Clinics in perinatology
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Clinics in perinatology · Sep 2010
ReviewAntibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and prevention including antibiotic stewardship.
Antimicrobial-resistant pathogens are of increasing concern in the neonatal intensive care unit population. A myriad of resistance mechanisms exist in microorganisms, and management can be complex because broad-spectrum antibiotics are increasingly needed. Control and prevention of antibiotic-resistant organisms (AROs) require an interdisciplinary team with continual surveillance. Judicious use of antibiotics; minimizing exposure to risk factors, when feasible; and effective hand hygiene are crucial interventions to reduce infection and transmission of AROs.
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Clinics in perinatology · Jun 2010
ReviewPathophysiology and treatment of septic shock in neonates.
Neonatal septic shock is a devastating condition associated with high morbidity and mortality. Definitions for the sepsis continuum and treatment algorithms specific for premature neonates are needed to improve studies of septic shock and assess benefit from clinical interventions. ⋯ Genomic and proteomic approaches, particularly those that use very small sample volumes, will increase our understanding of the pathophysiology and direct the development of novel agents for prevention and treatment of severe sepsis and shock in the neonate. Although at present antimicrobial therapy and supportive care remain the foundation of treatment, in the future immunomodulatory agents are likely to improve outcomes for this vulnerable population.
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Infections are a major cause of neonatal death in developing countries. High-quality information on the burden of early-onset neonatal sepsis and sepsis-related deaths is limited in most of these settings. Simple preventive and treatment strategies have the potential to save many newborns from sepsis-related death. Implementation of public health programs targeting newborn health will assist attainment of Millennium Development Goals of reduction in child mortality.
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Clinics in perinatology · Mar 2010
Quality improvement in respiratory care: decreasing bronchopulmonary dysplasia.
Chronic lung disease (CLD) is one of the most common long-term complications in very preterm infants. Bronchopulmonary dysplasia (BPD) is the most common cause of CLD in infancy. Modern neonatal respiratory care has witnessed the emergence of a new BPD that exhibits decreased fibrosis and emphysema, but also decreased alveolar septation, and microvascular development. ⋯ Controversy exists on whether quality improvement (QI) methods that implement multiple interventions will be effective in limiting pathology with multiple causes. Caution in generalization of QI findings is encouraged. QI methods toward improvement in CLD or any other outcome should be considered as a tool for implementing evidence and studying the effects of change in complex adaptive systems.
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The authors have conducted video review of neonatal resuscitations since 1999. Over this 10-year period 3 phases of our experience have been recognized. Our early reviews helped us recognize what we were doing in the delivery room, an area that had been ignored in improved intervention. ⋯ This period included making environmental changes by warming the room, the use of occlusive wrap, determining the effectiveness of bag and mask ventilation with colorimetric CO(2) detectors, and the introduction of crew resource management to develop consistent and effective communication. The third and current phase of our experience is to determine how these interventions affect delivery room and potentially later outcomes. Well-designed clinical trials are still needed to further establish the most optimal resuscitation interventions.