Clinics in perinatology
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Protracted mechanical ventilation is associated with increased morbidity and mortality in preterm infants and thus the earliest possible weaning from mechanical ventilation is desirable. Weaning protocols may be helpful in achieving more rapid reduction in support. ⋯ An improved ability to predict when a preterm infant has a high likelihood of successful extubation is highly desirable. In this article, available evidence is reviewed and reasonable evidence-based recommendations for expeditious weaning and extubation are provided.
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The photoplethysmogram (PPG) is a noninvasive circulatory signal related to the pulsatile volume in tissue and is displayed by many pulse oximeters. The PPG is similar in appearance to the invasive arterial waveform, but is noninvasive and ubiquitous in hospitals. There is increasing interest in seeking circulatory information from the PPG and developing techniques for a wide variety of novel applications. This article addresses the basic physics of photoplethysmography, physiologic principles behind pulse oximetry operation, and recent technological advances in the usefulness of the PPG waveform to assess microcirculation and intravascular fluid volume monitoring during intensive care.
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Clinics in perinatology · Jun 2012
ReviewAdvances in neonatal extracorporeal support: the role of extracorporeal membrane oxygenation and the artificial placenta.
This review addresses the history and evolution of neonatal extracorporeal membrane oxygenation (ECMO), with a discussion of the indications, contraindications, modalities, outcomes, and impact of ECMO. Controversies surrounding novel uses of ECMO in neonates, namely ECMO for premature infants and ex utero intrapartum therapy with transition to ECMO, are discussed. The development of an extracorporeal artificial placenta for support of premature infants is presented, including the rationale, research, and challenges. ECMO has had a dramatic effect on the care of critically ill neonates over the past 4 decades, and there is great potential to expand these benefits in the future.
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Necrotizing enterocolitis (NEC) is the most common acquired gastrointestinal disease of premature neonates and is a serious cause of morbidity and mortality. NEC is one of the leading causes of death in neonatal intensive care units. ⋯ Surgical options include peritoneal drainage and laparotomy, with studies showing no difference in outcome related to approach. Survivors, particularly those requiring surgery, face serious sequelae.
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Myelomeningocele (MMC) is a congenital neural tube defect that occurs in approximately 1 in 2900 live births in the United States. It is a devastating disability with significant morbidity and mortality within the first few decades of life. MMC was the first nonlethal disease to be considered and studied for fetal surgery and is now the most common open fetal surgery performed. The recently completed MOMS randomized controlled trial has shown that fetal repair for MMC can improve hydrocephalus and hindbrain herniation, can reduce the need for vetriculoperitoneal shunting, and may improve distal neurologic function in some patients.