Clinics in perinatology
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Optimal pain management can significantly impact the surgical outcome and length of stay in the neonatal intensive care unit (NICU). Regional anesthesia is an effective alternative that can be used in both term and preterm neonates. ⋯ Ultrasound guidance has increased the feasibility of using these techniques in neonates. Education and training staff in the use of continuous epidural infusions are important prerequisites for successful implementation of regional anesthesia in NICU management protocols.
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Clinics in perinatology · Sep 2013
ReviewSedation and analgesia to facilitate mechanical ventilation.
Regardless of age, health care professionals have a professional and ethical obligation to provide safe and effective analgesia to patients undergoing painful procedures. Historically, newborns, particularly premature and sick infants, have been undertreated for pain. ⋯ The authors review the use of sedation and analgesia to facilitate endotracheal tube placement and mechanical ventilation. Controversies regarding possible adverse neurodevelopmental outcomes after sedative and anesthetic exposure and in the failure to treat pain is also discussed.
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Accurate pain assessment in preterm and term neonates in the neonatal intensive care unit (NICU) is of vital importance because of the high prevalence of painful experiences in this population, including both daily procedural pain and postoperative pain. Over 40 tools have been developed to assess pain in neonates, and each NICU should choose a limited number of pain assessment tools for different populations and contexts. ⋯ Preterm neonates do not display behavior and physiologic indicators of pain as reliably and specifically as full term infants, and preterm infants are vulnerable to long term sequelae of painful experiences. "Brain-oriented" approaches for more objective measurement of pain in neonates may become available in the future. In the meantime, neonatal pain assessment tools need to be taught, implemented, and their ongoing use optimized to form a consistent, reproducible basis for the safe and effective treatment of neonatal pain.
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Clinics in perinatology · Jun 2013
Review Historical ArticleRetinopathy of prematurity and the oxygen conundrum: lessons learned from recent randomized trials.
Emerging data from randomised controlled trials of different pulse oximeter oxygen saturation (SpO(2)) target ranges shows that higher SpO(2) targets are associated with a higher risk of severe retinopathy of prematurity. However, the trials have also shown that higher SpO(2) targets are associated with improved survival. In the light of these results and pending the full results for long-term outcome, it is recommended that oxygen saturation targets for preterm infants of gestational age less than 28 weeks at birth should be maintained at or more than 90%.
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Clinics in perinatology · Mar 2013
ReviewNewer monitoring techniques to determine the risk of necrotizing enterocolitis.
Necrotizing enterocolitis affects up to 10% of neonates who are born weighing less than 1500 g. It has a high rate of morbidity and mortality, and predicting infants who will be affected has so far been unsuccessful. In this article, a number of new methods are discussed from the literature to determine if any currently available techniques may allow for the identification of patients who are at increased risk for developing this potentially lethal disease.