Clinics in perinatology
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Clinics in perinatology · Sep 2001
ReviewHypocapnia and hypercapnia in respiratory management of newborn infants.
Recent experimental and clinical data demonstrate that both hypocapnia and hypercapnia during the neonatal period may result in beneficial or adverse consequences. Multiple retrospective studies report a strong association between PaCO2 levels less than 25 to 30 mm Hg and an increased incidence of cystic PVL and CP in preterm infants. ⋯ A low tidal volume strategy combined with permissive hypercapnia is potentially a strategy that could prevent lung injury. Clearly, more randomized, controlled trials are needed before this latter strategy or that of permissive hypercapnia can be recommended routinely for preterm, near-term, or term gestation infants with respiratory disorders.
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Development of sophisticated transducers and microprocessor-based ventilators now enables the performance of volume-controlled ventilation of newborn infants. Volume-controlled modes include standard intermittent or synchronized intermittent mandatory ventilation; assist-control ventilation; and hybrid modes, such as pressure-support ventilation, pressure-regulated volume-control ventilation, volume-assured pressure support, and volume guarantee. This article describes the concepts and clinical applications of these ventilatory modes.
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Clinics in perinatology · Jun 2001
ReviewPrenatal diagnosis using fetal cells and free fetal DNA in maternal blood.
The presence of fetal cells and free fetal DNA in maternal blood offers an exciting opportunity for the development of safe noninvasive forms of prenatal diagnosis. Research in this field has, however, also indicated that their levels in the maternal circulation are increased in certain pregnancy-related disorders, such as preeclampsia. Their closer examination may shed new light on the underlying etiology of this enigmatic disorder.
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Perinatal arrhythmias may occur either during fetal life or in the early neonatal period. These arrhythmias include both tachycardias and bradycardias. This article presents a brief overview of fetal and neonatal arrhythmias concentrating on their presentation, diagnosis, and treatment.
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Clinics in perinatology · Jun 2000
ReviewBehavior, pain perception, and the extremely low-birth weight survivor.
This article explores the literature concerning responses to pain of both premature and term-born newborn infants, the evidence for short-term and long-term effects of pain, and behavioral sequelae in individuals who have experienced repeated early pain in neonatal life as they mature. There is no doubt that pain causes stress in babies and this in turn may adversely affect long-term neurodevelopmental outcome. Although there are methods for assessing dimensions of acute reactivity to pain in an experimental setting, there are no very good measures available at the present time that can be used clinically. ⋯ Animal evidence suggests that the neonatal brain is affected differently when exposed to morphine administered in the absence of pain than in the presence of pain. Pain control may be important for many reasons but overuse of morphine or benzodiazepines may have undesirable long-term effects. This is a rapidly evolving area of knowledge of clear relevance to clinical management likely to affect long-term outcomes of high-risk children.