Clinics in perinatology
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Clinics in perinatology · Mar 2006
ReviewEndotracheal delivery of medications during neonatal resuscitation.
If the endotracheal route is to be used for administration of epinephrine, the limited available evidence suggests that the currently recommended dose of 0.01 mg/kg is likely to be too low to be effective. Given the paucity of high-quality clinical data regarding endotracheal epinephrine, the intravenous route should be used as soon as venous access is established. Given the complete lack of clinical data in newborns, endotracheal administration of naloxone is not recommended.
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Clinics in perinatology · Dec 2005
ReviewManagement of low birth weight infants with congenital heart disease.
Low birth weight infants with congenital heart disease (CHD) have a higher mortality risk and likely a higher morbidity risk than their preterm or appropriate for gestational age counterparts without CHD and term counterparts with CHD. As our understanding of the pathophysiology and treatment of the diseases associated with prematurity and growth restriction improves, the outcomes for these infants should continue to improve. ⋯ At this time, there is no adequate evidence that mortality is improved by delaying surgery for weight gain or performing palliative operations initially. Given the challenging physiology in this population, optimal management includes early referral to a tertiary or quaternary facility and a multidisciplinary team approach consisting of cardiologists, neonatologists, surgeons, nurses, perfusionists, and anesthesiologists.
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Clinics in perinatology · Dec 2005
The neonate with congenital heart disease: what the cardiac surgeon needs to know from the neonatologist and the cardiologist.
To plan and accomplish a successful operation for a neonate with congenital heart disease, the cardiac surgeon requires a complete anatomic description of the cardiovascular malformation. For optimum outcome, this information must be supplemented by a complete report of the prenatal and postnatal course of the newborn as well as by a thorough summary of any noncardiac congenital or acquired abnormalities. In the most favorable circumstance, the neonate arrives in the operating room completely diagnosed, fully resuscitated, well nourished, and with appropriate monitoring devices in place. Unique perioperative considerations attach to each cardiac anomaly and are briefly reviewed, and the importance of continuity of care for the patient and family is emphasized.
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Clinics in perinatology · Sep 2005
ReviewEpidural analgesia for labor pain and its relationship to fever.
The association between labor epidural and maternal fever is well established. The direct effect of epidural on maternal temperature appears due to its interference with heat dissipation and rarely results in overt fever. ⋯ Thus it seems unreasonable to avoid labor epidurals due to the risk of fever. Epidural analgesia remains one of the most effective forms of pain relief in labor and is a reasonable option for most women.
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Urinary tract infections occur commonly in pregnancy. Bacterial colonization may occur in the lower and upper urinary tract, and is facilitated by the normal physiologic changes of pregnancy. Asymptomatic bacteriuria, cystitis, and pyelonephritis each pose a serious threat to the mother and fetus. Optimal treatment regimens and preventative strategies continue to be investigated.