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 peculiarities of...
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
Cardiac arrest in pregnancy
is a rare and frightening event. Although not every obstetrician will encounter cardiac arrest in pregnancy during their career, it is imperative to be prepared to manage this acute emergency. The management is particularly complex due to maternal physiologic changes from pregnancy and the simultaneous management of two patients, the mother and fetus. In 2010, the American Heart Association released their first scientific statement on guidelines for management of cardiac arrest in pregnancy that has since been updated in 2015. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - December 12, 2017 Category: Perinatology & Neonatology Authors: Jacqueline Kikuchi, Shad Deering Source Type: research
Introduction: Current preterm birth prevention strategies, Part 2
Preterm birth (PTB), defined as delivery before 37 completed weeks of gestation, remains an enormous obstetric problem as prematurity significantly increases the risk for neonatal mortality or lifelong morbidity. Given the vast and diverse amount of research in the area of preterm birth, it is always a challenge to keep up-to-date with the progress and exciting new discoveries that are being made in our field. In order to assist in this process, we are excited to introduce our second issue in this two-part series in Seminars and Perinatology entitled, “Current Preterm Birth Prevention Strategies.” In this second issue,...
Source: Seminars in Perinatology - November 28, 2017 Category: Perinatology & Neonatology Authors: Joy Vink, Cynthia Gyamfi-Bannerman Source Type: research
New techniques in evaluation of the cervix
The process of parturition is poorly understood, but the cervix clearly plays a key role. Because of this, recent research efforts have been directed at objective quantification of cervical remodeling. Investigation has focused on two basic areas: (1) quantification of tissue deformability and (2) presence, orientation, and/or concentration of microstructural components (e.g. collagen). Methods to quantify tissue deformability include strain elastography and shear wave elasticity imaging (SWEI). (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - November 28, 2017 Category: Perinatology & Neonatology Authors: Helen Feltovich, Lindsey Carlson Source Type: research
Tocolysis: Present and future treatment options
This article seeks to apply this perspective to tocolytic therapy. Here, we provide a review of current tocolytic options and what the last decade of discovery has revealed about the regulation of myometrial excitability and quiescence. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - November 28, 2017 Category: Perinatology & Neonatology Authors: Joshua D. Younger, Elena Reitman, George Gallos Source Type: research
Long-term childhood outcomes after interventions for prevention and management of preterm birth
Globally, preterm birth rates are rising and have a significant impact on neonatal morbidity and mortality. Preterm birth remains difficult to prevent and a number of strategies for preterm birth prevention (progesterone, cervical pessaries, cervical cerclage, tocolytics, and antibiotics) have been identified. While some of these show more promise, there is a paucity of evidence regarding the long-term effects of these strategies on childhood outcomes. Strategies used to improve the health of babies if born preterm, such as antenatal magnesium sulfate for fetal neuroprotection and antenatal corticosteroids for fetal lung m...
Source: Seminars in Perinatology - November 28, 2017 Category: Perinatology & Neonatology Authors: Sarah R. Murray, Sarah J. Stock, Jane E. Norman Source Type: research
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Source: Seminars in Perinatology - November 28, 2017 Category: Perinatology & Neonatology Source Type: research
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Source: Seminars in Perinatology - November 28, 2017 Category: Perinatology & Neonatology Source Type: research
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Source: Seminars in Perinatology - November 28, 2017 Category: Perinatology & Neonatology Source Type: research
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Source: Seminars in Perinatology - November 28, 2017 Category: Perinatology & Neonatology Source Type: research
The diagnosis and management of morbidly adherent placenta
The incidence of morbidly adherent placenta (MAP) has risen 13-fold since the early 1900s and is directly correlated with the rising rate of cesarean delivery. It is important for clinicians to screen all pregnancies for MAP at the time of routine second-trimester ultrasonography. In addition, patients with risk factors (e.g., multiple prior cesarean deliveries) should undergo targeted screening for MAP. Optimal maternal and fetal outcomes for these high-risk pregnancies result from accurate prenatal diagnosis and comprehensive multidisciplinary preparation and delivery between 34 and 36 weeks of gestation. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - November 28, 2017 Category: Perinatology & Neonatology Authors: Michael A. Belfort, Alireza A. Shamsirsaz, Karin A. Fox Source Type: research
