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Targeted fortification with human milk analysis: an opportunity for innovation
Human milk ’s variable macronutrient composition is a necessary consideration when caring for very low birthweight infants. Targeted fortification is the practice of fortifying human milk using its known composition from human milk analysis, rather than its assumed macronutrient values. Utilization of human milk analyzers to measure the protein, fat, lactose, and energy composition within human milk samples has allowed the translation of this practice into the clinical setting. This review discusses the rationale of why targeted fortification is an important practice, what barriers exist in its impleme ntation in the cli...
Source: Seminars in Fetal and Neonatal Medicine - September 12, 2022 Category: Perinatology & Neonatology Authors: Sharon Groh-Wargo, Stephanie Merlino Barr Source Type: research

Long Term Outcome of Babies with Pulmonary Hypertension
Neonatal pulmonary hypertension (PH) is associated with many severe congenital abnormalities (congenital diaphragmatic hernia) or acquired cardiorespiratory diseases such as pneumonia, meconium aspiration and bronchopulmonary dysplasia (BPD). If no cause is found it may be labelled idiopathic persistent pulmonary hypertension of the newborn. Although PH may result in life threatening hypoxia and circulatory failure, in the majority of cases, it resolves in the neonatal period following treatment of the underlying cause. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 11, 2022 Category: Perinatology & Neonatology Authors: Andrew Durward, Duncan Macrae Source Type: research

Diagnosis & Management of Pulmonary Hypertension in Congenital Diaphragmatic Hernia
Congenital diaphragmatic hernia (CDH) contributes to neonatal morbidity and mortality worldwide. Pulmonary hypertension (PH) is a key component of CDH pathophysiology and critical consideration for management and therapeutic options. PH associated with CDH has traditionally been attributed to pulmonary vascular maldevelopment and associated lung parenchymal hypoplasia, leading to pre-capillary increase in pulmonary vascular resistance (PVR). However, there is increasing recognition that left ventricular hypoplasia, dysfunction and elevated end diastolic pressure may contribute to post-capillary pulmonary hypertension in CD...
Source: Seminars in Fetal and Neonatal Medicine - August 11, 2022 Category: Perinatology & Neonatology Authors: Shazia Bhombal, Neil Patel Source Type: research

Pulmonary Hypertension in the Newborn – Towards Precision Medicine
Pulmonary hypertension (PHT) is a common cardio-pulmonary emergency in the neonatal patient. It is a disorder of transitional circulation with persistence of fetal circulatory patterns and ventilation-perfusion mismatch. Infants with pulmonary hypertension require timely assessment and management to improve short- and long-term outcomes. There have been significant advances in the understanding of the pathophysiology over the past decade but the classification of PHT in newborn infants and approaches to management are still evolving. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 10, 2022 Category: Perinatology & Neonatology Authors: Samir Gupta, Steven M. Donn Tags: Editorial Source Type: research

Pulmonary Hypertension in the Newborn- Etiology and Pathogenesis
A disruption in the well-orchestrated fetal-to-neonatal cardiopulmonary transition at birth results in the clinical conundrum of severe hypoxemic respiratory failure associated with elevated pulmonary vascular resistance (PVR), referred to as persistent pulmonary hypertension of the newborn (PPHN). In the past three decades, the advent of surfactant, newer modalities of ventilation, inhaled nitric oxide, other pulmonary vasodilators, and finally extracorporeal membrane oxygenation (ECMO) have made giant strides in improving the outcomes of infants with PPHN. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 7, 2022 Category: Perinatology & Neonatology Authors: Deepika Sankaran, Satyan Lakshminrusimha Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 1, 2022 Category: Perinatology & Neonatology Source Type: research

Nutrition for the micro preemie: Beyond milk
Nutritional support is a fundamental component of the care of the extremely preterm infant, including the “micro preemie” (here defined as a baby born weighing less than 500 g), but goes beyond considerations of milk as a food. This is because milk from an infant's own mother, unlike currently available substitutes, additionally provides invaluable non-nutritive benefits.Nutritional support requir es suitable devices or techniques to administer nutrients enterally or intravenously, products shown to be safe in preterm populations, and efficacy demonstrated in respect of important functional outcomes. (Source: Seminar...
Source: Seminars in Fetal and Neonatal Medicine - June 17, 2022 Category: Perinatology & Neonatology Authors: James Webbe, Sabita Uthaya, Neena Modi Source Type: research

Nursing care of infants born extremely preterm
With improving survival at the lowest gestations an increasing number of tiny and vulnerable infants are being cared for, and optimal outcomes require an approach to care that takes their specific characteristics into account. These include immature organ function and a risk for iatrogenic injury, and parental/familial strain due to the high degree of uncertainty, infant-mother separation, and long hospital stay. While the challenges in providing nursing care to these infants are obvious it is also clear that this field has tremendous potential to influence both short and long-term outcomes of this population. (Source: Sem...
Source: Seminars in Fetal and Neonatal Medicine - June 17, 2022 Category: Perinatology & Neonatology Authors: Victoria Karlsson, Ylva Thernstr öm Blomqvist, Johan Ågren Source Type: research

Protecting the brain of the micropreemie
Advances in perinatal care have seen substantial improvements in survival without disability for extremely preterm infants. Protecting the developing brain and reducing neurodevelopmental sequelae of extremely preterm birth are strategic priorities for both research and clinical care. A number of evidence-based interventions exist for neuroprotection in micropreemies, inclusive of prevention of preterm birth and multiple births with implantation of only one embryo during in vitro fertilisation, as well as antenatal care to optimize fetal wellbeing, strategies for supporting neonatal transition, and neuroprotective developm...
Source: Seminars in Fetal and Neonatal Medicine - June 17, 2022 Category: Perinatology & Neonatology Authors: S.M. Boyd, S.J. Tapawan, N. Badawi, H. Popat Source Type: research

The Interplay between Pressure, Flow, and Resistance in Neonatal Pulmonary Hypertension
Pulmonary hypertension, conventionally defined by absolute pulmonary artery pressure, is the result of a range of diagnoses that can result in clinical problems in neonatal practice. Causes include persistent pulmonary hypertension of the newborn, congenital heart disease, and left heart dysfunction, as well as the normally high pulmonary artery resistance in neonates. Elucidating the cause of pulmonary hypertension is vital to guide appropriate management. A first principles approach based on hemodynamic calculations provides a framework for the diagnostic work up and subsequent therapy. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 17, 2022 Category: Perinatology & Neonatology Authors: Caroline B. Jones, David Steven Crossland Source Type: research

The Role of Bedside Functional Echocardiography in the Assessment and Management of Pulmonary Hypertension
Pulmonary hypertension is an emergency in neonatal intensive care units with high morbidity and mortality. Its timely assessment and management is crucial for intact survival. Over the last couple of decades, there have been significant advances in management and techniques, which have resulted in improved survival. The use of neonatologist-performed echocardiography (NPE) is now increasingly utilized on neonatal intensive care units to understand the pathophysiology of the disease and to direct the treatment to the underlying cause. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 13, 2022 Category: Perinatology & Neonatology Authors: Kiran More, Roopali Soni, Samir Gupta Source Type: research

Management of Cardiac Dysfunction in Neonates with Pulmonary Hypertension and the role of the Ductus Arteriosus
Pulmonary hypertension in the neonate is associated with cardiopulmonary disturbances and neurodevelopment morbidity. The patent ductus arteriosus is a persistent fetal shunt that can be pathologic vs supportive in the setting of neonatal pulmonary hypertension. Understanding the underlying pathophysiology of pulmonary hypertension and the cardiopulmonary effects of various phenotypes can guide management in this vulnerable population. In this narrative, we will summarize the physiologic principles of pulmonary hypertension, the impact of the patent ductus arteriosus on various phenotypes, and the utility of serial targete...
Source: Seminars in Fetal and Neonatal Medicine - June 11, 2022 Category: Perinatology & Neonatology Authors: J.L. Ruoss, S Cavallaro Moronta, C. Bazacliu, R.E. Giesinger, P.J. McNamara Source Type: research

The Extremely Preterm Young Adult – State of the Art
Recently several studies have reported adult outcomes for individuals born at extremely low gestations, although they tend to be included as part of slightly more mature populations. The growth in collaborative studies allows greater confidence in the identification of persisting risk and allows us to have confidence in the likely outcomes in more contemporary cohorts. This review shows the persistence of adverse outcomes through to adult life and includes a range of outcomes including all body systems evaluated. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 2, 2022 Category: Perinatology & Neonatology Authors: Neil Marlow, Samantha Johnson, John R. Hurst Source Type: research

Pulmonary vasodilator strategies in neonates with acute hypoxemic respiratory failure and pulmonary hypertension
The management of acute hypoxemic respiratory failure (AHRF) in newborns continues to be a clinical challenge with elevated risk for significant morbidities and mortality, especially when accompanied with persistent pulmonary hypertension of the newborn (PPHN). PPHN is a syndrome characterized by marked hypoxemia secondary to extrapulmonary right-to-left shunting across the ductus arteriosus and/or foramen ovale with high pulmonary artery pressure and increased pulmonary vascular resistance (PVR). (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 2, 2022 Category: Perinatology & Neonatology Authors: Michael W. Cookson, Steven H. Abman, John P. Kinsella, Erica W. Mandell Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 1, 2022 Category: Perinatology & Neonatology Source Type: research