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. · Dec 2010
An imbalance between angiogenic and anti-angiogenic factors precedes fetal death in a subset of patients: results of a longitudinal study.
Women with a fetal death at the time of diagnosis have higher maternal plasma concentrations of the anti-angiogenic factor, soluble vascular endothelial growth factor receptor (sVEGFR)-1, than women with a normal pregnancy. An important question is whether these changes are the cause or consequence of fetal death. To address this issue, we conducted a longitudinal study and measured the maternal plasma concentrations of selective angiogenic and anti-angiogenic factors before the diagnosis of a fetal death. The anti-angiogenic factors studied were sVEGFR-1 and soluble endoglin (sEng), and the angiogenic factor, placental growth factor (PlGF). ⋯ Fetal death is characterised by higher maternal plasma concentrations of PlGF during the first trimester compared to normal pregnancy. This profile changes into an anti-angiogenic one during the second and third trimesters.
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J. Matern. Fetal. Neonatal. Med. · Oct 2010
Randomized Controlled TrialGeneral versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study.
To compare neonatal short-term outcome in patients who underwent spinal, general anaesthesia and conversion from spinal to general anaesthesia. ⋯ All kinds of anaesthesia seem to be safe, but loco-regional blockade shows more advantages on the neonatal outcome also when a conversion is necessary.
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J. Matern. Fetal. Neonatal. Med. · Oct 2010
ReviewNeurally adjusted ventilatory assist: a new approach to mechanically ventilated infants.
Neurally adjusted ventilator assist (NAVA) is a new mode of partial ventilatory support, in which neural inspiratory activity is monitored through the continuous esophageal recording of the electrical activity of the diaphragm. Assistance is triggered and cycled off in according to this signal and is delivered in proportion to its intensity. ⋯ Small preliminary studies have shown that NAVA can be successfully used also in term and preterm infants, being safe and well tolerated. However, much additional work is still needed before NAVA can be recommended in the everyday practice of the neonatologist.
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Shock defines a complex dysfunction of organ perfusion, that produces a status of cellular energy failure, resulting from an insufficient supply of oxygen and nutrients to tissues. The diagnosis of shock is very difficult because of the lack of sufficiently sensitive and specific clinical criteria, and is substantially based on the demonstration of an arterial hypotension, an indicator unfit to detect the organ hypoperfusion. It determines the necessity of firmly introducing in the diagnostic run the functional echocardiography, the near infrared spectroscopy and the amplitude – integrated electroencephalography, etc., in the monitoring of the critical newborn. In order to simplify the problem, the authors identify the clinical scenarios of the newborn's shock to enhance the different pathogenetic moments and to build up appropriate therapeutic algorithms, without forgetting that at present there is no evidence that treatment of shock improves outcomes, despite the large amount of the studies conducted on this topic.
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J. Matern. Fetal. Neonatal. Med. · Oct 2010
ReviewAcute kidney injury in critically ill infants: the role of urine Neutrophil Gelatinase-Associated Lipocalin (NGAL).
Acute kidney injury (AKI) has emerged as an important health problem in the intensive care units, especially among infants delivered prematurely. Recent efforts to define and characterize AKI have led to studies of early AKI detection and will ultimately contribute to improvements in AKI outcomes. ⋯ The recent availability of an automated immunoassay for measuring uNGAL in the clinical practice permits to introduce the test in emergency, having a turn around time (TAT) closely comparable with that of serum creatinine. On the basis of data reported in the literature, it is reasonable to forecast an increasing clinical use of uNGAL capable to change our approach to the diagnosis and leading to better preventative and therapeutic interventions which will improve outcomes of critically ill infants with acute kidney disease.