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
ReviewOxygen administration for the resuscitation of term and preterm infants.
Oxygen has been widely used in neonatal resuscitation for about 300 years. In October 2010, the International Liaison Committee on Neonatal Resuscitation released new guidelines. ⋯ They include: inaccuracy of oxygenation clinical assessment (colour), mandatory use of pulse oximeter, specific saturation targets and oxygen concentrations during positive pressure ventilation in preterm and term infants. In this review, we describe oxygen management in the delivery room in terms of clinical assessment, monitoring, treatment and the gap of knowledge.
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J. Matern. Fetal. Neonatal. Med. · Oct 2012
ReviewEarly onset sepsis in very low birth weight newborn infants.
Early onset sepsis (EOS) is a severe problem affecting very low birth weight (VLBW) infants and is associated with a threefold increased risk of mortality. Although advances in perinatal care have led to improved survival of VLBW infants over recent decades, survival without major neonatal morbidity has not increased. The authors reviewed the current literature on EOS, focusing on the peculiarities concerning risk factors, etiology, diagnosis, treatment and outcome in very low birth weight infants, and on the recent advances in the management of this condition.
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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.
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J. Matern. Fetal. Neonatal. Med. · Oct 2012
ReviewResearch in human resuscitation: what we learn from animals.
It was not until the 18th century that scientists throughout Europe established humane societies to develop resuscitation techniques and to keep registries of successful and unsuccessful cases. Since then, the science and art of cardiopulmonary resuscitation have flourished, multiple international organizations were found, and guidelines are proposed every 5 years in an everlasting attempt to improve the outcome of cardiac arrest victims. The aim of this article is to present the role of animal models in resuscitation research. ⋯ Animal models are used extensively in resuscitation research and possess a central role in the effort towards a better understanding of the underlying mechanisms. However, experimental results should always be cautiously extrapolated in humans.