Evidence-based use of acetaminophen for hemodynamically significant ductus arteriosus in preterm infants
While cyclooxygenase inhibitors have been the most common medications used to facilitate earlier closure of patent ductus arteriosus in preterm infants, adverse effects and variable efficacy have highlighted a need for alternative options. Acetaminophen facilitates ductal closure via an alternate pathway of prostaglandin inhibition. Despite treatment with high doses, toxicity is uncommon in preterm infants, possibly due to immature hepatic metabolism. Pooled data from randomized clinical trials of early treatment demonstrate that acetaminophen has similar efficacy as cyclooxygenase inhibitors for PDA closure with a favoura...
Source: Seminars in Perinatology - May 24, 2018 Category: Perinatology & Neonatology Authors: B. Jasani, D.E. Weisz, P. McNamara Tags: 42/4 Source Type: research

Changing patterns of patent ductus arteriosus surgical ligation in the united states
Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids ′ Inpatient Database (2000–2012) to determine if PDA ligation rates: 1) changed over time, 2) varied geographically, or 3) influenced surgical complication rates. In 2012, 47,900 infants (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 22, 2018 Category: Perinatology & Neonatology Authors: Jeff Reese, Theresa A. Scott, Stephen W. Patrick Source Type: research

Catheter-based closure of the patent ductus arteriosus in lower weight infants
Risks associated with drug therapy and surgical ligation have led health care providers to consider alternative strategies for patent ductus arteriosus (PDA) closure. Catheter-based PDA closure is the procedure of choice for ductal closure in adults, children, and infants ≥6kg. Given evidence among older counterparts, interest in catheter-based closure of the PDA in lower weight ( (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 11, 2018 Category: Perinatology & Neonatology Authors: Leeann R. Pavlek, Jonathan L. Slaughter, Darren P. Berman, Carl H. Backes Source Type: research

Transcriptional profiling of the ductus arteriosus: Comparison of rodent microarrays and human RNA sequencing
DA closure is crucial for the transition from fetal to neonatal life. This closure is supported by changes to the DA ′s signaling and structural properties that distinguish it from neighboring vessels. Examining transcriptional differences between these vessels is key to identifying genes or pathways responsible for DA closure. Several microarray studies have explored the DA transcriptome in animal models but va ried experimental designs have led to conflicting results. Thorough transcriptomic analysis of the human DA has yet to be performed. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 10, 2018 Category: Perinatology & Neonatology Authors: Michael T. Yarboro, Matthew D. Durbin, Jennifer L. Herington, Elaine L. Shelton, Tao Zhang, Cris G. Ebby, Jason Z. Stoller, Ronald I. Clyman, Jeff Reese Source Type: research

Novel drug targets for ductus arteriosus manipulation: Looking beyond prostaglandins
Forty years ago, non-steroidal anti-inflammatory drugs were first reported to decrease systemic prostaglandin levels and promote ductus arteriosus (DA) closure. And yet, prolonged patency of the DA (PDA) remains a significant clinical problem, complicated by imperfect therapies and wide variations in treatment strategy. There are few pharmacology-based tools available for treating PDA (indomethacin, ibuprofen, acetaminophen), or for maintaining DA patency (PGE1) as is needed to facilitate corrective surgery for ductus-dependent congenital heart defects. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 10, 2018 Category: Perinatology & Neonatology Authors: Elaine L. Shelton, Gautam K. Singh, Colin G. Nichols Source Type: research

Association between Prophylactic Indomethacin and Death or Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis of Observational Studies
The use of prophylactic indomethacin in very preterm infants is controversial. The last randomized controlled trial (RCTs) to study this therapy enrolled infants over 20 years ago. More recently, observational studies have investigated the association between exposure to prophylactic indomethacin and neonatal morbidities and mortality. We performed a systematic review and meta-analysis of these studies for the outcomes of death and bronchopulmonary dysplasia (BPD). Two observational studies involving a total of 11,289 very preterm infants were suitable for meta-analysis. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 10, 2018 Category: Perinatology & Neonatology Authors: Erik A. Jensen, Elizabeth E. Foglia, Barbara Schmidt Tags: 42/4 Source Type: research

Towards a greater understanding of the ductus arteriosus
(Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 9, 2018 Category: Perinatology & Neonatology Authors: Jeff Reese Source Type: research

Comparative physiology of the ductus arteriosus among vertebrates
The ductus arteriosus is typically viewed as a mammalian fetal blood vessel providing a right-to-left shunt of right ventricular outflow away from the lungs and to the systemic circuit, that must close at birth. This review provides a wider comparative examination of the ductus arteriosus in lungfish, reptiles, birds, and mammals. The ductus arteriosus evolved with the lung in the ancestors of the lungfish as a connection between the pulmonary arteries and dorsal aorta. During embryonic development, reptiles, birds, and mammals all possess either one or two paired ductus arteriosi that provide a fetal shunt of blood away f...
Source: Seminars in Perinatology - May 9, 2018 Category: Perinatology & Neonatology Authors: Edward M. Dzialowski Tags: 42/4 Source Type: research

Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity
A persistent left-to right shunt through a patent ductus arteriosus (PDA) increases the rate of hydrostatic fluid filtration into the lung ′s interstitium, impairs pulmonary mechanics, and prolongs the need for mechanical ventilation. In preclinical trials, pharmacologic PDA closure leads to improved alveolarization and minimizes the impaired postnatal alveolar development that is the pathologic hallmark of bronchopulmonary dysplasia (BPD). Although routine prophylactic treatment of a PDA on the day of birth does not appear to offer any more protection against BPD than delaying treatment for 2–3 days, recent ev...
Source: Seminars in Perinatology - May 9, 2018 Category: Perinatology & Neonatology Authors: Ronald I. Clyman Source Type: research

Congenital syphilis
remains a major public health problem worldwide, and its incidence is increasing in the United States. This review highlights the ongoing problem of this preventable infection, and discusses vertical transmission and clinical manifestations while providing a practical algorithm for the evaluation and management of infants born to mothers with reactive serologic tests for syphilis. Every case of congenital syphilis must be seen as a failure of our public health system to provide optimal prenatal care to pregnant women, as congenital syphilis can be prevented by early and repeated prenatal serologic screening of mothers and...
Source: Seminars in Perinatology - April 4, 2018 Category: Perinatology & Neonatology Authors: Joshua M. Cooper, Pablo J. S ánchez Source Type: research

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Source: Seminars in Perinatology - April 1, 2018 Category: Perinatology & Neonatology Source Type: research

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Source: Seminars in Perinatology - April 1, 2018 Category: Perinatology & Neonatology Source Type: research

Neonatal herpes simplex virus infections
Neonatal herpes simplex virus (HSV) is an uncommon but devastating infection in the newborn, associated with significant morbidity and mortality. The use of PCR for identification of infected infants and acyclovir for treatment has significantly improved the prognosis for affected infants. The subsequent use of suppressive therapy with oral acyclovir following completion of parenteral treatment of acute disease has further enhanced the long-term prognosis for these infants. This review article will discuss the epidemiology, risk factors and routes of acquisition, clinical presentation, and evaluation of an infant suspected...
Source: Seminars in Perinatology - March 12, 2018 Category: Perinatology & Neonatology Authors: Swetha G. Pinninti, David W. Kimberlin Source Type: research

Introduction
Congenital and perinatal infections remain an important cause of mortality and morbidity in neonates, and the epidemiology, diagnosis, treatment, and prevention of these infections continues to change. Congenital infections are acquired from the mother in-utero either by transplacental spread to the bloodstream or by direct extension. Perinatal infections typically are transmitted during labor or delivery from the mother or in the early neonatal period from nosocomial transmission. In this issue of Seminars in Perinatology, experts review many of the most common and important congenital and perinatal infections in the neon...
Source: Seminars in Perinatology - March 8, 2018 Category: Perinatology & Neonatology Authors: Shannon A. Ross Source Type: research

Update on the management of hepatitis B and C infections in the neonatal period
Hepatitis B virus and hepatitis C virus have received a significant amount of attention in recent years, and both viruses share a significant amount of similarities with one another beyond just that they both primarily target the liver. In recent years, cases of both infections have been fueled by a nationwide epidemic of injection drug use. Most relevant to this audience, they are both transmitted from mother to child. The increased cases in young adults combined with mother to child transmission translate into more exposed infants that will need to be managed and followed. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - March 8, 2018 Category: Perinatology & Neonatology Authors: Claudia M. Espinosa, Ravi Jhaveri Source Type: research

Neonatal nonpolio enterovirus and parechovirus infections
Nonpolio enteroviruses and parechoviruses are frequent causes of neonatal infection. Clinical manifestations of infection range from asymptomatic infection to mild infection without sequelae to septic shock with muiltiorgan failure. Neonates with clinically apparent infection typically have mothers and/or other contacts with recent symptoms consistent with a viral illness. Severe neonatal infection with nonpolio enterovirus or parechovirus cannot be differentiated clinically from serious bacterial infection. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - March 8, 2018 Category: Perinatology & Neonatology Authors: Nada Harik, Roberta L. DeBiasi Source Type: research

Introduction
Congenital and perinatal infections remain an important cause of mortality and morbidity in neonates, and the epidemiology, diagnosis, treatment, and prevention of these infections continues to change. Congenital infections are acquired from the mother in-utero either by transplacental spread to the bloodstream or by direct extension. Perinatal infections typically are transmitted during labor or delivery from the mother or in the early neonatal period from nosocomial transmission. In this issue of Seminars in Perinatology, experts review many of the most common and important congenital and perinatal infections in the neon...
Source: Seminars in Perinatology - March 8, 2018 Category: Perinatology & Neonatology Authors: Shannon A. Ross Source Type: research

Update on the management of hepatitis B and C infections in the neonatal period
Hepatitis B virus and hepatitis C virus have received a significant amount of attention in recent years, and both viruses share a significant amount of similarities with one another beyond just that they both primarily target the liver. In recent years, cases of both infections have been fueled by a nationwide epidemic of injection drug use. Most relevant to this audience, they are both transmitted from mother to child. The increased cases in young adults combined with mother to child transmission translate into more exposed infants that will need to be managed and followed. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - March 8, 2018 Category: Perinatology & Neonatology Authors: Claudia M. Espinosa, Ravi Jhaveri Source Type: research

Neonatal nonpolio enterovirus and parechovirus infections
Nonpolio enteroviruses and parechoviruses are frequent causes of neonatal infection. Clinical manifestations of infection range from asymptomatic infection to mild infection without sequelae to septic shock with muiltiorgan failure. Neonates with clinically apparent infection typically have mothers and/or other contacts with recent symptoms consistent with a viral illness. Severe neonatal infection with nonpolio enterovirus or parechovirus cannot be differentiated clinically from serious bacterial infection. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - March 8, 2018 Category: Perinatology & Neonatology Authors: Nada Harik, Roberta L. DeBiasi Source Type: research

Adverse outcomes of pregnancy-associated Zika virus infection
The spread of Zika virus to the Americas was accompanied by surge in the number of infants with CNS abnormalities leading to a declaration of a health emergency by the WHO. This was accompanied by significant responses from governmental health agencies in the United States and Europe that resulted in significant new information described in the natural history of this perinatal infection in a very short period of time. Although much has been learned about Zika virus infection during pregnancy, limitations of current diagnostics and the challenges for accurate serologic diagnosis of acute Zika virus infection has restricted...
Source: Seminars in Perinatology - March 6, 2018 Category: Perinatology & Neonatology Authors: William J. Britt Source Type: research

Congenital cytomegalovirus infection
Each year, thousands of children are born with or develop permanent disabilities such as hearing loss, vision loss, motor and cognitive deficits from congenital CMV infection (cCMV). However, awareness of cCMV and its associated sequelae is very low in pregnant women and healthcare providers. Both targeted and universal approaches to screen newborns for CMV infection are now achievable due to recent scientific advances including the development of a rapid, high-throughput method for detecting CMV in saliva, the efficacy of antiviral treatment in symptomatic infants, and the demonstration of cost effectiveness of CMV screen...
Source: Seminars in Perinatology - March 1, 2018 Category: Perinatology & Neonatology Authors: Karen B. Fowler, Suresh B. Boppana Source Type: research

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Source: Seminars in Perinatology - February 24, 2018 Category: Perinatology & Neonatology Source Type: research

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Source: Seminars in Perinatology - February 24, 2018 Category: Perinatology & Neonatology Source Type: research

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Source: Seminars in Perinatology - February 24, 2018 Category: Perinatology & Neonatology Source Type: research

Table of contents
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Source: Seminars in Perinatology - February 24, 2018 Category: Perinatology & Neonatology Source Type: research

Neuromonitoring in the neonatal ECMO patient
Utilization of extraocorporeal membrane oxygenation (ECMO) has become increasingly widespread as a bridging therapy for neonates with severe, reversible respiratory or cardiac diseases. While significant risks remain, due to advances in medical and surgical management, overall mortality has decreased. However, short and long-term neurological morbidity has remained high. Therefore, increasing attention has been focused on multimodal neuromonitoring to track and optimally, minimize or prevent intracranial injury. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - February 2, 2018 Category: Perinatology & Neonatology Authors: Nan Lin, John Flibotte, Daniel J. Licht Source Type: research

Maternal sepsis
This article will provide the reader with rational steps to aid in the recovery of such a patient. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - February 1, 2018 Category: Perinatology & Neonatology Authors: Arthur Jason Vaught Source Type: research

Trauma in pregnancy
Trauma is the leading non-obstetric cause of death during pregnancy and approximately 6 –8% of all pregnancies are complicated by injury, both accidental and intentional. The initial evaluation and management of the injured pregnant patient often requires a multidisciplinary, collaborative team to provide the optimal outcome for both mother and fetus. It is important to recognize tha t even minor mechanisms of injury may result in poor outcomes for both fetus and mother. Injured pregnant patients meeting admission criteria experience a progressive increase in the number of complications as well as the number of patie...
Source: Seminars in Perinatology - February 1, 2018 Category: Perinatology & Neonatology Authors: Christopher Kevin Huls, Corey Detlefs Source Type: research

Managing congenital heart disease in the obstetric patient
Objective: Cardiovascular disease is the major cause of pregnancy-related maternal mortality in the United States, and congenital heart disease (CHD) is the most common form of structural heart disease affecting women of childbearing age. Most females born with CHD will reach childbearing age and consider pregnancy. Adult CHD and maternal-fetal medicine (MFM) specialists managing women with CHD should provide preconception counseling, cardiovascular risk assessment prior to pregnancy that estimates maternal and fetal risk, management during pregnancy, and in the peripartum period and also know the potential complications a...
Source: Seminars in Perinatology - February 1, 2018 Category: Perinatology & Neonatology Authors: Heidi M. Connolly Source Type: research

Cover
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Source: Seminars in Perinatology - February 1, 2018 Category: Perinatology & Neonatology Source Type: research

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Source: Seminars in Perinatology - February 1, 2018 Category: Perinatology & Neonatology Source Type: research

Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia
Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly which impairs normal pulmonary development leading to acute and chronic respiratory failure, pulmonary hypoplasia, pulmonary hypertension, and mortality. CDH is the most common non-cardiac indication for neonatal ECMO. Prenatal and postnatal predictors of CDH severity aid in patient selection. Centers vary in preferred mode of ECMO and timing of CDH repair. Survivors of severe CDH with ECMO are at risk for long-term sequelae including neurodevelopmental delays. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 12, 2018 Category: Perinatology & Neonatology Authors: Theresa R. Grover, Natalie E. Rintoul, Holly L. Hedrick Source Type: research

An overview of medical ECMO for neonates
Extracorporeal membrane oxygenation (ECMO), a life-saving therapy for respiratory and cardiac failure, was first used in neonates in the 1970s. The indications and criteria for ECMO have changed over the years, but it continues to be an important option for those who have failed other medical therapies. Since the Extracorporeal Life Support Organization (ELSO) Registry was established in 1989, more than 29,900 neonates have been placed on ECMO for respiratory failure, with 84% surviving their ECMO course, and 73% surviving to discharge or transfer. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 11, 2018 Category: Perinatology & Neonatology Authors: Kathryn Fletcher, Rachel Chapman, Sarah Keene Source Type: research

Anticoagulation in neonatal ECMO
Despite advances made in technology and neonatal intensive care, the rate of hemorrhagic and thrombotic complications remains unacceptably high in patients undergoing extracorporeal membrane oxygenation (ECMO) and these complications negatively impact morbidity and mortality. Management of anticoagulation in neonates who have a developing hemostatic system is vastly different from adults and poses unique challenges. Variation in practice among ECMO centers regarding anticoagulation monitoring and titration reflects the lack of high-quality evidence. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 11, 2018 Category: Perinatology & Neonatology Authors: Aditi Kamdar, Natalie Rintoul, Leslie Raffini Source Type: research

Education for ECMO providers: Using education science to bridge the gap between clinical and educational expertise
A well-organized educational curriculum for the training of both novice and experienced ECMO providers is critical for the continued function of an institutional ECMO program. ELSO provides guidance for the education for ECMO specialists, physicians and staff, which incorporates “traditional” instructor-centered educational methods, such as didactic lectures and technical skill training. Novel research suggests utilization of strategies that align with principles of adult learning to promote active learner involvement and reflection on how the material can be applied to understand existing and new constructs ma...
Source: Seminars in Perinatology - January 11, 2018 Category: Perinatology & Neonatology Authors: Lindsay Johnston, Susan B. Williams, Anne Ades Source Type: research

Ethical and end of life considerations for neonates requiring ECMO support
ECMO has proven to be a life-saving intervention for a variety of disease entities with a high rate of survival in the neonatal population. However, ECMO requires clinical teams to engage in many ethical considerations. Even with ongoing improvements in technology and expertise, some patients will not survive a course of ECMO. An unsuccessful course of ECMO can be difficult to accept and cause a great deal of angst. These questions can result in real conflict both within the care team, and between the care team and the family. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 10, 2018 Category: Perinatology & Neonatology Authors: Roxanne Kirsch, David Munson Source Type: research

Multidisciplinary obstetric critical care delivery: The concept of the “virtual” intensive care unit
With an increasing prevalence of chronic medical conditions and the associated potential for decompensation to critical illness among modern day parturients, we present here the concept of the “virtual” intensive care unit. We challenge the traditional association of the word “unit” to extend beyond a fixed physical setting to portray an individualized, predetermined patient care team capable of managing these complex patients in a variety of settings. In this model, obstetric cri tical care is provided through a multidisciplinary patient care team, with emphasis on early identification of complicat...
Source: Seminars in Perinatology - January 5, 2018 Category: Perinatology & Neonatology Authors: Michael P. Leovic, Hailey N. Robbins, Roman S. Starikov, Michael R. Foley Source Type: research

Special equipment considerations for neonatal ECMO
Extracorporeal membrane oxygenation (ECMO) for neonates is applied routinely at major children ’s hospitals around the world. While the practice seems routine, the peculiar physiology of the small human imposes particular constraints on selection of equipment, performance of the circuit, and risks to the child. The physiology of small patients and physics of circuit elements leave many area s opaque and far from optimal, but still allow assembly of a set of useful heuristics for good practice. Here, we examine individual mechanical components of the ECMO circuit with attention to selection, pitfalls, and peculiaritie...
Source: Seminars in Perinatology - January 4, 2018 Category: Perinatology & Neonatology Authors: James Connelly, Thane Blinman Source Type: research

Current trends in neonatal ECMO
Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for patients with respiratory and cardiac failure refractory to maximal medical management. The extracorporeal life support organization registry is the largest available resource for describing the population and outcomes of patients treated with this therapy. The use of ECMO for neonatal patients is decreasing in proportion to the total annual ECMO runs most likely due to advancements in medical management. Although the overall survival for neonatal ECMO has decreased, this is likely a reflection of the increasingly complex neonatal patients treated with...
Source: Seminars in Perinatology - January 2, 2018 Category: Perinatology & Neonatology Authors: Burhan Mahmood, Debra Newton, Eugenia K. Pallotto Source Type: research

Extracorporeal membrane oxygenation in congenital heart disease
This review article will discuss the indications for and outcomes of neonates with congenital heart disease who receive extracorporeal membrane oxygenation (ECMO) support. Most commonly, ECMO is used as a perioperative bridge to recovery or temporary support for those after cardiac arrest or near arrest in patients with congenital or acquired heart disease. What had historically been considered a contraindication to ECMO, is evolving and more of the sickest and most complicated babies are cared for on ECMO. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - January 2, 2018 Category: Perinatology & Neonatology Authors: Kiona Y. Allen, Catherine K. Allan, Lillian Su, Mary E. McBride Source Type: research

Introduction: Update on neonatal extracorporeal membrane oxygenation
Extracorporeal membrane oxygenation (ECMO) has been used as a treatment modality since the 1970s, when the first patient, an infant with severe meconium aspiration syndrome, was cannulated and supported during a 3-day ECMO run. Since this time, there has been an explosion in the application of this support to critically ill neonates, children, and adults. Countless clinicians and researchers have worked together to continue to improve the safety and efficacy of this technology, but it is clear that the leadership of a smaller number of individuals, including Dr. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - December 29, 2017 Category: Perinatology & Neonatology Authors: Lindsay C. Johnston, Natalie Rintoul, Anne M. Ades Source Type: research

Introduction
For centuries, childbirth was considered one of the greatest dangers a woman faced during pregnancy. However, no one can deny that breakthroughs in obstetrics in the past hundred years have saved more maternal lives than have been saved since the dawn of civilization. Understandably, since ancient times, people have developed rituals, spells, and ceremonies focused on making every aspect of childbearing go smoothly. The dangers of childbirth were not only described in medical books but also in paintings and in works of literature. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - December 15, 2017 Category: Perinatology & Neonatology Authors: Roman S. Starikov, Michael R. Foley Source Type: research