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 2011
Review Comparative StudyRed blood cell transfusion in preterm infants: restrictive versus liberal policy.
Preterm neonates represent a category of patients with high transfusion needs. Ideally, red blood cells (RBC) transfusion should be tailored to the individual requirements of the single infant. However, despite the progress in neonatal transfusion medicine, many controversies still remain, and the decision on whether to transfuse or not is often made on empirical basis, with large variation in transfusion practices among neonatologists. ⋯ Magnetic resonance imaging scans, performed at an average age of 12 years, showed that intracranial volume was substantially smaller in the liberal group compared with controls. When sex effects were evaluated, the girls in the liberal group had the most significant abnormalities. In conclusion, when preventive measures, as favoring cord clamping delay or cord milking, ensuring optimal nutrition, and minimizing phlebotomy losses, fail to avoid the need for transfusion, it is preferable to adopt restrictive criteria.
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J. Matern. Fetal. Neonatal. Med. · Oct 2011
ReviewBrain cooling and eligible newborns: should we extend the indications?
Therapeutic hypothermia (whole body or selective head cooling) is recognized as standard of care for brain injury control in term infants with perinatal hypoxic ischemic encephalopathy (HIE). Recent metanalyses and systematic reviews in human newborns have shown 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. HIE is most often noted in term newborns. ⋯ Similarly, recent reviews have emphasized the possible role of therapeutic hypothermia after pediatric cardiac arrest, and a trial is ongoing to assess the benefits of induced hypothermia in pediatric traumatic brain injury. So far, there is a lack of data on other possible indications, i.e., neonates with stroke or after cardio-pulmonary resuscitation, and necrotizing enterocolitis. Carefully designed safety studies and large randomized trials for all the above conditions and especially for preterm infants should be planned.
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J. Matern. Fetal. Neonatal. Med. · Oct 2011
ReviewPrevention of nosocomial infections and surveillance of emerging resistances in NICU.
Neonates hospitalized in NICU are at risk for healthcare associated infections because of their poor immune defenses, related to gestational age, colonization of mucous membranes and skin with nosocomial microorganisms, exposure to antibiotics, invasive procedures and frequent contacts with healthcare workers (HCWs). Healthcare associated infections are the major source of morbidity and mortality in NICU in the developed world. Most infections are caused by Gram-positive organisms, fulminant sepsis are often associated to Gram-negative organisms, fungal sepsis occurs frequently in ELBW infants. ⋯ Multidrug-resistant Gram-negatives are frequently reported. Overuse of antimicrobial drugs and crosstransmission via caregiver hands, contaminated equipment or inanimate objects are the major drivers of selection and dissemination. Strategies to control outbreaks of MDRO colonization/infection in the NICU may include performing hand hygiene, cohorting and isolating patients, screening healthcare workers and performing admission and periodic surveillance cultures.
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J. Matern. Fetal. Neonatal. Med. · Oct 2011
ReviewUrine neutrophil gelatinase-associated lipocalin (uNGAL) and netrin-1: are they effectively improving the clinical management of sepsis-induced acute kidney injury (AKI)?
Neutrophil gelatinase-associated lipocalin (NGAL) and Netrin-1 have been proposed over the past years as emergent biomarkers for the early and accurate diagnosis and monitoring of acute kidney injury (AKI). During the early phases of AKI, a rapid and massive up-regulation of NGAL mRNA takes place in the thick ascending limb of Henle's loop and in the collecting ducts, and therefore, changes in urinary NGAL (uNGAL) excretion seem to be more specific than plasma NGAL in assessing early kidney injury. ⋯ To improve the effectiveness of therapeutic treatment in septic newborns with AKI, there is the need to accurately distinguish NGAL molecular forms originating within the distal nephron from those originating from neutrophils. This concise review summarizes properties and perspectives of uNGAL and Netrin-1 for their appropriate clinical utilization.
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J. Matern. Fetal. Neonatal. Med. · Oct 2011
Review"Ventilatory management of asphyxiated infant during hypothermia".
Hypothermia is used for its neuroprotective effect in perinatal asphyxia. Mechanical ventilation is often used as a supportive therapy for severe asphyxiated infants who can present various degrees of respiratory failure. Animal studies demonstrated a protective effect of cooling on the lungs due to reduced ventilatory requirements. Even if actual knowledge on the effects of hypothermia and rewarming on respiratory parameters during mechanical ventilation is limited, nevertheless human studies seem to demonstrate that hypothermia is safe and does not cause significant changes in the level of respiratory supports.