Clinics in perinatology
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Clinics in perinatology · Mar 2010
Comprehensive Oxygen Management for the Prevention of Retinopathy of Prematurity: the pediatrix experience.
Comprehensive oxygen management, focused on avoiding hyperoxia and repeated episodes of hypoxia-hyperoxia in very low birth weight infants, has been successfully used for the reduction of retinopathy of prematurity. Building on this experience, the Comprehensive Oxygen Management for the Prevention of Retinopathy of Prematurity quality improvement initiative was developed to facilitate the spread and refinement of these techniques. The initiative focused on staff education and evaluation and redesign of the processes and practices involving oxygen use. Monitoring of the effectiveness of the system changes was supported through audits of clinical practice changes, use of oxygen saturation trending data, and the incidence of retinopathy of prematurity.
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Clinics in perinatology · Mar 2010
Decreasing central line associated bloodstream infection in neonatal intensive care.
Central Line Associated Bloodstream Infections (CLABSIs) have come to be recognized as preventable adverse events that result from lapses in technique at multiple levels of care. CLABSIs are associated with increased mortality and adverse outcomes that may have lifelong consequences. ⋯ Implementation of these strategies in "bundles" is also discussed, citing examples of successful quality improvement collaboratives. The methods of implementation require an understanding of the scientific data and technical developments, as well as knowledge of how to influence change within the unique and complicated milieu of the newborn intensive care unit.
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Clinics in perinatology · Dec 2009
ReviewAdvances in near-infrared spectroscopy to study the brain of the preterm and term neonate.
This article reviews tissue oximetry and imaging to study the preterm and newborn infant brain by near-infrared spectroscopy. These two technologies are now advanced; nearly 100 reports on their use in newborn infants have been published, and commercial instruments are available. The precision of oximetry, however, is a limitation for its clinical use of assessing cerebral oxygenation. Imaging of brain function needs very well defined protocols for sensory stimulation as well as signal analysis to provide meaningful results.
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The term fetal surgery is used widely for fetal intervention during pregnancy; maternal-fetal surgery may be more appropriate, because all these invasive procedures also affect the mother. Although there is no direct benefit to the mother from these procedures, the risk to her is for a purely altruistic purpose. It is therefore important to understand the potential complications of maternal-fetal surgery, so the physician can provide accurate counseling to the patient.
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Painful procedures in the neonatal ICU are common, undertreated, and lead to adverse consequences. The drugs most commonly used to treat neonatal pain include the opiates, benzodiazepines, barbiturates, ketamine, propofol, acetaminophen, and local and topical anesthetics. This article discusses the indications for and advantages and disadvantages of the commonly used analgesic drugs. Guidance and references for drugs and dosing for specific neonatal procedures are provided.