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The Difficult Neonatal Airway
Airway management is one of the most crucial aspects of neonatal care. The occurrence of difficult airway is more common in neonates than any other age group, and any neonatal intubation can develop into a difficult airway scenario. Understanding the intricacies of the difficult neonatal airway is paramount for healthcare professionals involved in the care of newborns. This chapter explores the multifaceted aspects of the difficult neonatal airway. We begin with a review of the definition and incidence of difficult airway in the neonate. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Taylor Sawyer, Nicole Yamada, Rachel Umoren Source Type: research

‘Perinatal management of the anticipated difficult airway’
The ex-utero intrapartum treatment (EXIT) procedure was originally developed to reverse tracheal occlusion in fetuses with severe congenital diaphragmatic hernia that underwent fetal tracheal occlusion. The EXIT procedure has since been applied to a wide range of indications, but the primary indication remains securing a patent airway and providing respiratory support in fetuses with anticipated difficult airways. The authors review perinatal management of the anticipated difficult airway and their single-institution's experience with the EXIT procedure. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: M. Silena Mosquera, Sara Yuter, Alan W. Flake Source Type: research

Videolaryngoscopy in Neonatal Clinical Care
Endotracheal intubation is a life-saving procedure for many newborns. Historically, it has been achieved by obtaining an airway view through the mouth via direct laryngoscopy. It is a skill that takes time and practice to achieve proficiency. Increasing evidence for the benefit of videolaryngoscopy in adults and the new development of technology has allowed videolaryngoscopy to become a reality in neonatal care. Studies have examined its use as both a technique to improve intubation safety and success, and as a training tool for those learning the skill in this vulnerable population. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Sandy Kirolos, Gemma Edwards, Joyce O ’Shea Source Type: research

Apnoeic Oxygenation During Neonatal Intubation
'Apnoeic oxygenation ’ describes the diffusion of oxygen across the alveolar-capillary interface in the absence of tidal respiration. Apnoeic oxygenation requires a patent airway, the diffusion of oxygen to the alveoli, and cardiopulmonary circulation. Apnoeic oxygenation has varied applications in adult medicine incl uding facilitating tubeless anaesthesia or improving oxygenation when a difficult airway is known or anticipated. In the paediatric population, apnoeic oxygenation prolongs the time to oxygen desaturation, facilitating intubation. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Elizabeth K. Baker, Peter G. Davis, Kate A. Hodgson Source Type: research

Alternatives to Neonatal Intubation
Opportunities to learn and maintain competence in neonatal intubation have decreased. As many clinicians providing care to the newborn infant are not skilled in intubation, alternative strategies are critical. Most preterm infants breathe spontaneously, and require stabilisation rather than resuscitation at birth. Use of tactile stimulation, deferred cord clamping, and avoidance of hypoxia can help optimise breathing for these infants. Nasal devices appear a promising alternative to the face mask for early provision of respiratory support. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Calum T. Roberts, Joyce O ’Shea Source Type: research

Improving rates of successful extubation: medications
This chapter focuses on the pharmacological management of newborn infants in the peri-extubation period to reduce the risk of re-intubation and prolonged mechanical ventilation. Drugs used to promote respiratory drive, reduce the risk of apnoea, reduce lung inflammation and avoid bronchospasm are critically assessed. When available, Cochrane reviews and randomised trials are used as the primary sources of evidence. Methylxanthines, particularly caffeine, are well studied and there is accumulating evidence to guide clinicians on the timing and dosage that may be used. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Matteo Bruschettini Source Type: research

Optimising success of neonatal extubation: respiratory support
In this review, we examine lung physiology before, during and after neonatal extubation and propose a three-phase model for the extubation procedure. We perform meta-analyses to compare different modes of non-invasive respiratory support after neonatal extubation and based on the findings, the following clinical recommendations are made. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Vincent D. Gaertner, Christoph M. R üegger Source Type: research

Introduction to Neonatal Intubation and Extubation
The authors do not have any conflicts to declare. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Kate A. Hodgson, Peter G. Davis Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 1, 2023 Category: Perinatology & Neonatology Source Type: research

Operationalizing Neonatal Palliative Care
Caring for seriously ill newborns requires neonatal and palliative care clinicians to have a variety of skill sets. Issue I of this series entitled “Palliative and End of Life Care in the NICU” in Seminars in Fetal and Neonatal Medicine, focused primarily on the skills that clinicians need related to bioethical principles, moral reasoning, values-based decision-making, and counseling. Seven articles in Issue I explored the ethical underpinn ings for perinatal treatment options, the legal parameters relevant to decision-making prenatally and postnatally, and the communication skills key to navigating goals and values wi...
Source: Seminars in Fetal and Neonatal Medicine - July 14, 2023 Category: Perinatology & Neonatology Authors: Renee D. Boss, Mark R. Mercurio Tags: Editorial Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 1, 2023 Category: Perinatology & Neonatology Source Type: research

Editorial: Palliative and End of Life Care in the NICU Issue I
It has been fifty years since Duff and Campbell ’s seminal article in the New England Journal of Medicine entitled “Moral and Ethical Dilemmas in the Special Care Nursery.”1 In 1973, those authors described the circumstances surrounding 299 consecutive newborn deaths at Yale New Haven Hospital, in what is said to be the first modern newborn intensive care unit (NICU) in the United States. The authors drew a great deal of attention and controversy, because they were among the first to publicly acknowledge that many newborn deaths were the immediate result of decisions, reached by physicians and parents working togethe...
Source: Seminars in Fetal and Neonatal Medicine - May 31, 2023 Category: Perinatology & Neonatology Authors: Mark R. Mercurio, Renee D. Boss Tags: Editorial Source Type: research

Neurological conditions: Prognostic communication, shared decision making, and symptom management
Neonatal neurologic conditions represent a heterogeneous group of illnesses that can pose significant challenges to infants, their families, and clinicians. Neonates with neurologic injury are at increased risk for developmental and physical disabilities, seizures, spasticity, and pain, dependence on medical technologies, and death [1]. While these children are at risk of increased morbidity and mortality, accurate prognostication is complex. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - May 19, 2023 Category: Perinatology & Neonatology Authors: Dana Peralta, Jori Bogetz, Monica E. Lemmon Source Type: research

The Physiology, assessment, and treatment of neonatal pain
Studies have clearly shown that development of pain receptors starts as early as 20-weeks ’ gestation. Despite contrary belief, the human fetus develops a similar number of receptive pain fibers as seen in adults. These receptors’ maturation is based on response to sensory stimuli received after birth which makes the NICU a critical place for developing central nervous system’s pai n perception. In practice, the assessment of pain relies mostly on bedside staff. In this review we will discuss the various developing features of pain pathways in the neonatal brain and the modification of pain perception secondary to va...
Source: Seminars in Fetal and Neonatal Medicine - May 19, 2023 Category: Perinatology & Neonatology Authors: Megan H. Tucker, Priya Tiwari, Brian S. Carter Source Type: research

Seminars in Fetal & Neonatal Medicine: Palliative and End of Life Care in the NICU
Neonatal neurologic conditions represent a heterogeneous group of illnesses that can pose significant challenges to infants, their families, and clinicians. Neonates with neurologic injury are at increased risk for developmental and physical disabilities, seizures, spasticity, and pain, dependence on medical technologies, and death.1 While these children are at risk of increased morbidity and mortality, accurate prognostication is complex. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - May 19, 2023 Category: Perinatology & Neonatology Authors: Dana Peralta, Jori Bogetz, Monica E. Lemmon Source Type: research