Early human development
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Early human development · May 2012
Review"Getting to Zero": preventing invasive Candida infections and eliminating infection-related mortality and morbidity in extremely preterm infants.
Prevention of invasive Candida infections (ICI) is an achievable goal for every NICU and supported by A-1 evidence. Due to the incidence of ICI, high infection-associated mortality and neurodevelopmental impairment, antifungal prophylaxis should be targeted to infants <1000 g or ≤ 27 weeks gestation. There is A-1 evidence for both fluconazole and nystatin prophylaxis for the prevention of ICI. ⋯ For infants 1000-1500 g if there is concern for ICI in the NICU, either drug could be chosen for prophylaxis. Fluconazole prophylaxis administered at 3 mg/kg twice a week, while intravenous access is required, appears to be the safest and most effective schedule in preventing ICI while attenuating the emergence of fungal resistance. Invasive Candida infections are one group of infections we can prevent.
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Early human development · May 2012
Gentle ventilation: the new evidence from the SUPPORT, COIN, VON, CURPAP, Colombian Network, and Neocosur Network trials.
Many neonates have respiratory disorders requiring oxygen supplementation and respiratory support. Even though advances in respiratory care such as surfactant and new ventilatory techniques have improved outcomes, mortality from respiratory failure and morbidities such as bronchopulmonary dysplasia are still common. ⋯ It is possible that the control infants had lung injury secondary to mechanical ventilation. This review will address the recent trials of early continuous positive airway pressure (CPAP) as an alternative to the common practice of surfactant and mechanical ventilation.
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Early human development · Apr 2012
Comparative StudySpecific change in spectral power of fetal heart rate variability related to fetal acidemia during labor: comparison between preterm and term fetuses.
Spectral analysis of fetal heart rate (FHR) variability is a useful method to assess fetal condition. There have been several studies involving the change in spectral power related to fetal acidemia, but the results have been inconsistent. ⋯ The changes in spectral power responding to a low pH are different between term and preterm fetuses. Spectral analysis of FHR variability may be useful fetal monitoring for early detection of fetal acidemia.
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We sought to determine the risk factors, incidence, and mortality of very late onset bacterial infection (blood, urine, or cerebrospinal fluid culture positive occurring after day of life 120) in preterm infants. ⋯ Important predictive risk factors for early and late onset sepsis (birth weight and gestational age) did not contribute to risk of developing very late onset infection. Evaluation for infection (whether positive or negative) was a significant risk factor for death. GPC and fungal infections were associated with high mortality.