Optimizing antenatal corticosteroid therapy
“Even the best proven interventions must be evaluated continually through research for their safety, effectiveness, efficacy, accessibility and quality,” Declaration of Helsinki [1]. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - May 16, 2019 Category: Perinatology & Neonatology Authors: Matthew W. Kemp, Augusto F. Schmidt, Alan H. Jobe Source Type: research

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Kendig's Disorders of the Respiratory Tract in Children remains the definitive text for pediatric pulmonologists. Although the internet is a massive database of information, and connectivity and social media enable knowledge transfer like never before, this book is the who's who of pediatric pulmonology, and features a nice mix of established experts and up and coming stars. It is also nice to see a more international flavor to the authors than in previous editions. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - May 10, 2019 Category: Perinatology & Neonatology Authors: Ian Sinha Tags: Book Review Source Type: research

Pain and distress management in palliative neonatal care
Palliative care concentrates on preventing and relieving suffering by reducing the severity of disease symptoms. Consistent treatment of pain and distress must therefore be an integral component of every palliative care concept. In this review non-pharmacological and pharmacological measures for pain and distress management in the context of palliative neonatal care are summarised. Furthermore, recommendations are given focusing on two special palliative neonatal care settings: compassionate extubation and withdrawing artificial nutrition and hydration. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - May 2, 2019 Category: Perinatology & Neonatology Authors: Lars Garten, Christoph B ührer Source Type: research

Prophylactic postnatal corticosteroids: Early hydrocortisone
Inflammation is a key contributor to the pathogenesis of bronchopulmonary dysplasia (BPD) in preterm infants, and cortisol plays a central role in controlling inflammation. Insufficient cortisol limits the ability of the sick newborn to handle stress and inhibit pulmonary inflammation. Evidence of lower cortisol and lower response to adrenocorticotropic hormone in infants subsequently developing BPD led to studies of early low-dose hydrocortisone to prevent BPD. Based on four randomised clinical trials enrolling almost 1000 extremely preterm infants, prophylaxis of early adrenal insufficiency with low-dose hydrocortisone s...
Source: Seminars in Fetal and Neonatal Medicine - April 29, 2019 Category: Perinatology & Neonatology Authors: Olivier Baud, Kristi L. Watterberg Source Type: research

Antenatal corticosteroids after 34  weeks’ gestation: Do we have the evidence?
There is evidence to support the use of antenatal corticosteroids prior to late preterm birth at 35+0 to 36+6 weeks' gestation and for specific ‘at-risk’ populations, such as planned cesarean section birth and infants of women with diabetes in pregnancy, to reduce short-term neonatal respiratory morbidity. However, the overall size of effect at late preterm and term gestational ages is less than for early and moderate preterm birth and should be countered against the potential harms. Evidence from randomized trials suggest an increase in the incidence of neonatal hypoglycemia after corticosteroid use prior to l...
Source: Seminars in Fetal and Neonatal Medicine - April 24, 2019 Category: Perinatology & Neonatology Authors: Katie M. Groom Source Type: research

Alternatives to systemic postnatal corticosteroids: Inhaled, nebulized and intratracheal
Concern about adverse outcomes with the use of systemic postnatal corticosteroids (PCS) for bronchopulmonary dysplasia (BPD) have led to the widespread use of alternative methods of administration in research and clinical care. Theoretically, administration of topical (directly to the lung) corticosteroids may allow for beneficial effects on the pulmonary system with a lower risk of undesirable side effects compared with systemic administration. Current evidence suggests that inhaled corticosteroids may be an effective therapy in the management of developing BPD in preterm infants, but questions about their safety remain. ...
Source: Seminars in Fetal and Neonatal Medicine - April 13, 2019 Category: Perinatology & Neonatology Authors: Christoph M. R üegger, Dirk Bassler Source Type: research

Assessment of pain in newborn infants
Hospitalized newborn infants experience pain that can have negative short- and long-term consequences and thus should be prevented and treated. National and international guidelines state that adequate pain management requires valid pain assessment. Nociceptive signals cause a cascade of physical and behavioral reactions that alone or in combination can be observed and used to assess the presence and intensity of pain.Units that are caring for newborn infants must adopt sufficient pain assessment tools to cover the gestational ages and pain types that occurs in their setting. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - April 12, 2019 Category: Perinatology & Neonatology Authors: Mats Eriksson, Marsha Campbell-Yeo Source Type: research

Long-term effects of neonatal pain
Pain experienced during neonatal intensive care management can influence neurodevelopmental outcome and the somatosensory and/or emotional components of pain response in later life. Alterations in biological factors (e.g. peripheral and central somatosensory function and modulation, brain structure and connectivity) and psychosocial factors (e.g. gender, coping style, mood, parental response) that influence pain have been identified in children and young adults born very preterm or extremely preterm. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - April 12, 2019 Category: Perinatology & Neonatology Authors: Suellen M. Walker Source Type: research

Non-invasive monitoring of stress biomarkers in the newborn period
The neonatal period is a highly sensitive time span during which stressful experiences may have an influence on later health outcomes. Medical procedures applied to newborn babies during hospitalization are stressors that trigger a physiological and psychological stress response. Stress response has been traditionally evaluated using scores based on behavioural signs such as facial expressions, limb movements, crying, etc., which are subjectively interpreted. Only few studies have employed measurable physiological signs to objectively evaluate the stress response to specific interventions. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - April 10, 2019 Category: Perinatology & Neonatology Authors: C. Pe ña-Bautista, R. Escrig, I. Lara, A. García-Blanco, C. Cháfer-Pericás, M. Vento Source Type: research

Managing neonatal pain in the era of non-invasive respiratory support
Non-invasive ventilation is currently the preferred respiratory support for premature infants with respiratory distress. The lung-protective effects of non-invasive ventilation should however not prompt disregard for the possible pain and discomfort it can generate. Non-pharmacological interventions should be used in all premature infants, regardless of their respiratory support, and are not detailed in this review. This review includes currently available evidence and gaps in knowledge regarding three aspects of pain management in premature infants receiving non-invasive ventilation: optimisation of non-invasive ventilati...
Source: Seminars in Fetal and Neonatal Medicine - April 6, 2019 Category: Perinatology & Neonatology Authors: Manon Tauzin, Xavier Durrmeyer Source Type: research

Long-term effects of postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia: Balancing the risks and benefits
Postnatal corticosteroids are effective in preventing or treating bronchopulmonary dysplasia (BPD) in preterm newborns, but their benefits need to exceed their risks. Several types of corticosteroids, and different timing and administration modes have been trialed. Systemic corticosteroids, given either early or late, have proven efficacy for reducing BPD and the combined outcome of death or BPD. Inhaled corticosteroids are less effective. However, systemic dexamethasone given early is associated with more neurosensory disability and cerebral palsy in survivors. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - April 5, 2019 Category: Perinatology & Neonatology Authors: Jeanie Ling Yoong Cheong, Lex William Doyle Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - April 1, 2019 Category: Perinatology & Neonatology Source Type: research

Models of care for neonatal abstinence syndrome: What works?
Opioid use disorders and the prescription of long-acting medications for their treatment have increased dramatically over the last decade among pregnant women. Newborns who experience prolonged in utero opioid exposure may develop neonatal abstinence syndrome (NAS). Until recently, much of the focus on improving care for NAS has been on pharmacologically-based care models. Recent studies have illustrated the benefits of rooming-in and parental presence on NAS outcomes. Single center Quality Improvement (QI) initiatives demonstrate the benefits of non-pharmacologic care bundles and symptom prioritization in decreasing the p...
Source: Seminars in Fetal and Neonatal Medicine - March 26, 2019 Category: Perinatology & Neonatology Authors: Bonny L. Whalen, Alison V. Holmes, Stacy Blythe Source Type: research

Breastmilk feeding for mothers and infants with opioid exposure: What is best?
With rare exception, breastfeeding is the optimal way to feed infants, and has special benefits for women and infants with perinatal opioid exposure. Infants breastfed and/or fed their mother's own breastmilk experience less severe opioid withdrawal symptoms, have shorter hospital stays, and are less likely to be treated with medication for withdrawal. The specific impact of mothers' milk feeding on opioid withdrawal may be related to the act of breastfeeding and associated skin-to-skin contact, qualities of breastmilk, healthier microbiome, small amounts of opioid drug in breastmilk, or a combination of these. (Source: Se...
Source: Seminars in Fetal and Neonatal Medicine - March 25, 2019 Category: Perinatology & Neonatology Authors: Debra L. Bogen, Bonny L. Whalen Source Type: research

Introduction
Maternal substance use is not a new phenomenon. However, in recent years, the number of mothers using addictive drugs, especially opioids, has increased exponentially, particularly in Western countries. These drugs are easier to obtain and are more potent than ever before. Unfortunately, any substance taken by a mother will traverse the placental barrier to affect the developing fetus. The consequences of these drugs at critical stages of fetal development as well as the associated risks inherent in drug-use behaviors are concerning and uncertain. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - March 16, 2019 Category: Perinatology & Neonatology Authors: Ju Lee Oei Source Type: research

Cannabis: An ancient friend or foe? What works and doesn't work
Cannabis has been cultivated by mankind for a multitude of uses over a period of thousands of years. This review explores how our relationship with the cannabis plant has evolved over this period of time, including the use of cannabis for recreational purposes and for its medicinal properties. The endocannabinoid system plays a complex role in the development of the fetal, infant and adolescent brain. Use of exogenous cannabinoids has the potential to result in supra-physiological stimulation and impact on normal central nervous system development. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - March 1, 2019 Category: Perinatology & Neonatology Authors: Philip Henschke Source Type: research

Stimulants: How big is the problem and what are the effects of prenatal exposure?
Globally, cocaine use increased by 7% –18.2 million people in 2016 or 0.4% of the world population aged 15–64. In 2016, over 34 million (0.7%) people aged 15–64 used amphetamines and a further 0.4% used MDMA (Ecstasy). Women of child bearing age worldwide are increasingly using and becoming dependent on stimulants; and are, in tur n, more vulnerable to sexually transmitted diseases, sexual violence, unplanned pregnancies and mental health problems. Stimulant use during pregnancy increases obstetric complications for the mother, increases the rate of preterm birth and decreases birth weight, length and hea...
Source: Seminars in Fetal and Neonatal Medicine - February 22, 2019 Category: Perinatology & Neonatology Authors: Trecia A. Wouldes, Barry M. Lester Source Type: research

After NAS
Mothers have used opioids for thousands of years but neonatal abstinence syndrome (NAS) or rather, survivors of NAS, is a modern phenomenon. Unrecognized and/or untreated opioid withdrawal was almost always fatal but with greater awareness and standardization of treatment, NAS is now an uncommon direct cause of infant death. However, opioids are now increasingly accessible and potent and the outcomes of children after the neonatal period are of great concern, especially when coupled with multiple other social and health risks. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - February 21, 2019 Category: Perinatology & Neonatology Authors: Ju Lee Oei Source Type: research

Epidemiology of perinatal substance use: Exploring trends in maternal substance use
This article offers a general overview of the epidemiology of perinatal substance use focusing primarily on the United States but when available international trends will be presented as well. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - February 15, 2019 Category: Perinatology & Neonatology Authors: Jennifer J. Rodriguez, Vincent C. Smith Source Type: research

Screening for substance use in pregnancy and the newborn
Substance use during pregnancy is common, costly and associated with maternal and newborn health consequences. Assessment of substance use should be integrated into prenatal care. Substance use identification methods include patient interview, screening instruments, and biological testing. In this review, we critically evaluate screening and testing for substance use during pregnancy, highlighting the benefits and barriers of integrated assessment into prenatal care. We also discuss the limitations and negative consequences that should be considered when implementing screening and/or testing procedures. (Source: Seminars i...
Source: Seminars in Fetal and Neonatal Medicine - February 13, 2019 Category: Perinatology & Neonatology Authors: Kathryn Polak, Sydney Kelpin, Mishka Terplan Source Type: research

Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS)
Neonatal abstinence syndrome is defined by signs and symptoms of withdrawal that infants develop after intrauterine maternal drug exposure. All infants with documented in utero opioid exposure, or a high pre-test probability of exposure should have monitoring with a standard assessment instrument such as a Finnegan Score. A Finnegan score of>8 is suggestive of opioid exposure, even in the absence of declared use during pregnancy. At least half of infants in most locales can be treated without the use of pharmacologic means. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - February 9, 2019 Category: Perinatology & Neonatology Authors: A.K. Mangat, G.M. Schm ölzer, W.K. Kraft Source Type: research

Effects of unconventional recreational drug use in pregnancy
Recreational drug toxicity is a rapidly evolving aspect in clinical practice. The prevalence of recreational drug abuse in the past decade has achieved an epidemic scale due to invention of new agents and ease of accessibility to the abused drugs. “Unconventional recreational drugs” is the term that includes new psychoactive drugs and medications diverted for recreational goals. Misuse of unconventional recreational drugs during pregnancy can affect both the pregnant woman and the fetus. However, the problems are usually unrecognized and overlooked by healthcare professionals. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - February 8, 2019 Category: Perinatology & Neonatology Authors: Summon Chomchai, Jariya Phuditshinnapatra, Pattaraporn Mekavuthikul, Chulathida Chomchai Source Type: research

Beyond the Finnegan scoring system: Novel assessment and diagnostic techniques for the opioid-exposed infant
Infants with in-utero opioid exposure are most commonly assessed using the Finnegan Neonatal Abstinence Scoring System (FNASS) or a modified version of that tool. Traditionally, the purpose of these tools has been to characterize the extent of withdrawal signs to guide the pharmacologic treatment for infants with neonatal opioid withdrawal syndrome (NOWS). In the past decade however, in response to some of the limitations of the FNASS tool, there has been an increasing emphasis on developing novel assessment tools not based on the FNASS in addition to the promotion of non-pharmacologic treatment options as the first line t...
Source: Seminars in Fetal and Neonatal Medicine - February 7, 2019 Category: Perinatology & Neonatology Authors: Davida M. Schiff, Matthew R. Grossman Source Type: research

Assessment of the newborn prenatally exposed to drugs: The history
This paper reviews the history of the development of scoring tools used to assess the occurrence and severity of the Neonatal Abstinence Syndrome. Beginning with the first tools published in 1975, this review describes tools published through 2010; identifies each tool's strengths and weaknesses; and discusses their representation in the literature. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - February 7, 2019 Category: Perinatology & Neonatology Authors: Karol Kaltenbach Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - February 1, 2019 Category: Perinatology & Neonatology Source Type: research

The genetics and epigenetics of Neonatal Abstinence Syndrome
Neonatal abstinence syndrome (NAS) due to in-utero opioid exposure is a growing epidemic with significant variability in clinical presentation and severity. Currently, NAS severity cannot be predicted based on clinical factors alone. To date, small studies have identified genetic variants in opioid receptor and stress response genes that are associated with differences in NAS pharmacologic treatment rates and length of hospitalization. In addition, epigenetic variation in the mu opioid receptor (OPRM1) gene has been associated with differences in NAS hospitalization outcomes. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - January 29, 2019 Category: Perinatology & Neonatology Authors: Elisha M. Wachman, Lindsay A. Farrer Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 27, 2018 Category: Perinatology & Neonatology Source Type: research

Adult outcomes of being born late preterm or early term – What do we know?
The literature on adult outcomes of people born late preterm (LPT, 34 –36 completed weeks) or early term (ET, 37–38 weeks) was reviewed. In PubMed, 9547 articles were identified; 53 were eligible. Of these, 12 were based on clinical cohorts, 32 on medical birth register linkages, and nine on historical birth cohorts; 48 out of 53 on Nordic countries; 50 out of 53 reported on LPT and eight out of 53 reported on ET. LPT plus ET have increased early ( (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 9, 2018 Category: Perinatology & Neonatology Authors: Eero Kajantie, Sonja Strang-Karlsson, Kari Anne Indredavik Evensen, Peija Haaramo Source Type: research

Is it possible to safely prevent late preterm and early term births?
Late preterm and early term birth is associated with adverse short- and long-term consequences, particularly for neurodevelopment. A clear reduction in these births can be achieved by avoidance of non-medically indicated births prior to 39 weeks gestation, as shown following the introduction of prohibitive policies in the USA. However, clinicians and policy-makers must always consider the potential for unintended adverse consequences of such action, such as a potential for an increase in term stillbirth. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 2, 2018 Category: Perinatology & Neonatology Authors: Scott W. White, John P. Newnham Source Type: research

Early childhood health and morbidity, including respiratory function in late preterm and early term births
Late preterm (LP) and early term (ET) infants have generally been considered in the same way as their healthy full term (FT) counterparts. It is only in the last decade that an increased risk of later poor health in children born LP has been recognised; evidence for health outcomes following ET birth is still emerging. However, reports are largely consistent in highlighting an increased risk, which lessens approaching FT but is measurable and persists into adolescence and beyond. The most thoroughly explored area to date is respiratory morbidity. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - October 19, 2018 Category: Perinatology & Neonatology Authors: Trishula Muganthan, Elaine M. Boyle Source Type: research

Late preterm births: New insights from neonatal neuroimaging and neurobehaviour
With increasing evidence of neurodevelopmental problems faced by late preterm children, there is a need to explore possible underlying brain structural changes. The use of brain magnetic resonance imaging has provided insights of smaller and less mature brains in infants born late preterm, associated with developmental delay at 2 years. Another useful tool in the newborn period is neurobehavioural assessment, which has also been shown to be suboptimal in late preterm infants compared with tern infants. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - October 17, 2018 Category: Perinatology & Neonatology Authors: Jeanie Ling Yoong Cheong, Deanne Kim Thompson, Joy Elizabeth Olsen, Alicia Jane Spittle Source Type: research

The continuum of late preterm and early term births
As noted in a recent “perspective” it is now well over a decade since the US National Institute of Child Health and Human Development (NICHD) expert panel recommended that infants born between 340 and 366 weeks be designated “late preterm” (LP) rather than being thought of as near-term and therefore healthy and mature without immediate or later problems related to their gestation [1]. More recently infants born at 370–386 weeks have been called “early term” (ET) to differentiate these births from those at full gestation. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - October 17, 2018 Category: Perinatology & Neonatology Authors: Brian A. Darlow, Jeanie L.Y. Cheong Tags: Editorial Source Type: research

Nutritional policies for late preterm and early term infants – can we do better?
Late preterm (LP) and early term (ET) infants can be considered the “great dissemblers”: they resemble healthy full-term infants in appearance, but their immaturity places them at increased risk of poor short- and long-term outcomes. Nutritional requirements are greater than for full-term babies, but there are few good data on the nutritional requirements for LP and ET babies, leading to substantial variation in practice. Recent data indicate that rapid growth may be beneficial for neurocognitive function but not for body composition and later metabolic health. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - October 16, 2018 Category: Perinatology & Neonatology Authors: Mariana Muelbert, Jane E. Harding, Frank H. Bloomfield Source Type: research

The prediction of preterm delivery: What is new?
Preterm birth, defined as birth occurring prior to 37 weeks gestation, is a serious obstetric problem accounting for 11% of pregnancies worldwide. It is associated with significant neonatal morbidity and mortality. Predictive tests for preterm birth are incredibly important, given the huge personal, economic, and health impacts of preterm birth. They can provide reassurance for women who are unlikely to deliver early, but they are also important for highlighting those women at higher risk of premature delivery so that we can offer prophylactic interventions and help guide antenatal management decisions. (Source: Seminars i...
Source: Seminars in Fetal and Neonatal Medicine - October 15, 2018 Category: Perinatology & Neonatology Authors: Natalie Suff, Lisa Story, Andrew Shennan Source Type: research

The place of antenatal corticosteroids in late preterm and early term births
Infants born in the late preterm period and via non-labour caesarean section in the early term period are at increased risk of respiratory morbidity when compared to their term-born counterparts. The morbidity in these infants is less frequent and severe than in early preterm infants. Antenatal corticosteroids reduce respiratory morbidity in these populations; however, the magnitude of the reduction appears to be small and predominantly in the self-limiting condition of transient tachypnoea of the neonate. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - October 12, 2018 Category: Perinatology & Neonatology Authors: Hagar Rahel Haviv, Joanne Said, Ben Willem Mol Source Type: research

Neurodevelopmental outcomes of the late preterm infant
Late preterm infants (born at 340/7 –366/7 weeks gestation) have been found to have increased morbidity and mortality compared to full term infants. Research has also been done to explore longer-term neurodevelopmental outcomes. This review details neurodevelopmental outcomes from birth to adulthood for late preterm infants. Outcome studies indicate that they are at increased risk of developmental disability, school failure, behavior problems, social and medical disabilities, and death. Many questions still remain regarding late preterm infant neurodevelopmental outcomes and future research should be done into this t...
Source: Seminars in Fetal and Neonatal Medicine - October 12, 2018 Category: Perinatology & Neonatology Authors: Melissa Woythaler Source Type: research

Epidemiology of late preterm and early term births – An international perspective
Late preterm (34 –36 weeks of gestational age (GA)), and early term (37–38 weeks GA) birth rates among singleton live births vary from 3% to 6% and from 15% to 31%, respectively, across countries, although data from low- and middle-income countries are sparse. Countries with high preterm birth rates are more likely to have high early term birth rates; many risk factors are shared, including pregnancy complications (hypertension, diabetes), medical practices (provider-initiated delivery, assisted reproduction), maternal socio-demographic and lifestyle characteristics and environmental factors. (Source: Semin...
Source: Seminars in Fetal and Neonatal Medicine - October 8, 2018 Category: Perinatology & Neonatology Authors: Marie Delnord, Jennifer Zeitlin Source Type: research

Genetic predisposition to necrotizing enterocolitis in premature infants: Current knowledge, challenges, and future directions
The role of genetics in the pathogenesis of necrotizing enterocolitis (NEC) was initially informed by epidemiological data indicating differences in prevalence among different ethnic groups as well as concordance in twins. These early observations, together with major advances in genomic research, paved the way for studies that begin to reveal the contribution of genetics to NEC. Using the candidate gene or pathway approach, several potential pathogenic variants for NEC in premature infants have already been identified. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - October 3, 2018 Category: Perinatology & Neonatology Authors: Alain Cuna, Lovya George, Venkatesh Sampath Source Type: research

The rising incidence and impact of non-medically indicated pre-labour cesarean section in Latin America
In the poorest populations of the world the difficulties of performing a surgical procedure lead to extremely low cesarean section rates associated with very high perinatal mortality. Meanwhile the proportion of births by cesarean section has been increasing for several decades in many areas of the world, reaching alarmingly high rates especially in Latin America. This review aims to describe this secular trend. The causes of the increase in cesarean deliveries are analyzed with a multidimensional approach, trying to recognize the reasons behind the choice of the route of delivery. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - October 3, 2018 Category: Perinatology & Neonatology Authors: Gonzalo L. Mariani, Nestor E. Vain Source Type: research

What to do if A  + B doesn't work
The majority of newborn resuscitations require very little beyond simple airway management and assisted ventilation. If cardiovascular collapse is serious enough to warrant additional support, resuscitation algorithms recommend moving to chest compressions and then on to medications and possibly volume replacement if vital signs remain marginal or absent. The evidence base upon which this part of the neonatal resuscitation algorithm is structured is sparse. Chest compressions and medications are rare interventions that do not lend themselves easily to clinical trials. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - October 3, 2018 Category: Perinatology & Neonatology Authors: Lindsay F.J. Mildenhall, Tetsuya Isayama Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - October 1, 2018 Category: Perinatology & Neonatology Source Type: research

Editorial: The science to improve neonatal delivery room resuscitation
The number of medical publications continues to rise at a rate which almost defies individual clinicians ’ ability to keep up to date [1]. However, the profusion of evidence is not always of high quality [2] and individual papers may be misleading in terms of defining practice or guidelines [3]. The International Liaison Committee on Resuscitation (ILCOR) recognized this in revising the approach to e valuation of evidence and utilizing the GRADE methodology [4]. The future ILCOR process of evidence evaluation has become continuous but at present most international resuscitation committees maintain a five-year cycle f...
Source: Seminars in Fetal and Neonatal Medicine - October 1, 2018 Category: Perinatology & Neonatology Authors: M.H. Wyckoff, J. Wyllie Tags: Editorial Source Type: research

The science to improve neonatal delivery room resuscitation
The number of medical publications continues to rise at a rate which almost defies individual clinicians ’ ability to keep up to date [1]. However, the profusion of evidence is not always of high quality [2] and individual papers may be misleading in terms of defining practice or guidelines [3]. The International Liaison Committee on Resuscitation (ILCOR) recognized this in revising the approach to e valuation of evidence and utilizing the GRADE methodology [4]. The future ILCOR process of evidence evaluation has become continuous but at present most international resuscitation committees maintain a five-year cycle f...
Source: Seminars in Fetal and Neonatal Medicine - October 1, 2018 Category: Perinatology & Neonatology Authors: M.H. Wyckoff, J. Wyllie Tags: Editorial Source Type: research

Necrotizing enterocolitis
(NEC) has emerged as a major cause of mortality and morbidity in infants. Despite considerable research, prevention and/or cure remain elusive because NEC is not a clear target. It represents more than one disease with multifactorial pathogenic mechanisms. Databases for NEC are blurry at best; hence, epidemiologic research on this disease is hampered by the lack of a clear definition of what constitutes the major form of this disease. Likewise, animal models that putatively represent the disease are off mark since they only represent a limited component of the disease seen in human infants. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 29, 2018 Category: Perinatology & Neonatology Authors: Josef Neu Tags: Editorial Source Type: research

Health economic aspects of late preterm and early term birth
Despite an increasing body of knowledge on the adverse clinical sequelae associated with late preterm birth and early term birth, little is known about their economic consequences or the cost-effectiveness of interventions aimed at their prevention or alleviation of their effects. This review assesses the health economic evidence surrounding late preterm and early term birth. Evidence is gathered on hospital resource use associated with late preterm and early term birth, economic costs associated with late preterm and early term birth, and economic evaluations of prevention and treatment strategies. (Source: Seminars in Fe...
Source: Seminars in Fetal and Neonatal Medicine - September 29, 2018 Category: Perinatology & Neonatology Authors: Stavros Petrou Source Type: research

Intestinal microcirculation and necrotizing enterocolitis: The vascular endothelial growth factor system
Necrotizing enterocolitis (NEC), a leading cause of morbidity and mortality in preterm neonates, is a devastating disease characterized by intestinal tissue inflammation and necrosis. NEC pathogenesis is multifactorial but remains unclear. Translocation of bacteria and/or bacterial products across a weak intestinal barrier in the setting of impaired mucosal immunity leads to an exaggerated inflammatory response and secondary mucosal epithelial injury. In addition to prematurity, other risk factors for NEC include congenital heart disease, maternal pre-eclampsia with placental vascular insufficiency, severe anemia and blood...
Source: Seminars in Fetal and Neonatal Medicine - September 10, 2018 Category: Perinatology & Neonatology Authors: Rakhee M. Bowker, Xiaocai Yan, Isabelle G. De Plaen Source Type: research

Surgical considerations for neonates with necrotizing enterocolitis
Necrotizing enterocolitis (NEC) is a potentially devastating condition that preferentially affects premature and low birth weight infants, with approximately half requiring acute surgical intervention. Surgical consult should be considered early on, and deterioration despite maximal medical therapy or the finding of pneumoperitoneum are the strongest indications for emergent surgical intervention. There is no clear consensus on the optimal surgical approach between peritoneal drainage and laparotomy; the best course of action likely depends on the infant's comorbidities, hemodynamic status, size, disease involvement, and a...
Source: Seminars in Fetal and Neonatal Medicine - September 5, 2018 Category: Perinatology & Neonatology Authors: Charles R. Hong, Sam M. Han, Tom Jaksic Source Type: research

Necrotizing enterocolitis: The intestinal microbiome, metabolome and inflammatory mediators
Necrotizing enterocolitis (NEC) is a disease of preterm infants and associated with significant mortality and morbidity. Although the pathogenesis of NEC is not clear, microbial dysbiosis, with a bloom of the phylum Proteobacteria, has been reported. Antibiotics and the use of H2 blockers, which affect the gut microbiome, are associated with increased incidence of NEC. In association with dysbiosis, inflammatory processes are upregulated with increased Toll-like receptor signaling, leading to translocation of nuclear factor kappa- β, a transcription factor that induces transcription of various pro-inflammatory cytokin...
Source: Seminars in Fetal and Neonatal Medicine - August 29, 2018 Category: Perinatology & Neonatology Authors: Josef Neu, Mohan Pammi Source Type: research

Innate and adaptive immunity in necrotizing enterocolitis
Necrotizing enterocolitis (NEC) is the most frequent and devastating gastrointestinal disease of premature infants. Although the precise mechanisms are not fully understood, NEC is thought to develop following a combination of prematurity, formula feeding, and adverse microbial colonization. Within the last decade, studies increasingly support an important role of a heightened mucosal immune response initiating a pro-inflammatory signaling cascade, which can lead to the disruption of the intestinal epithelium and translocation of pathogenic species. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 23, 2018 Category: Perinatology & Neonatology Authors: Madison A. Mara, Misty Good, Joern-Hendrik Weitkamp Source Type: research

The cost of necrotizing enterocolitis in premature infants
Necrotizing enterocolitis (NEC), a common morbidity of prematurity, affects 5 –10% of premature infants with a birthweight (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 22, 2018 Category: Perinatology & Neonatology Authors: Meredith E. Mowitz, Dmitry Dukhovny, John A.F. Zupancic Source Type: research