settings in immature infants. Today it is possible to measure, set directly, and fix tidal volume, which can protect the immature lung from large volumes and fluctuations of the tidal volume. This strategy can be used in...
Source: Clinics in Perinatology - October 2, 2021 Category: Perinatology & Neonatology Authors: Manuel S ánchez-Luna, Noelia González-Pacheco, Martín Santos-González, Francisco Tendillo-Cortijo Source Type: research
Mechanical Ventilation During Chronic Lung Disease
For infants with the most severe forms of chronic lung disease, regardless of etiology, chronic mechanical ventilation can provide stability, reduce acute respiratory events, and alleviate increased work of breathing. This approach prioritizes the baby ’s growth and development during early life. Once breathing comfortably, these infants can tolerate developmental therapies with the goal of achieving the best neurocognitive outcomes possible. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - October 2, 2021 Category: Perinatology & Neonatology Authors: Christopher D. Baker Source Type: research
Lung Protection During Mechanical Ventilation in the Premature Infant
Mechanical ventilation can be life-saving for the premature infant, but is often injurious to immature and underdeveloped lungs. Lung injury is caused by atelectrauma, oxygen toxicity, and volutrauma. Lung protection must include appropriate lung recruitment starting in the delivery suite and throughout mechanical ventilation. Strategies include open lung ventilation, positive end-expiratory pressure, and volume-targeted ventilation. Respiratory function monitoring, such as capnography and ventilator graphics, provides clinicians with continuous real-time information and an adjunct to optimize lung-protective ventilatory s...
Source: Clinics in Perinatology - October 2, 2021 Category: Perinatology & Neonatology Authors: Emma E. Williams, Anne Greenough Source Type: research
A New Era in the Respiratory Support of the Sick and Immature Neonate
We are living today in a new era in respiratory support of the sick and immature neonate. From the knowledge that ventilator-induced lung injury can be prevented or reduced due to a better understanding of the respiratory physiology, therapies, and more friendly medical devices, a “new respiratory distress syndrome (RDS) of the prematurity” is the leading respiratory problem and represents, instead of the old hyaline membrane disease, a new disease due to the multiple mechanisms involved in the respiratory insufficiency of the immaturity. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - October 2, 2021 Category: Perinatology & Neonatology Authors: Manuel S ánchez-Luna Tags: Preface Source Type: research
The Term Newborn
Term newborn infants without significant medical problems usually transition from fetal to newborn life without medical assistance. Infants requiring therapy often need care in a neonatal intensive care unit as opposed to a well-baby unit. Infants with unclear physiologic status or disease that may require therapies in the immediate newborn period may benefit from a period of observation with close monitoring before admission to a well-baby unit. Whenever possible, providing care for a newborn infant in an area that provides care for the newborn and mother together in the same room facilitates adaptation to normal breastfe...
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Tina A. Leone, Wanda J. Abreu Source Type: research
Cord Management of the Term Newborn
This article provides arguments for delaying cord clamping for a minimum of 3 minutes. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Ola Andersson, Judith S. Mercer Source Type: research
The Term Newborn
The changing epidemiology of early-onset neonatal sepsis among term infants has required reappraisal of approaches to management of newborn infants at potential risk. As this is now a rare disease, new strategies for reduction in diagnostic testing and empirical treatment have been developed. Adoption and refinement of these strategies should be a priority for all facilities where babies are born. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Karen M. Puopolo, Sagori Mukhopadhay, Adam Frymoyer, William E. Benitz Source Type: research
The Term Newborn
This article focuses on the evaluation and management of infants with common congenital infections such as cytomegalovirus, and infections that warrant early diagnosis and treatment to prevent serious complications, such as toxoplasmosis, human immunodeficiency virus, and syphilis. Zika virus and Chagas disease remain uncommon. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Amaran Moodley, Kurlen S.E. Payton Source Type: research
Human Milk for the Term Newborn
Human milk provides optimal nutrition for term newborns, but the prevalence of its use is below target, and risks have been identified. Infants of black mothers as well as term newborns admitted to the neonatal intensive care unit are at risk for not receiving human milk. To improve human milk intake, multiple individual-level interventions have been shown to be effective, but some popular system-level interventions are ineffective or harmful. Expressed milk and donor milk may be less beneficial than direct breastfeeding. Nuanced public policies can help support lactation while promoting individual choice and equity. (Sour...
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Isabelle Von Kohorn, Valerie Flaherman Source Type: research
Hyperbilirubinemia in the Term Infant
This article attempts to highlight contemporary issues relating to term neonatal hyperbilirubinemia and to focus attention on controversial issues and concepts with the potential to effect change in clinical approach. On the one hand, the focus is bilirubin neurotoxicity, which is now known to encompass a wide, diverse spectrum of features. The various aspects of this spectrum are outlined and defined. On the other hand, bilirubin also possesses antioxidant properties. As such, mild hyperbilirubinemia is suggested as actually offering the neonate some protective advantage. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Cathy Hammerman, Michael Kaplan Source Type: research
The Term Newborn
Prenatal genetic screening, including evaluation for inherited genetic disorders, aneuploidy risk assessment, and sonographic assessment, combined with a thorough newborn examination and standard newborn screening, including blood, hearing, and congenital heart disease screening, can reveal conditions requiring further evaluation after delivery. Abnormal prenatal or newborn screening results should prompt additional diagnostic testing guided by maternal fetal medicine, perinatal genetics, or pediatric specialists. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Kathryn A. Johnson, Valerian Catanzarite Source Type: research
Perinatal Cardiovascular Physiology and Recognition of Critical Congenital Heart Defects
This article reviews diagnosis and management of CHD in the delivery room and before surgery in the NICU. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Yogen Singh, Satyan Lakshminrusimha Source Type: research
Pathophysiology and Management of Persistent Pulmonary Hypertension of the Newborn
Persistent pulmonary hypertension of the newborn (PPHN) is a disorder of circulatory transition resulting in high pulmonary vascular resistance with extrapulmonary right-to-left shunts causing hypoxemia. There has been substantial gain in understanding of pathophysiology of PPHN over the past 2 decades, and biochemical pathways responsible for abnormal vasoconstriction of pulmonary vasculature are now better understood. Easy availability of bedside echocardiography helps in establishing early definitive diagnosis, understanding the pathophysiology and hemodynamic abnormalities, monitorin g the disease process, and respon...
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Yogen Singh, Satyan Lakshminrusimha Source Type: research
Sudden Unexpected Infant Death
Sudden unexpected infant death is a leading cause of death in infancy. Both safe sleep practices and breastfeeding can help decrease the risk, although the current practice of educating parents about the recommendations has not resulted in universal adherence. Prenatal counseling provides opportunities to discuss recommendations as well as troubleshoot common barriers to breastfeeding and safe infant sleep with goals to gradually change attitudes, address social norms, and prepare new parents. A conversational, motivational approach to discussions about the importance of safe sleep and continued breastfeeding, with explana...
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Ann Kellams, Lori Feldman-Winter Source Type: research
The Term Newborn
This article reviews specific adverse perinatal outcomes associated with the use of a variety of substances and provides guidance on exposure with continued breastfeeding. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - August 1, 2021 Category: Perinatology & Neonatology Authors: Courtney Townsel, Torri D. Metz, Maya Bunik Source Type: research
