Clinics in perinatology
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Clinics in perinatology · Sep 2003
Historical ArticleIn their footsteps: a brief history of maternal-fetal surgery.
These four individuals are recognized because at a critical point in the evolution of maternal-fetal surgery they contributed in ways that uniquely advanced progress in the field, enabling other researchers to make even greater discoveries. They were not the only significant contributors; there were many, too numerous to recount. ⋯ Among their peers, however, these four pioneers stand out because at a critical nexus their vision and perseverance carried researchers forward to a new level of excellence. We all follow in their footsteps.
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Clinics in perinatology · Jun 2003
Cochrane neonatal systematic reviews: a survey of the evidence for neonatal therapies.
A survey is reported of 113 systematic reviews of therapies in neonatology, based on 559 eligible randomized trials in total. These reviews were prepared by the CNRG and were published in the Cochrane Library, Issue 3,2001. The median number of included trials per review was 3 (range 0 to 32) and participants 207 (range 0 to 5460). ⋯ Among many reviews finding no evidence of treatment effect, large and potentially important benefits or harms could not be excluded. Most CNRG reviews were current. There is a continuing need to prepare systematic review of therapies not yet covered and to keep an increasing number of reviews up-to-date.
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The basic mechanism of kernicterus and bilirubin encephalopathy has not been unequivocally determined. Much knowledge has been gained about phenomena that contribute to bilirubin neurotoxicity, and this knowledge has implications for clinical practice. Conditions that impact on blood-brain barrier function, increase brain blood flow, or impact on bilirubin metabolism, including its transport in serum, should be avoided, if possible. ⋯ If these conditions are not avoidable then there should be a more aggressive approach to the treatment of hyperbilirubinemia. The limits of tolerance for hyperbilirubinemia varies among neonates and there are no tools to determine with certainty when a particular infant is approaching the danger zone. Neurological symptoms in a jaundiced infant require extreme vigilance, and, in most cases, immediate intervention.
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Clinics in perinatology · Dec 2002
ReviewAdvances in postnatal neuroimaging: relevance to pathogenesis and treatment of brain injury.
The human brain is susceptible to a wide variety of insults. The permanent residua of these abnormalities are represented in dysfunction of one or more areas of neurodevelopment. ⋯ Advanced magnetic resonance techniques, such as quantitative morphometric magnetic resonance techniques, diffusion-weighted magnetic resonance techniques, and magnetic resonance spectroscopy applied to the study of early human brain development have given us a better understanding of the pathophysiologic mechanisms of brain injury and its effects on subsequent brain development. Magnetic resonance imaging has provided an invaluable tool for the study of the fetal and newborn brain in vivo.
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Clinics in perinatology · Dec 2002
ReviewThe effects of temperature on hypoxic-ischemic brain injury.
Over the past 15 years it has been recognized that the temperature of the brain has an important influence on the extent of brain injury that follows intervals of hypoxia-ischemia. Available data in animals and humans show that brain injury is worsened when fever is superimposed on an ischemic event. Furthermore, data in neonates and adults strongly suggest a neuroprotective role for modest hypothermia (temperature reductions of 1 to 6 degrees C) applied during or following ischemia or hypoxia-ischemia. This article provides an overview of the effects of brain temperature, including its role in the development of brain injury, mechanisms of brain injury which may be temperature sensitive, the regulation of brain temperature, thermal characteristics during brain cooling, and current clinical investigations that use temperature as a therapeutic modality.