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
ReviewSoluble CD14 subtype presepsin (sCD14-ST) and lipopolysaccharide binding protein (LBP) in neonatal sepsis: new clinical and analytical perspectives for two old biomarkers.
Several biochemical markers have been proposed over the past years to manage critically ill newborns with acute inflammation and sepsis. The state of the art in diagnosing and monitoring neonatal sepsis, severe sepsis and septic shock consists of the measurement of plasma C-reactive protein (CRP) and procalcitonin (PCT) at the onset and in the course of the disease. CRP and PCT in combination are clinically significant in diagnosing and monitoring septic newborns; however, CRP and PCT have a very limited value for risk stratification and in predicting outcome. The availability of commercial methods for the automated measurement of the soluble CD14 subtype presepsin (sCD14-ST) and lipopolysaccharide binding protein (LBP) represent a challenge for the evaluation in clinical practice of reliable markers of neonatal sepsis, specifically for the very early diagnosis, the classification into class of severity, and the prediction of complications and death.
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J. Matern. Fetal. Neonatal. Med. · Oct 2011
ReviewNew possibilities of prevention of infection in the newborn.
Severe infections represent the main cause of neonatal mortality and morbidity. Strategies of proven effectiveness in reducing the incidence of infection in neonatal intensive care units (NICUs) include hand hygiene practices and prevention of central venous catheter-related bloodstream infections. In recent years, new strategies have been developed to prevent infections in NICU including prevention of neonatal sepsis with lactoferrin, the use of heparin for the prevention of CRBSIs, the judicious use of antibiotics and chemoprophylaxis, prevention of invasive fungal infections with fluconazole, the use of specific anti-staphylococcal immunoglobulins, and the early identification of infants at higher risk of infection with the use of specific markers (mannose-binding lectin). This review will focus on these new strategies and on their role in clinical practice in order to further reduce the incidence of infection in NICU.
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J. Matern. Fetal. Neonatal. Med. · Oct 2011
ReviewEvidence-based platelet transfusion recommendations in neonates.
Even though for certain varieties of neonatal thrombocytopenia, intravenous immunoglobulin or corticosteroids are recommended as treatments, platelet transfusions represent the only specific therapy currently available for most thrombocytopenic neonates in NICUs. The majority of these NICU platelet transfusions, up to 98% in some recent reports, are given to prevent, rather than to treat, bleeding. The trigger limit of platelet count to prophylactically treat non-bleeding patients is generally arbitrary. ⋯ To increase benefits and safety, new widespread changes in platelet transfusion guidelines are necessary. New transfusion paradigms should not be based on reasoning alone, but on important experimental validation. The neonatologists would better accept them and more closely adhere to.
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J. Matern. Fetal. Neonatal. Med. · Oct 2011
Clinical TrialUnexpected effect of recruitment procedure on lung volume measured by respiratory inductive plethysmography (RIP) during high frequency oscillatory ventilation (HFOV) in preterm neonates with respiratory distress syndrome (RDS).
In clinical practice, one of the major problems in optimizing recruitment or lung volume during HFOV in preterm infants is the inability to accurately measure direct changes in lung volume at bedside. ⋯ Because RIP cannot differentiate between changes in lung fluid or intrathoracic gas, we hypothesized that as CDP increases and total lung capacity is approached, pulmonary vascular resistance increases as a consequence of the compression of intra-alveolar vessels. This increases right ventricular afterload which, combined with re-establishment of right-to left shunting, results in decreased pulmonary blood flow and then decreased lung volume. Caution should then be used when using high CDP values during the recruitment procedure.
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Neonatal and paediatric intensive care are usually provided in distinct units, characterized by highly specialized staffs dedicated either to critically ill newborns (NICUs) or to critically ill children (PICUs). However, such a model may be not suitable or even applicable to all medical organisations or to different local needs. ⋯ Whilst many aspects of modern neonatal care do resemble those routinely used in the paediatric intensive care setting, several clinical issues are unique to each respective sector and cannot be easily translated to the other one. In order to guarantee the best quality of care, NICU doctors and nurses should acquire adequate competence and skills, by means of focused multidisciplinary training programmes, as well as extensive exposure to a wide paediatric case mix.