Neonatology
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Since ancient times, various methods have been used to revive apparently stillborn infants; many were of dubious efficacy and had the potential to cause harm. Based largely on studies of acutely asphyxiated term animal models, clinical assessment and positive pressure ventilation have become the cornerstones of neonatal resuscitation over the last 40 years. Over the last 25 years, care of extremely preterm infants in the delivery room has evolved from a policy of indifference to one of increasingly aggressive support. ⋯ Therefore, concerning neonatal 'resuscitation', it is time to 'call it' something else. This will allow us to dispassionately distinguish preterm infants who are dead, or nearly dead, from those who are merely at high risk of parenchymal lung disease. We may then be able to refine our interventions and determine what methods of support benefit these infants most.
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Perinatal hypoxia-ischemia or birth asphyxia is a serious complication with a high mortality and morbidity. For decades, neuroprotective options have been explored to reduce reperfusion and reoxygenation injury to the brain, which accounts for a substantial part of birth asphyxia-related brain damage. ⋯ Since hypothermia has been proven to be beneficial for a selected group of asphyxiated neonates, we assume that a combination of this treatment option with a pharmacological means of neuroprotection will be the appropriate approach in the future. Finally, it is important to consider possible gender effects in view of the discussed pharmacological strategies.
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Respiratory distress syndrome (RDS) is a severe form of neonatal respiratory distress which occurs almost exclusively in premature infants. At present, the diagnosis is based on radiological findings and clinical course. Lung ultrasound in RDS has not yet been fully assessed. ⋯ We found that lung ultrasound is a reliable tool in the diagnosis of RDS. We speculate that it may be considered as a screening method for the diagnosis of RDS, and for early administration of surfactant in preterm infants with respiratory distress.
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Evaluation of the agreement between axillary temperature measurements and rectal temperature measurements in neonates. ⋯ The mean difference between axillary and rectal temperature shows a wide variation. Axillary temperature measurements cannot be used interchangeably with rectal measurements in neonates.
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Pediatric units, especially neonatal units, are highly vulnerable to error generally and to medication error in particular. Potential failures are distributed across the entire medication process, occurring mostly at the time of medication prescription and during preparation for drug administration. ⋯ Violations of good prescribing practice are common in neonatal units. A simple intervention should improve the quality of handwritten medical prescriptions for newborns admitted to intensive care settings.