The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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Caffeine is a silver bullet in neonatology. This ubiquitous trimethylxanthine, pervasively used in the human diet and beverages, significantly impacts on major acute neonatal morbidities including apnea of prematurity, bronchopulmonary dysplasia, patent ductus arteriousus with or without surgical ligation and post-operative apnea. Potential uses in respiratory distress syndrome as suggested by improved lung function in primate models is supported by the decreased time on mechanical ventilation and need for oxygen therapy. ⋯ Ongoing and future research studies focus on optimizing current dose regimens to determine whether benefits can be maximized while maintaining an impressive safety profile. Molecular pharmacologic studies focused on the molecular and the biochemical mechanisms underlying the protective effects of caffeine are also being done to optimize treatment regimes and to target potential molecular pathways leading to further decreases in acute and long term neonatal morbidities. Since its use in newborns three decades ago, caffeine is now one of the safest, most cost-beneficial and effective therapies in the newborn.
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J. Matern. Fetal. Neonatal. Med. · Oct 2010
ReviewEthical problems in the care of high risk neonates.
Recent progress in neonatal care has greatly improved the prognosis and the probabilities of survival in very sick or very preterm neonates and has modified the concept and limits of the so called viability. However, in some circumstances, when the death of the baby can only be postponed temporarily, at the price of severe suffering, or when survival is associated with severe disabilities and an intolerable life for the child and the family, then it might not be appropriate to utilize all the armamentarium of neonatal intensive care. In such circumstances, limitation of intensive treatments (withholding or withdrawal) generally invasive and painful, could represent a more human and reasonable alternative. The ethical principles underlying those decisions, the most frequent situations occurring in practice, the role of parents in the decision-making process, and the opinions and behavior of neonatologists from many European intensive care units will be examined and discussed.
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J. Matern. Fetal. Neonatal. Med. · Oct 2010
ReviewTreatment of organic acidurias and urea cycle disorders.
Three steps are extremely important in emergency management (awaiting diagnosis) of organic acidurias and urea cycle disorders. The first is to obtain adequate samples (blood and urine) before any treatment, parenteral and/or enteral nutrition with protein-free solution and toxin removal procedures are the second step. Additional therapies with cofactors and vitamins are the last step. It is very important to quickly carry out this strategy every time we suspect an inborn error of metabolism.