Neonatology
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Hemodynamic problems are common in neonatal intensive care. They occur in the context of incomplete myocardial and vascular development and in cardiovascular responses to interventions which are, as a result, limited and often uncertain and unpredictable. In this review, I outline the hemodynamic features of 4 neonatal conditions which often require intervention: (1) persistent pulmonary hypertension of the newborn, (2) cardiogenic shock (most commonly in the context of hypoxic ischemic injury), (3) sepsis and (4) low blood pressure in the transitional period of the extremely preterm infant. I also look at the evidence which exists for effective interventions and the most important research questions for the future.
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Randomized Controlled Trial
Pasteurization of mother's own milk for preterm infants does not reduce the incidence of late-onset sepsis.
Feeding preterm infants human milk has a beneficial effect on the risk of late-onset sepsis (LOS). Due to lack of microbiological standards, practices such as pasteurization of mother's own milk differ widely among neonatal intensive care units worldwide. ⋯ For preterm infants, pasteurization of mother's own milk shows a trend towards an increase in infectious morbidity, although no statistical significance was reached. Practices should focus on collection, storage and labeling procedures to ensure the safety and quality of expressed milk.
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Comparative Study Observational Study
Cerebral near-infrared spectroscopy during transition of healthy term newborns.
Values of regional cerebral tissue oxygen saturation (cStO2) have been described during transition of term and preterm infants after birth. However, use of different devices precludes comparison of measurements. ⋯ Healthy term newborns had similar cStO2 changes from 2 min after birth regardless of the mode of delivery. cStO2 of healthy term infants was lower than cStO2 of VLBW infants during transition. cStO2 values as measured by the FORE-SIGHT oximeter seem in the range of values as measured by the NIRO 300 oximeter. They were lower than values as measured by the INVOS 5100 oximeter.
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Therapeutic hypothermia (HT) is the standard treatment for newborns after perinatal asphyxia. Preclinical studies report that HT is more effective when started early. ⋯ Starting cooling before 3 h of age in surviving asphyxiated newborns is safe and significantly improves motor outcome. Cooling should be initiated as soon as possible after birth in eligible infants.
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Comparative Study
Molecular detection of late-onset neonatal sepsis in premature infants using small blood volumes: proof-of-concept.
Conventional blood culture is still the gold standard for sepsis diagnosis but results are not immediately available and pathogens are only detected in approximately 25% of cases. New molecular assays for the detection of blood stream pathogens are promising diagnostic tools. ⋯ These first data demonstrate the usability and potential benefit of this multiplex PCR using a modified DNA extraction for the rapid detection of nosocomial sepsis in preterm infants in addition to blood culture.