Clinics in perinatology
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Clinics in perinatology · Sep 1998
ReviewGuidelines for management of the jaundiced term and near-term infant.
Factors believed to have contributed to the reemergence of kernicterus in the United States during the 1990's are discussed: these include decreased concern about toxicity of bilirubin in term and near-term infants, increased prevalence of breastfeeding, and increasingly shortened postnatal hospital stays. The rationale for a universal predischarge bilirubin measurement at the time of the routine predischarge metabolic screen is presented: the hour-specific level of bilirubin at discharge, plotted on an Hour-Specific Bilirubin Nomogram, improves prediction of risk of excessive jaundice postdischarge and facilitates safe, cost-effective follow-up. This minimizes repeat bilirubin measurements and maximizes recognition of confounding variables and risk of hyperbilirubinemia so that timely, minimally invasive, preventive therapy can be instituted if needed.
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Clinics in perinatology · Sep 1998
ReviewSevere neonatal hyperbilirubinemia. A potential complication of glucose-6-phosphate dehydrogenase deficiency.
G-6-PD deficiency is frequently associated with neonatal hyperbilirubinemia, which may be severe enough to cause kernicterus and death. Because of its association with acute trigger-induced hemolytic crises, G-6-PD deficiency-associated neonatal hyperbilirubinemia has been labelled as hemolytic in origin. In this article, the authors summarize recent evidence demonstrating that hemolysis cannot in and of itself be responsible for jaundice and that decreased bilirubin elimination plays a major role in its pathogenesis.
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An accumulating body of data indicates that optimal newborn resuscitation is not performed with 100% oxygen. On the contrary, ambient air seems to have several advantages compared with supplemental oxygen. Present guidelines on newborn resuscitation should be critically reviewed and revised according to scientific evidence.
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Clinics in perinatology · Sep 1998
ReviewDecision-making and the role of surrogacy in withdrawal or withholding of therapy in neonates.
Ideally, decisions to forego life-sustaining treatments in neonates should be arrived at by a team of expert physicians, nurses, and social workers, together with both parents. Surrogates, however, may occasionally have other considerations than the best interest of the ill neonate, and sometimes the postpartum mother may be temporarily incompetent to make such grave decisions. Therefore, a careful assessment of the parents' decision is required. Physical help in the caring for the child, psychologic family counseling, educational and vocational assistance, and even quality institutionalization must be provided if the parents are unable to fully care for the child.
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Clinics in perinatology · Mar 1998
ReviewVolutrauma, PaCO2 levels, and neurodevelopmental sequelae following assisted ventilation.
Today it is essential that we define care practices in neonatology that not only increase survival but also produce optimal pulmonary and neurodevelopmental outcomes for our patients. Assisted ventilatory care continues to be influential at all three levels. In this article, the authors discuss current understanding of the possible mechanisms for pulmonary and neurologic injury, or benefits associated with ventilation at both low and high PaCO2 levels, as well as evidence for neurodevelopmental sequelae with various ventilator strategies.