Neonatology
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The fetal-to-neonatal transition is a complex process that includes changes in cardiac and respiratory systems. ⋯ Routine HR monitoring using electrocardiography or pulse oximetry is used to evaluate adequate hemodynamic transition, and reference ranges have been established. Measuring blood pressure noninvasively though noncontinuously might be of some value in future, considering that the normative data have been established recently. Echocardiographic monitoring during the immediate transition period will improve the knowledge about cardiac function changes, but introduction in clinical routine remains questionable.
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Peripheral muscle near-infrared spectroscopy (NIRS) measurements are of increasing interest especially in the care of critically ill patients. ⋯ In the care of critically ill neonates peripheral muscle NIRS measurements alone or in combination with cerebral or multi-site NIRS measurements provide useful additional information about peripheral circulation and oxygenation. This method is a promising tool in the recognition of early states of centralization (compensated shock) in this vulnerable group of patients. However, before this method can be used in the clinical routine it has to be tested as monitoring to guide interventions in further studies.
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Survival of extremely preterm infants has increased over recent years, but bronchopulmonary dysplasia (BPD) remains a major cause of morbidity. In the USA, BPD is the most common chronic respiratory disorder of infancy and affects the pulmonary and overall health of 10,000 preterm infants annually. Preclinical and clinical studies suggest a crucial role for lung inflammation and host immune response in the pathogenesis of BPD. ⋯ No clinically significant adverse effects were observed during the study and at the time of the follow-up assessment at 2-3 years of age. In the future, intratracheal instillation of budesonide using surfactant as a vehicle may play a role in the prevention of BPD in ELBW infants. However, before this therapy can be introduced into routine clinical care, remaining open questions need to be answered and appropriately powered studies need to be performed.