Clinics in perinatology
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Hemorrhage in the infant from vitamin K deficiency is still a concern in pediatrics. Vitamin K given intramuscularly will largely prevent hemorrhagic disease in the newborn, even in infants who are exclusively breast-fed and are thus at the greatest risk for bleeding. ⋯ Any role of vitamin K in the prevention of IVH in premature infants has not been sufficiently demonstrated. Ongoing developments in this field will lead to improved methods of detecting early vitamin K deficiency and perhaps suitable alternatives to intramuscular vitamin K prophylaxis in the newborn.
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Clinics in perinatology · Jun 1995
ReviewHypoxic-ischemic encephalopathy. Therapeutic approaches against microvascular injury, and role of neutrophils, PAF, and free radicals.
The asphyxiated newborn undergoes progressive brain damage even after resuscitation. This article reviews the microvascular events that contribute to evolving brain injury. The role of neutrophils, platelet-activating factor (PAF), and free radicals is stressed as pivotal mechanisms of injury and opportunities for therapeutic intervention.
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Clinics in perinatology · Jun 1993
ReviewLong-term follow-up of term neonates with perinatal asphyxia.
Available evidence shows adverse sequelae do not follow perinatal asphyxia unless encephalopathy is part of the neonatal clinical presentation. Where neonatal encephalopathy follows evidence of late fetal and/or early neonatal distress, the staging of the encephalopathy is useful for determination of prognosis; those with mild encephalopathy do well; those with severe encephalopathy do poorly. We believe this staging could be made more universally useful as an outcome variable for study of the etiology and timing of perinatal hypoxic-ischemic injury as well as for prediction of long-term outcome, if clinical correlates to pathophysiologic hypoxic-ischemic insults were used more broadly as the basis for defining the staging criteria. ⋯ School-aged nondisabled moderate encephalopathy survivors did not show the perceptual-motor delay reported in younger survivors. Overall, tests used to evaluate subtle changes that may relate to perinatal hypoxic-ischemic injury have been inadequate; future studies should include tests of acquisition of new learning, memory, problem solving, and reasoning. Further research is required to define the nature and timing of perinatal insults and the continued function of survivors.
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The rapid evolution of the subspecialty of neonatology, biologic sciences, and health care delivery provide a myriad of career opportunities. The expected complexity of a academic career in neonatal medicine in the 21st century will require training in patient care, basic and clinical sciences, and teaching and an understanding of local and national issues that have impact on care of newborns. The training of skilled neonatal health care workers and health of our infants will depend on the preparation of neonatologists who will provide clinical care and training and generate new knowledge related to the care of newborn infants and their families.
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Bronchopulmonary dysplasia (BPD) is both a significant clinical problem associated with neonatal intensive care and a sign of the success of that care. It can best be understood in the context of the historical continuum of improving survivability for prematurely born infants. ⋯ All the molecular-biologic and technologic approaches used in the past 25 years have not clearly reduced the overall incidence of BPD. It would seem time to approach seriously the problem of decreasing the overall incidence of BPD by decreasing the incidence of premature birth in the United States.