Clinics in perinatology
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Late preterm neonates have unique susceptibilities to infection. The closed setting of the neonatal ICU (NICU) and the immunologic immaturity of premature infants set the state for the development of nosocomial infections. This article discusses infections that might be seen in this population and gives options for diagnosis and treatment.
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Clinics in perinatology · Dec 2006
ReviewHyperbilirubinemia and bilirubin toxicity in the late preterm infant.
Late preterm gestation is an important risk factor for the development of severe neonatal hyperbilirubinemia and kernicterus. An exaggerated hepatic immaturity contributes to the greater prevalence, severity, and duration of neonatal jaundice in late preterm infants. Breast milk feeding is almost uniformly present and large for gestational age status, male sex, and G6PD deficiency are over-represented among that cohort of late preterm infants with kernicterus. Attention to screening measures for jaundice in the newborn nursery, the provision of lactation support, parental education, timely postdischarge follow-up, and appropriate treatment when clinically indicated should help to reduce the risk of late preterm neonates developing severe neonatal jaundice or kernicterus.
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Clinics in perinatology · Dec 2006
ReviewLate preterm gestation: physiology of labor and implications for delivery.
The late preterm infant represents a significant portion of preterm deliveries. Historically, this cohort has been referred to as near-term, which may not address adequately the increased perinatal morbidity these neonates experience. The changing demographics of pregnant women also are increasing the number of inductions in this gestational age group. ⋯ The increasing numbers of multi-fetal gestations also have an average gestational age at delivery in this range of 34 to 36.6 weeks. Preeclampsia is another factor that can lead to delivery and induction during this gestational age. This article discusses some of the physiologic causes behind late preterm deliveries.
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Near-infrared spectroscopy allows for real-time, noninvasive measurement of cerebral hemodynamics and oxygenation at the bed-side. This article describes animal and clinical research using near-infrared spectroscopy to study cerebral hemodynamic function in the fetus, neonate, and child.
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Clinics in perinatology · Sep 2006
Training neonatal staff in recording and reporting continuous electroencephalography.
Continuous electroencephalography can contribute useful information to clinical decision-making in neonatal care. Equipment is now reliable and user-friendly enough that its use can be taught to medical and nursing staff so that a 24-hour capability is achieved. It is possible to teach neonatologists, in a 1-day course, background knowledge on EEG and amplitude-integrated EEG (aEEG), recognition of aEEG patterns that have clinical significance, recognition of seizures using aEEG and "raw" EEG, the essentials of electrode placement for aEEG, and interpretation of findings in the clinical context. This must be followed up by background reading, frequent peer-review sessions on EEG recordings, and a reliable system for storing and access, as well as willingness to consult experienced operators elsewhere.