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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J. Matern. Fetal. Neonatal. Med. · Oct 2012
Cryopreservation of ovarian tissue in pediatrics: what is the child's best interest?
In paediatric female patients the only option for restoring fertility after chemotherapy and radiotherapy is ovarian tissue banking. Even if this procedure is considered the most promising available, anyway it is still an experimental option due to the paucity of data. The possibility to offer an experimental preventive technique with potential benefits but with known risks arises a dilemma: what is the best interest for suffering child? Is it most important to minimize risk of the disease or to preserve the future fertility? However, if it is right to propose fertility preservation when physical and psychic risks are acceptable, we think it is not in the child's best interest to retrieve ovarian tissue from very young patients whose ovaries are small and for whom surgery is a high risk procedure. Moreover fertility preservation should not be offered if this could increase the risk of disease worsening.
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J. Matern. Fetal. Neonatal. Med. · Oct 2012
Communication in the neonatal intensive care unit: a continuous challenge.
Communication between the healthcare team and the parents in Neonatal Intensive Care Unit (NICU) is very important, and may affect both trust in medical team and the health of premature babies. The aim of this study is to confirm that a good relationship with families can be obtained if all the healthcare team adopts a good common communication scheme. ⋯ In NICU, communication between the members of the team and the newborn's parents may be improved by specific tools.
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J. Matern. Fetal. Neonatal. Med. · Oct 2012
ReviewCaffeine citrate: when and for how long. A literature review.
The efficacy of caffeine in an episode of Apnoea of Prematurity (AOP) has been known for over thirty years. Its use over long periods of time has not only found it to be manageable within the field of neonatology, but it has also been found to have other favourable actions, such as reducing the incidence of extubation failure, preventing Bronchopulmonary Dysplasia (BPD), reducing the need for Patent Ductus Arteriosus treatment and the beneficial effect it has on Retinopathy of Prematurity. Recent in vitro trials have highlighted the neuroprotective role that caffeine plays, which has already partly been observed from in vivo trials. Just recently, caffeine citrate has become a "label" drug and it would be beneficial if more studies could confirm the more significant effects it has on the more severe conditions of prematurity.
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J. Matern. Fetal. Neonatal. Med. · Oct 2012
ReviewHigh-flow nasal cannula: transient fashion or new method of non-invasive ventilatory assistance?
Respiratory failure in the premature infants remains a difficult challenge. An alternative to the use of nasal continuous positive airway pressure (NCPAP) as a non-invasive modality to support respiratory distress in premature infants has been the recent introduction of high flow nasal cannula (HFNC) devices in many neonatal units. ⋯ The paucity of evidence regarding its efficacy and safety, would support a caution approach to the use of HFNC. Particular concern has focused on the imprecise regulation and generation of pressure that may occur at higher flows especially in the smallest of infants.
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J. Matern. Fetal. Neonatal. Med. · Oct 2012
ReviewTherapeutic hypothermia in the prevention of hypoxic-ischaemic encephalopathy: new categories to be enrolled.
Therapeutic hypothermia is now the standard of care for brain injury control in term infants with perinatal hypoxic ischemic encephalopathy (HIE). Accumulated evidence shows a reduction in mortality and long-term neurodevelopmental disability at 12-24 months of age, with more favourable effects in the less severe forms of HIE. Only few trials recruited newborns <36 weeks gestational age, or mild-to-moderate encephalopathy with base deficit (BD) <16. The new categories of patients to be enrolled should include (late) preterm infants, neonates with unexpected postnatal collapse, and newborns with stroke. Preterm HIE: Therapeutic hypothermia shows a good safety profile in clinical studies, and no adverse effects were noted in the preterm fetal animal model. Recently, it has been shown that mild hypothermia in preterm newborns with necrotizing enterocolitis (NEC) and multiple organ dysfunction syndrome (MODS) does not increase mortality, bleeding, infection, or need for inotropes in cooled newborns. A pilot study (NCT00620711) is currently recruiting newborns of > 32 but < 36 weeks gestation with standard criteria for HIE. Postnatal Collapse: The postnatal collapse (PNC) is a rare (0.03-0.5/1000 live births) but life-threatening hypoxic-ischemic event. No clinical trials of therapeutic hypothermia have specifically addressed to PNC. Nevertheless, a beneficial effect of brain cooling is expectable, and it has been proposed to include in brain hypothermia trials the infants with PNC fulfilling the entry criteria for HIE. Stroke: Perinatal arterial ischemic stroke is the most common cause of cerebral palsy (CP) in term and near-term newborn. In a systematic review and meta-analysis of animal studies of focal cerebral ischemia, hypothermia reduced the infarct size by 44%. No specific neuroprotective interventions are available for the management of acute perinatal stroke. Hypothermia may decrease seizures in newborns with encephalopathy and a focal infarct, potentially improving the long-term outcome for these infants. ⋯ Future studies of therapeutic hypothermia should include the categories of newborns excluded from the published clinical trials, that is infants <36 weeks gestation, PNC or stroke, or admitted outside of the established 6-hour window, and with encephalopathy not imputable to HIE. New entry criteria will allow significant number of newborns to benefit from the treatment.