American journal of perinatology
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Peripherally inserted central venous catheters (PICCs) are increasingly used in the neonatal intensive care unit (NICU). Malpositioning of the catheter's tip is a known occurrence that may require repositioning or removal of the catheter. ⋯ We also report on five newborn infants in whom the tips of the catheters were malpositioned. Their subsequent course showed spontaneous correction of the tips of those catheters within 1 day.
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Case Reports
Bubbles in the brain veins as a complication of daily management of a scalp vein catheter.
Recently, it has been suspected that venous dural sinus air embolisms could occur as a result of scalp vein infusion. The possible mechanism for this complication has not been documented to date, and procedures to avoid venous dural sinus air embolism have not been presented. ⋯ Clinicians should avoid injecting air into a scalp vein catheter and leaving it open to air. Following careful examination and review of the infant's case, we were able to conclude that positioning the infant in either supine or Trendelenburg position during daily management of scalp venous infusions and using an air-occlusive dressing once the catheter is removed could limit the risk of venous dural sinus air embolisms caused by scalp vein infusions.
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Comparative Study
Clinical use of new-generation pulse oximeters in the neonatal intensive care unit.
Continuous monitoring by pulse oximetry is a common practice for preterm and critically ill newborns. A new generation of motion-tolerant pulse oximeters have been designed for improved clinical performance with a substantial reduction in alarm frequency. However, little is known about the differences among these new-generation pulse oximeters in the neonatal intensive care unit (NICU). ⋯ The two new-generation pulse oximeters, the Philips FAST and Masimo SET, are equally sensitive in their ability to identify true and false alarms. Masimo pulse oximeter with its signal extraction technology, however, provides more consistent and accurate reporting of SpO2 values as demonstrated by its markedly decreased incidence of data dropouts. The Masimo unit appears to be more resistant to the effects of motion artifact.
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Clinical Trial
Insulin-like growth factor binding protein-1 detection in preterm labor: evaluation of a bedside test.
Phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) is secreted by decidual cells and may leak into cervical secretions during detachment of the fetal membrane. The aim of this study was to determine whether a rapid bedside test for phIGFBP-1 predicts preterm birth in women with preterm uterine contractions. This was a prospective study of pregnant women who sought medical care for symptoms of preterm labor. ⋯ Eleven of them (17%) delivered preterm (< 35 weeks). phIGFBP-1 in cervical secretions predicted preterm birth with a sensitivity of 72.7%, a specificity of 83.0%, a positive predictive value of 47.0%, and negative predictive value of 93.6%. Positive phIGFBP-1 bedside test in women with preterm uterine contractions may indicate a significant risk for subsequent preterm birth. The absence of phIGBP-1 is a reassuring sign that the likelihood of preterm birth is low.
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Review
Preterm premature rupture of membranes: perspectives surrounding controversies in management.
Preterm premature rupture of the membranes (PPROM) occurs in approximately 3% of all pregnancies, and accounts for one third of all preterm births. Despite its prevalence, optimal management of PPROM remains largely undefined and lacks conformity. In this article, we review the pathophysiology of PPROM, and summarize the available literature describing various management strategies in an effort to define current controversies in the management of PPROM.