Management of Hypertension in Pregnancy
Hypertensive diseases of pregnancy remain a leading cause of maternal and neonatal morbidity and mortality. Therefore, we sought to review the management of these conditions in pregnancy. In this review we discuss the most updated definitions, different antihypertensives, delivery recommendations and overall goals of management, including their effects on uteroplacental perfusion. We also highlight different medical situations where one antihypertensive may be preferable over others. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 27, 2020 Category: Perinatology & Neonatology Authors: Farah Amro, Baha Sibai Source Type: research

Histopathology of the Fetal Inflammatory Response to Intra-amniotic Pathogens
Obstetric endorsement of the utility of placental histologic examination remains infrequent, especially from obstetricians who do not have a placental pathologist as part of their own local clinical care team. Placental pathologic examinations are viewed as useless if they do not provide answers to urgent clinical questions. Increasingly, however, it is appreciated that while placental analysis should be considered with regard to its longer term value; results can assess lifelong risks of a wide range of diseases that have been tied to prenatal exposures (e.g., 1), including distinguishing sex-specific differences in those...
Source: Seminars in Fetal and Neonatal Medicine - August 27, 2020 Category: Perinatology & Neonatology Authors: Carolyn M. Salafia, Dawn P. Misra Source Type: research

FIRS: Neonatal Considerations
Fetal Inflammatory Response Syndrome (FIRS) is the fetal counterpart of systemic inflammatory response syndrome (SIRS) described in adults. When the fetus is directly exposed to inflammation of the fetal membranes or the placental-fetal circulation, and organs are adversely affected, the disorder is known as FIRS. This syndrome can significantly affect multiple organs with significant short and long term implications for the newborn. In cases of neonatal encephalopathy when no obvious etiology is identified, FIRS needs to be considered. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 25, 2020 Category: Perinatology & Neonatology Authors: Jonathan Muraskas, Sachin Amin, Lauren Astrug Source Type: research

Near-Infrared Spectroscopy for Perfusion Assessment and Neonatal Management
Term and preterm infants often present with adverse conditions after birth resulting in abnormal vital functions and severe organ failure, which are associated or sometimes caused by low oxygen and/or blood supply. Brain injury may lead to substantial mortality and morbidity often affecting long-term outcome. Standard monitoring techniques in the NICU focus on arterial oxygen supply and hemodynamics and include respiratory rate, heart rate, blood pressure and arterial oxygen saturation as measured by pulse oximetry but provide only limited information on end organ oxygen delivery. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 14, 2020 Category: Perinatology & Neonatology Authors: Helmut Hummler Source Type: research

Neuroimaging Findings Associated with the Fetal Inflammatory Response Syndrome
The fetal inflammatory response syndrome (FIRS) is a condition whereby the fetus mounts an inflammatory response to intrauterine infection/inflammation. Clinical consequences include preterm premature rupture of membranes (PPROM), spontaneous preterm delivery, neonatal sepsis, bronchopulmonary dysplasia, and brain and other organ injury. Mechanisms leading to brain injury in FIRS have been investigated in animal and human studies. We review the neuroimaging findings of brain injury in FIRS, which overlap those of hypoxic-ischemic injury, and clinical correlation is necessary for a correct diagnosis. (Source: Seminars in Fe...
Source: Seminars in Fetal and Neonatal Medicine - August 2, 2020 Category: Perinatology & Neonatology Authors: Luis Concalves, Patricia Cornejo, Richard Towbin Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 1, 2020 Category: Perinatology & Neonatology Source Type: research

Assessment of Neonatal Perfusion
Disorders of perfusion in newborn infants are frequently observed in neonatal intensive care units. The current assessment practices are primarily based on clinical signs. Significant technologic advances have opened new avenues for continuous assessment at the bedside. Combining these devices with functional echocardiography provides an in-depth understanding of perfusion and allows targeting therapy to the pathophysiology rather than monitoring and targeting blood pressure. This change in approach is guided by the fact that perfusion disorders can result from a number of causes and a single management approach might do m...
Source: Seminars in Fetal and Neonatal Medicine - July 30, 2020 Category: Perinatology & Neonatology Authors: Samir Gupta, Steven M. Donn Source Type: research

The epidemiology of FIRS in term and late preterm births
The definition of FIRS requires systemic inflammation and elevated levels of IL-6 in fetal plasma. That definition does not specify how systemic inflammation is to be recognized, and perinatal measurement of IL-6 is not a standard procedure. FIRS has not been examined in a population-based study that included post-neonatal outcome so its incidence and natural history are not known. The overlap, and similarities and differences, of FIRS as compared with other causes of neonatal encephalopathy, and how these relate to findings in the placenta, have not been jointly examined in a generalizable sample. (Source: Seminars in Fet...
Source: Seminars in Fetal and Neonatal Medicine - July 18, 2020 Category: Perinatology & Neonatology Authors: Karin B. Nelson Source Type: research

Prevention of postpartum hemorrhage
Postpartum hemorrhage is a leading cause of severe maternal morbidity and mortality worldwide and the United States. While the rates of maternal mortality attributable to hemorrhage are declining, severe maternal morbidity continues to be a growing problem. Efforts in recent years to more appropriately identify patients at risk, define significant hemorrhage, quantify blood loss, and standardize approaches to care in pregnancy and postpartum have led to an increasing preventability of PPH. We aim to review the most current recommendation for the prevention and effective management of obstetric hemorrhage. (Source: Seminars...
Source: Seminars in Fetal and Neonatal Medicine - July 13, 2020 Category: Perinatology & Neonatology Authors: Veronica Gonzalez-Brown, Patrick Schneider Source Type: research

The Hypertensive Neonate
Hypertension in neonates is increasingly recognized because of improvements in neonatal intensive care that have led to improved survival of premature infants. Although normative data on neonatal blood pressure remain limited, several factors appear to be important in determining blood pressure levels in neonates, especially gestational age, birth weight and maternal factors. Incidence is around 1% in most studies and identification depends on careful blood pressure measurement. Common causes of neonatal hypertension include umbilical catheter associated thrombosis, renal parenchymal disease, and chronic lung disease, and ...
Source: Seminars in Fetal and Neonatal Medicine - July 10, 2020 Category: Perinatology & Neonatology Authors: Joseph T. Flynn Source Type: research

Optimizing Hemodynamic Care in Neonatal Encephalopathy
Hemodynamic impairment occurs in up to 80% of infants with neonatal encephalopathy (NE). Not all infants benefit from therapeutic hypothermia (HT); there are some indications that the trajectory of brain injury might be modified by neurologic monitoring and early management over the first 72-hour period. It is also possible that optimizing hemodynamic management may further improve outomes. The coupling between cerebral blood flow and cerebral metabolism is disrupted in NE, increasing the vulnerability of the newborn brain to secondary injury. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - July 10, 2020 Category: Perinatology & Neonatology Authors: Raymand Pang, Alison Mintoft, Rose Crowley, Mark Sellwood, Subhabrata Mitra, Nicola J. Robertson Source Type: research

Evaluation for the etiology of neonatal encephalopathy and the diagnosis of FIRS
A common disorder managed in the neonatal intensive care unit (NICU) is neonatal encephalopathy (NE). There are multiple causes of NE, including hypoxic-ischemic encephalopathy (HIE) and the fetal inflammatory response syndrome (FIRS). It is important to ascertain the specific cause of NE in an affected child, as it may affect the clinical management and will assist in prognostication. This paper discusses the background of inflammatory damage to the fetal brain, the history of FIRS as a clinical diagnosis, the characteristics of infants with FIRS, and methods to evaluate the etiology of NE. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - July 8, 2020 Category: Perinatology & Neonatology Authors: Thomas E. Wiswell Source Type: research

Neurologic Outcome After Fetal Inflammatory Response Syndrome: Trimester-Specific Considerations
Clinical signs and neuroimaging patterns associated with the fetal inflammatory response syndrome (FIRS) worsen or mimic the clinical repertoire after intrapartum hypoxic-ischemic encephalopathy (HIE) during labor and/or parturition. Diagnostic considerations expressed as neonatal encephalopathy (NE) must consider chronic as well as acute factors associated with FIRS. Trimester-specific factors adversely alter the interactions of the maternal/placental/fetal (MPF) triad and influence the postnatal phenotype of FIRS. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - July 2, 2020 Category: Perinatology & Neonatology Authors: Mark S. Scher Source Type: research

Arterial Spin Labeling perfusion in neonates
Abnormal brain perfusion is a key mechanism underlying neonatal brain injury. Understanding the mechanisms leading to brain perfusion changes in high-risk neonates and how these alterations may influence brain development is key to improve therapeutic strategies preventing brain injury and the neurodevelopmental outcome of these infants. To date, several studies demonstrated that Arterial Spin Labeling is a reliable tool to accurately and non-invasively analyze brain perfusion, facilitating the understanding of normal and pathological mechanisms underlying neonatal brain maturation and injury. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 20, 2020 Category: Perinatology & Neonatology Authors: Domenico Tortora, Mariasavina Severino, Andrea Rossi Source Type: research

Medico-Legal Implications of the Fetal Inflammatory Response Syndrome
Babies who sustain long term neurologic injury and disability are frequent subjects in medical malpractice litigation. In the United States, the tort system enables adjudication of claims through a proscribed system. This paper will review salient elements of the tort system-duty, breach, causation, and damages- and how they apply to encephalopathic infants whose injuries are believed to be the result of fetal inflammatory response syndrome (FIRS) and/or hypoxic-ischemic damage. FIRS may confound the diagnosis of neonatal encephalopathy but may be a credible explanation for it as well. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 12, 2020 Category: Perinatology & Neonatology Authors: Jonathan M. Fanaroff, Steven M. Donn Source Type: research